So I finally received my pathology report from my colonoscopy (and lab report from stool samples), but I don't know if this clears things up or leaves me more confused! The report is the official one, signed by the pathologist who examined the biopsies. This is exactly how it looks (yes, there's a blank space after the word "Diagnosis").
DIAGNOSIS:
COLON, BIOPSY: Colonic epithelial lymphocytosis
MICROSCOPIC DESCRIPTION: Sections show colonic mucosa with undisturbed crypt architecture and minimal increase in lamina propria cellularity primarily involving the superficial something-third [can't clearly make out the prefix due to a lousy printout--it looks like "one-third"] of the mucosa. There is cryptal and surface epithelial lymphocytosis. Increased epithelial lymphocytes in an otherwise normal colonic mucosa is a common endpoint to many inflammatory triggers and may be found in patients with gluten-sensitive enteropathy, autoimmune diseases and drug reactions. The same associations can be found in lymphocytic and collagenous colitis, suggesting that there may be a disease spectrum from a limited and a mild increase in intraepithelial lymphocytes at one end and collagenous colitis at the other.
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My question...No lymphocyte count was given by the pathologist, so is THAT why they didn't want to give me a firm MC diagnosis? It's as if the pathologist's narrative is more a description of everything it MIGHT be rather than what it actually is.
Also interesting to note is that even though I was told by the physician's assistant that all the stool tests I did prior to the colonoscopy came back negative, the lab report shows "RARE WBCs SEEN" in the fecal leukocytes test, but I really don't know what that means, either. If white blood cells are present in a Fecal Leukocytes test...how is that a negative result?
Any help interpreting this is much appreciated!
Thanks,
Fiona
Pathology report interpretation
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I should add to the above, in case it's useful info, the "Final Report" for the stool tests:
C. Difficile Toxin A and B: NEGATIVE
CULTURE, STOOL: Reduced gram negative enteric flora. No salmonella, shigella, campylobacter, aeromonas or plesimonas recovered.
And of course, the aforementioned "RARE WBCs SEEN" on the fecal leukocytes test.
C. Difficile Toxin A and B: NEGATIVE
CULTURE, STOOL: Reduced gram negative enteric flora. No salmonella, shigella, campylobacter, aeromonas or plesimonas recovered.
And of course, the aforementioned "RARE WBCs SEEN" on the fecal leukocytes test.
Hi Fiona,
Obviously, I'm not a pathologist, and those guys tend to use their own somewhat unique language, some of which may be unique to certain individual pathologists, rather than to the specialty itself, so bear in mind that I might misinterpret what this particular pathologist is trying to say, but here is how I read that report:
In most of the pathogy reports (of MC patients) that I've seen, the actual lymphocyte count is almost never stated in a pathology report. The remark, "undisturbed crypt architecture" rules out Crohn's disease and UC. The notation of lymphocytosis shows that the count was higher than normal, but the absence of a stated diagnosis suggests that the lymphocyte count may not have been high enough to qualify for a diagnosis of LC. This condition is common in a couple of other types of MC, namely paucicellular LC and CC. IOW, if you have paucicellular LC, your lymphocyte count would not meet the minimum count for a diagnosis of LC, but since paucicellular LC is probably not even on the radar of most pathologists, most of them would fail to properly diagnose it.
It could also mean that you have CC, but the pathologist failed to measure the collagen band thickness of the samples, so he or she missed the diagnosis due to his or her failure to do a complete analysis. The remark, "minimal increase in lamina propria cellularity" suggests that CC may not be present, but without actually measuring the thickness of collagen bands in the lamina propria, that doesn't necessarily rule out CC, and I don't see any notation that would indicate that the collagen band thickness was actually measured. The term "cellularity" should presumably refer to the present of lymphocytes (white blood cells) in the lamina propria, not collagen band thickness.
In fact, this pathology report appears to be rather vague and nonspecific. Most pathology reports include individual notes on the individual specifics of numerous biopsy samples taken from various locations in the colon, rather than simply a broad assessment that suggests that the results for all samples were alike. IOW, a normal, comprehensive pathology report associated with a colonoscopy should contain individual details from the examination under the microscope of a representative biopsy sample taken from the descending colon, details of the examination of a representative biopsy sample taken from the transverse colon, details of the examination of a representative biopsy sample taken from the ascending colon, and if the terminal ileum can be reached with the colonoscope (depending on the length of the patient's colon), the report should also include details from the examination of a representative biopsy sample taken from the ileum.
Since most of that information is absent from the report (the report mentions only a single biopsy sample), that suggests to me that only a single biopsy sample was actually examined by the pathologist, which would be very irregular, to say the least. Did your doctor take only 1 biopsy sample, and expect to get a reliable diagnosis from that? That would be very amateurish, if true, and it would indicate a total lack of understanding of the proper way to diagnose or rule out MC.
To get back to the possible reason why no diagnosis was stated, CC patients commonly have elevated lymphocyte counts, but they may or may not meet the minimum specs for a diagnosis of LC. Since I see nothing in the pathology report to indicate that collagen band thickness was even considered, this is a very likely explanation for the incomplete diagnosis.
Or, it might even mean that the lymphocyte count actually qualified for a diagnosis of LC, but the pathologist was inexperienced, and unfamiliar with how LC is actually diagnosed, so he or she didn't understand that a diagnosis was actually indicated. A failure to measure collagen band thickness would confirm the possibility of inexperience/incompetence in understanding how to diagnose or rule out the various types of MC. And the wishy-washy format of the pathology report in general seems to confirm that suspicion. And if only 1 biopsy sample was taken by the doctor who did the colonoscopy procedure, that suggests the same about the GI specialist — possible inexperience/incompetence in understanding how to properly diagnose or rule out the various types of MC.
The remark, "RARE WBCs SEEN" is commonly seen, and it simply means that a few white blood cells (lymphocytes) were present, presumably there to destroy any pathogenic bacteria that might be present. The term "rare" used in this sense does not imply that they are unusual in any way. It simply means that only a relatively low number were seen.
I hope that I'm misinterpreting that report, and that the pathologist who wrote it actually knows what he or she is doing, but I'm having a difficult time understanding how that could be the case, in view of what the report says (and what it doesn't say). But maybe it's just me.
Tex
Obviously, I'm not a pathologist, and those guys tend to use their own somewhat unique language, some of which may be unique to certain individual pathologists, rather than to the specialty itself, so bear in mind that I might misinterpret what this particular pathologist is trying to say, but here is how I read that report:
In most of the pathogy reports (of MC patients) that I've seen, the actual lymphocyte count is almost never stated in a pathology report. The remark, "undisturbed crypt architecture" rules out Crohn's disease and UC. The notation of lymphocytosis shows that the count was higher than normal, but the absence of a stated diagnosis suggests that the lymphocyte count may not have been high enough to qualify for a diagnosis of LC. This condition is common in a couple of other types of MC, namely paucicellular LC and CC. IOW, if you have paucicellular LC, your lymphocyte count would not meet the minimum count for a diagnosis of LC, but since paucicellular LC is probably not even on the radar of most pathologists, most of them would fail to properly diagnose it.
It could also mean that you have CC, but the pathologist failed to measure the collagen band thickness of the samples, so he or she missed the diagnosis due to his or her failure to do a complete analysis. The remark, "minimal increase in lamina propria cellularity" suggests that CC may not be present, but without actually measuring the thickness of collagen bands in the lamina propria, that doesn't necessarily rule out CC, and I don't see any notation that would indicate that the collagen band thickness was actually measured. The term "cellularity" should presumably refer to the present of lymphocytes (white blood cells) in the lamina propria, not collagen band thickness.
In fact, this pathology report appears to be rather vague and nonspecific. Most pathology reports include individual notes on the individual specifics of numerous biopsy samples taken from various locations in the colon, rather than simply a broad assessment that suggests that the results for all samples were alike. IOW, a normal, comprehensive pathology report associated with a colonoscopy should contain individual details from the examination under the microscope of a representative biopsy sample taken from the descending colon, details of the examination of a representative biopsy sample taken from the transverse colon, details of the examination of a representative biopsy sample taken from the ascending colon, and if the terminal ileum can be reached with the colonoscope (depending on the length of the patient's colon), the report should also include details from the examination of a representative biopsy sample taken from the ileum.
Since most of that information is absent from the report (the report mentions only a single biopsy sample), that suggests to me that only a single biopsy sample was actually examined by the pathologist, which would be very irregular, to say the least. Did your doctor take only 1 biopsy sample, and expect to get a reliable diagnosis from that? That would be very amateurish, if true, and it would indicate a total lack of understanding of the proper way to diagnose or rule out MC.
To get back to the possible reason why no diagnosis was stated, CC patients commonly have elevated lymphocyte counts, but they may or may not meet the minimum specs for a diagnosis of LC. Since I see nothing in the pathology report to indicate that collagen band thickness was even considered, this is a very likely explanation for the incomplete diagnosis.
Or, it might even mean that the lymphocyte count actually qualified for a diagnosis of LC, but the pathologist was inexperienced, and unfamiliar with how LC is actually diagnosed, so he or she didn't understand that a diagnosis was actually indicated. A failure to measure collagen band thickness would confirm the possibility of inexperience/incompetence in understanding how to diagnose or rule out the various types of MC. And the wishy-washy format of the pathology report in general seems to confirm that suspicion. And if only 1 biopsy sample was taken by the doctor who did the colonoscopy procedure, that suggests the same about the GI specialist — possible inexperience/incompetence in understanding how to properly diagnose or rule out the various types of MC.
The remark, "RARE WBCs SEEN" is commonly seen, and it simply means that a few white blood cells (lymphocytes) were present, presumably there to destroy any pathogenic bacteria that might be present. The term "rare" used in this sense does not imply that they are unusual in any way. It simply means that only a relatively low number were seen.
I hope that I'm misinterpreting that report, and that the pathologist who wrote it actually knows what he or she is doing, but I'm having a difficult time understanding how that could be the case, in view of what the report says (and what it doesn't say). But maybe it's just me.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Tex, thank you so much for thinking it over so thoroughly. I did leave off some info from the the path report--I assumed only the "DIAGNOSIS" and "MICROSCOPIC DESCRIPTION" sections were what mattered. I hope I haven't confused the issue as a result, but I have a feeling this additional info probably won't clarify much.
After those two sections, there is also one section that says "CLINICAL HISTORY" which only lists the word "diarrhea."
Then there is "GROSS DESCRIPTION" which lists the following:
LABEL: whole colon
TOTAL PIECES: multiple
SIZE: [I honestly can't tell what these numbers are because the printout they gave me is so bad. My best guess is 9.8x0 5x0.2cm in aggregate.]
COLOR: [Once again, the type is very unclear, but it looks like a three-letter word.]
COMMENTS: all tissue submitted
CASSETTE: J
That's all the info I have, other than the observations from the colonoscopy itself, all of which were described as normal. I guess, ultimately, it doesn't matter. I don't need an "official" diagnosis. EnteroLab has confirmed that I'm producing antibodies to gluten and casein and that I carry two NCGS genes. I'm treating myself as if I have MC (eliminated gluten from the moment I heard the words "intraepithelial lymphocytosis" and casein soon after, going through the Pepto protocol, avoiding raw fruits and vegetables, etc.), and I'm learning everything I can about it. I'm certainly in a much better place now than I was at the time of the colonoscopy. It's just hard not to feel, I don't know, duped or let down or whatever. I don't expect 100% of doctors to have 100% of the answers 100% of the time, but wow, you'd think my case would be fairly straightforward given the complexity of some of the cases I've read about here.
Thanks again for your thorough analysis. Onward and upward.
Fiona
After those two sections, there is also one section that says "CLINICAL HISTORY" which only lists the word "diarrhea."
Then there is "GROSS DESCRIPTION" which lists the following:
LABEL: whole colon
TOTAL PIECES: multiple
SIZE: [I honestly can't tell what these numbers are because the printout they gave me is so bad. My best guess is 9.8x0 5x0.2cm in aggregate.]
COLOR: [Once again, the type is very unclear, but it looks like a three-letter word.]
COMMENTS: all tissue submitted
CASSETTE: J
That's all the info I have, other than the observations from the colonoscopy itself, all of which were described as normal. I guess, ultimately, it doesn't matter. I don't need an "official" diagnosis. EnteroLab has confirmed that I'm producing antibodies to gluten and casein and that I carry two NCGS genes. I'm treating myself as if I have MC (eliminated gluten from the moment I heard the words "intraepithelial lymphocytosis" and casein soon after, going through the Pepto protocol, avoiding raw fruits and vegetables, etc.), and I'm learning everything I can about it. I'm certainly in a much better place now than I was at the time of the colonoscopy. It's just hard not to feel, I don't know, duped or let down or whatever. I don't expect 100% of doctors to have 100% of the answers 100% of the time, but wow, you'd think my case would be fairly straightforward given the complexity of some of the cases I've read about here.
Thanks again for your thorough analysis. Onward and upward.
Fiona
Fiona,
The gross description is simply a basic description of the visual appearance of the samples as received. I don't understand why the exact number of samples submitted was not listed. Usually the number is specified. "Multiple" is about as ambiguous as a description of the quantity can get.
The physical size of the samples is not important — that's a function of the colonoscope used.
So apparently, at least several samples were submitted, suggesting that your doc apparently did his or her part. The pathologist dropped the ball though, and turned in a rather disappointing performance, IMO.
It certainly appears that you have some form of MC, but unfortunately the pathologist's report leaves out so much information that it's impossible to make an accurate determination based on the sparse data contained in the report. Either the pathologist was having a bed day, or he or she was too lazy to do a thorough job of analyzing the samples and writing a comprehensive report.
You're right — the actual diagnosis is somewhat irrelevant, as long as you understand how to properly treat it so as to resolve the symptoms.
And you're very welcome, of course. Best of luck with your treatment.
Tex
The gross description is simply a basic description of the visual appearance of the samples as received. I don't understand why the exact number of samples submitted was not listed. Usually the number is specified. "Multiple" is about as ambiguous as a description of the quantity can get.
The physical size of the samples is not important — that's a function of the colonoscope used.So apparently, at least several samples were submitted, suggesting that your doc apparently did his or her part. The pathologist dropped the ball though, and turned in a rather disappointing performance, IMO.
It certainly appears that you have some form of MC, but unfortunately the pathologist's report leaves out so much information that it's impossible to make an accurate determination based on the sparse data contained in the report. Either the pathologist was having a bed day, or he or she was too lazy to do a thorough job of analyzing the samples and writing a comprehensive report.
You're right — the actual diagnosis is somewhat irrelevant, as long as you understand how to properly treat it so as to resolve the symptoms.
And you're very welcome, of course. Best of luck with your treatment.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.