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On August 26th I had a Flex Sigmoidoscopy to look for the source of blood that showed up in a stool screening I did for my GI doc. I decided since we were going to go to that expense and trouble I was at least going to ask for a mast cell staining. I did ask and the doctor went along with me.
Here are my results of the biopsies: The crypt architecture appears normal. The lamina propria contains a normal number of inflammatory cells.
There are a couple of small benign lymphoid aggregates present.
There is no evidence of active inflammation or intraepithelial lymphocytosis.
Giemsa stains show no evidence of increased mast cells or eosinophils. There are scattered eosinophils but they do not appear to be particularly increased.
I looked up some of the terms online but I didn't learn much. What is a "normal number of inflammatory cells"? Does the general population typically have inflammatory cells?
I asked the nurse who called me, when they said no increase in eosinophils, if that relative to my last biopsies 3 years ago or relative to the normal population. She didn't know, just that it was normal-- so I'll be sure to ask my GI doc next time I see her.
"no evidence of active inflammation or intraepithelial lymphocytosis"-- so I'm guessing this indicates remission.
I'd welcome anyone else's interpretation on these results. Some of you have a great deal more experience reading these than I do.
thanks,
Carol
“.... people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” Maya Angelou
I don't see anything other than good news in that report. Everything appears to be within normal limits.
Carol wrote:The crypt architecture appears normal. The lamina propria contains a normal number of inflammatory cells.
There are a couple of small benign lymphoid aggregates present.
This means no sign of any IBDs, or other abnormal physical characteristics on a cellular level.
Carol wrote:Giemsa stains show no evidence of increased mast cells or eosinophils. There are scattered eosinophils but they do not appear to be particularly increased.
Those few eosinophils are probably associated with a pollen allergy or something of that sort.
Normally, lymphocytes are present at a rate of less than 10 per 100 enterocytes. A count above 20 (per 100 enterocytes) would be diagnostic of LC.
The reason why there is a normal resident number of lymphocytes present is because these represent the equivalent of a "standing army" on guard, hopefully capable of handling most minor pathologic insurgensies, such as pathogenic bacteria in food that make it past the stomach acid.
The phraseology "no increase in eosinophils" is simply a pathologist's way of reporting that the count is within the normal range (for the general population).
Carol wrote:"no evidence of active inflammation or intraepithelial lymphocytosis"-- so I'm guessing this indicates remission.
You are right on target. Congratulations!
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.
Thanks Tex. I seem to be reluctant to accept good news. I am pleased that mast cells were not problematic so that's one less area I have to worry about treating.
About all I concluded was that I'm not getting worse and my LC is not advancing in a negative direction.
I think my GI doc was concerned that maybe there might be ulcerative colitis so that's the reason for the look although I wasn't convinced it was necessary. I wasn't experiencing pain that people with UC describe. So I guess now that should be ruled out.
We'll continue to work on my motility issues. I hope my GI doc finds these results insightful.
Thanks again for your interpretation. I think it just left me flat... as in "okay so I'm not worse, but can I get better?"
Carol
“.... people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” Maya Angelou
Just thought I'd point out that my daughter's amoeba, D fragilis, which is apparently grossly unrecognized in our population, is characterized by increased eosinophils in the colon and in peripheral blood. It can be mistaken for (or perhaps contribute to) food allergies. Crazy what these microbes can do to us!!
Were "benign lymphoid aggregates" noted in your previous pathology report? That might be why your doctor was concerned about the possibility of UC. Of course with UC they aren't benign. And the fact that your biopsy samples continue to show normal crypt architecture verifies that UC is not present.
I'm impressed that your healing has already progressed to the point where your lymphocyte count is not only below the threshold for LC diagnosis, but back down in the normal range.
You're most welcome,
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.
Great news Carol. Thanks for posting your results. Just curious if you have any relatives that have been diagnosed with UC? I have a brother with this diagnosis and that's why my GI questioned the diagnosis with me.
Tex, It doesn't say 'lymphoid aggregates'... here are my biopsy results from exactly 3 years ago (this was a different lab that the one that did my recent Flex Sig, if that makes any difference).
Distal bowel ileum biopsy- Lymphoid follicle with mucosal edema and superficial hemorrhage.
Colon biopsy at 30 cm- Superficial mucosal hemorrhage and edema.
Colon biopsy at 20 cm-Chronic colitis with mucosal edema, lymphoid follicle and surface erosion with hemorrhage.
Rectal biopsy- Mucosal edema, chronic inflammation and hemorrhage.
Report notes: Biopsies show chronic active colitis with mild activity. There is edema and small lymphoid follicles are seen. (MILD? it didn't feel mild.)
Then a diagnosis of lymphocytic colitis. I see that on my CBC at that time my white blood count was high, and Neutrophils and absolute Neutrophils were also too high and lymphocytes were below the normal range.
Interestingly I see that the last time I saw my GI doc at the end of July 2014 the diagnosis reads: Other and unspecified noninfectious gastroenteritis and colitis. But that's also when she ordered the stool screenings, followed by the Flex Sig and we tried Lialda (which seemed to be helping until I developed the 'intolerance syndrome' side effects.
Cathy- I seem to be the only one in my family that has colitis.
Zizzle- I'm sorry your daughter has to go through this and am wishing her a speedy recovery.
Thanks, Carol
“.... people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” Maya Angelou
The swelling and bleeding was probably what made your GI doc wonder about possible UC. Also, when UC is active, neutrophils are more active.
This is getting way beyond my rudimentary understanding of the cellular histology associated with UC, but basically active UC tends to cause lymphoid follicular hyperplasia (hyperplasia refers to an increase in the number of cells in an organ, such as in precancerous growth), and the result of this process is lymphoid aggregates. As UC becomes more severe, these aggregates increase in size, and they contain a large number of apoptosis-resistant cells. Obviously that didn't happen, since your more recent results represent a huge improvement over those earlier results. If you had UC, your results would have gone the other way.
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.
I saw my GI doc today and you are right Tex, the reference is the normal population (or the norming sample) and not my previous results, so inflammatory cells and lymphocytes are now in the normal range, and the absence of mast cells and eosinophils indicate that I'm not having allergic reactions. She did not want to try me on another anti-inflammatory even though I felt I saw improvement on Lialda before I had the side effects that made me stop. She was concerned that side effects of diarrhea and nausea were more risky than any benefit. Based on my biopsies it would be hard to justify another med I would think. Basically we looked at my weekly log, talked about how to carefully introduce fiber and not to let C go on for longer than 48 hours. I'm staying with Amitriptyline. At this point I'm having virtually no cramping or spasming.
She doesn't want to see me for a year unless I have something come up that prompts an earlier visit. Certainly I can't complain. I'm happy with the lack of mast cells and eosinophils, and surprised I no longer meet the criteria for lymphocytic colitis.
Thanks again for your help.
“.... people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” Maya Angelou
Paula, as I've said countless times, it's because of the sound advice and information on this site that I've reached this point. We keep telling the newbies that the diet heals and I have biopsies to support that. What better data could there be?
Carol
“.... people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” Maya Angelou
Congratulations!
I am pleased that mast cells were not problematic so that's one less area I have to worry about treating. 
