Colon (tumor & nontumor)
Noninfectious colitis
Ipilimumab associated colitis
Author: Raul S. Gonzalez, M.D.
Topic Completed: 1 May 2016
Minor changes: 27 July 2020
Revised: 8 January 2019, last major update May 2016
Copyright: (c) 2016, PathologyOutlines.com, Inc.
PubMed Search: colon colitis Ipilimumab
Table of Contents
Definition / general | Essential features | Epidemiology | Sites | Pathophysiology | Clinical features | Radiology description | Prognostic factors | Case reports | Treatment | Clinical images | Gross images | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Differential diagnosisCite this page: Gonzalez R. Ipilimumab associated colitis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/coloncolitisipilimumab.html. Accessed August 6th, 2020.
Definition / general
- Colitis caused by use of the anti-CTLA4 medication, ipilimumab
Essential features
- Colitis is a somewhat common side effect of ipilimumab
- Can be mild (diarrhea) or severe (perforation, death)
- Histology: increased intraepithelial lymphocytes, increased apoptosis, cryptitis
Epidemiology
- Occurs in up to 29% of patients taking ipilimumab, an immunologic agent used for melanoma and other malignancies (Melanoma Res 2015;25:321)
Sites
- Can affect entire gastrointestinal tract, even liver (Am J Surg Pathol 2015;39:1075)
Pathophysiology
- Causes dysregulation of gastrointestinal mucosal immunity
Clinical features
- Diarrhea, colitis
Radiology description
- Mesenteric vessel engorgement and bowel wall thickening (Am J Roentgenol 2013;200:W468)
Prognostic factors
- Side effects are dose dependent, schedule related and cumulative (Scientifica (Cairo) 2013;2013:857519)
Case reports
- 52 year old man with perforating ipilimumab associated colitis (J Surg Case Rep 2014 Mar 5;2014(3))
Treatment
- Steroids are usually effective, but anti TNF agents or surgery may be required for severe cases (Dig Dis Sci 2016 Feb 5 [Epub ahead of print])
Clinical images
Image hosted on other servers:
Ipilimumab associated colitis
on colonoscopy
Gross images
Image hosted on other servers:
Cecal perforation due to severe colitis
Microscopic (histologic) description
- Lymphoplasmacytic expansion of lamina propria; increased apoptosis and intraepithelial lymphocytes; cryptitis and crypt elongation (Am J Surg Pathol 2008;32:1130)
- Severe cases may show ulceration/perforation, pseudopolyp formation and crypt dilation, without lymphocytosis or apoptosis (J Clin Gastroenterol 2013;47:781)
Microscopic (histologic) images
Images hosted on Pathout server:
Contributed by Raul S. Gonzalez, M.D.
Differential diagnosis
- Inflammatory bowel disease: less apoptosis; signs of chronicity
- Idelalisib-associated colitis: also caused by immune modulation (PI3K inhibitor); similar histology; history probably necessary for distinction (Am J Surg Pathol 2015;39:1661)
