Duodenum: Difference between revisions

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{{Top
<noinclude>{{Top
|author1=[[User:Mikael Häggström|Mikael Häggström]]
|author1=[[User:Mikael Häggström|Mikael Häggström]]
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{{Endoscopic biopsies}}
{{Endoscopic biopsies}}
==Common requests==
==Common requests==
*[[Small intestine in celiac disease]]
*[[Small intestine in celiac disease]]  
<noinclude/>
==Microscopic examination==
Generally look for:
*Signs of peptic duodenitis
*Intra-epithelial lymphocytes
*Tumors
*Giardia organisms


==Common microscopy findings==
===Peptic injury===
===Peptic duodenitis===
Peptic injury<ref group=note>Peptic injury is also called '''peptic duodenitis''', but "duodenitis" may be reserved for cases with an inflammatory infiltrate.</ref> typically showing the following:<ref>{{cite web|url=http://www.pathologyoutlines.com/topic/smallbowelduodenitis.html|title=Small intestine & ampulla - Inflammatory disorders - Peptic duodenitis|author=Hasan Samra, M.D., Mohamed Mostafa, M.D.|website=Pathology Outlines}} Topic Completed: 13 April 2020. Minor changes: 13 April 2020</ref>
Peptic duodenitis typically showing the following:<ref>{{cite web|url=http://www.pathologyoutlines.com/topic/smallbowelduodenitis.html|title=Small intestine & ampulla - Inflammatory disorders - Peptic duodenitis|author=Hasan Samra, M.D., Mohamed Mostafa, M.D.|website=Pathology Outlines}} Topic Completed: 13 April 2020. Minor changes: 13 April 2020</ref>
<gallery mode=packed heights=210>
<gallery mode=packed heights=220>
File:Histopathology of peptic duodenitis - annotated.jpg|Brunner gland hyperplasia shows as Brunner glands above the muscularis mucosae.
File:Histopathology of peptic duodenitis - annotated.jpg|Brunner gland hyperplasia shows as Brunner glands above the muscularis mucosae.
File:Histopathology of foveolar metaplasia of peptic duodenitis.jpg
File:Histopathology of foveolar metaplasia of peptic duodenitis.jpg
</gallery>
</gallery>
===Others===
<gallery mode=packed heights=210>
File:Histopathology of duodenal intra-epithelial lymphocytes.jpg|'''Intra-epithelial lymphocytes''' (IELs) is the main finding in '''celiac disease''' (even in earliest stage)<ref>{{cite journal | vauthors = Marsh MN |title=Gluten, major histocompatibility complex, and the small intestine. A molecular and immunobiologic approach to the spectrum of gluten sensitivity ('celiac sprue') |journal=Gastroenterology |volume=102 |issue=1 |pages=330–54 |year=1992 |pmid=1727768 |doi=10.1016/0016-5085(92)91819-p}}</ref>,<ref group=images>{{cite journal | vauthors = Marsh MN |title=Gluten, major histocompatibility complex, and the small intestine. A molecular and immunobiologic approach to the spectrum of gluten sensitivity ('celiac sprue') |journal=Gastroenterology |volume=102 |issue=1 |pages=330–54 |year=1992 |pmid=1727768 |doi=10.1016/0016-5085(92)91819-p}}<br>- [https://www.researchgate.net/figure/Photomicrograph-showing-increased-intraepithelial-lymphocytes-H-E-x-200cb_fig3_236066468 Figure 2- available via license: Creative Commons Attribution 2.0 Generic] license.</ref> and is best evaluated at tips of villi<ref name="pmid15280404">{{cite journal| author=Biagi F, Luinetti O, Campanella J, Klersy C, Zambelli C, Villanacci V | display-authors=etal| title=Intraepithelial lymphocytes in the villous tip: do they indicate potential coeliac disease? | journal=J Clin Pathol | year= 2004 | volume= 57 | issue= 8 | pages= 835-9 | pmid=15280404 | doi=10.1136/jcp.2003.013607 | pmc=1770380 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15280404  }} </ref>.<br>25 - 29 IEL/100 enterocytes is considered borderline.<ref name=pathologyoutlinesceliac>{{cite web|url=https://www.pathologyoutlines.com/topic/smallbowelceliacsprue.html|title=Small intestine & ampulla. Malabsorption. Celiac sprue|author=Juwairiya Arshi, M.B.B.S., Aaron R. Huber, D.O.|website=Pathology Outlines|accessdate=2022-04-04}}</ref><br> > 30 IEL/100 enterocytes represents a pathological lymphocytosis.<ref name=pathologyoutlinesceliac/>
File:Histopathology of leiomyoma of the ileocecal valve.jpg|'''Tumors''' (leiomyoma pictured): evaluate as per '''[[intestine with tumor]]'''
File:Duodenal biopsy with chronic active peptic duodenitis.jpg|The addition of a neutrophilic infiltrate in case of peptic injury confers a diagnosis of '''chronic active duodenitis'''
File:Histopathology of Giardia lamblia in duodenum.png|Also take a quick look in crypts for any '''Giardia''' organisms.
</gallery>
===Report===
Example in a normal case:
{|class=wikitable
| (Duodenum, biopsy:)
*Duodenal mucosa without significant histopathologic changes.
*(Negative for celiac disease.)
|}
Example in (chronic) peptic injury:
{|class=wikitable
| (Small bowel, biopsy:)
*Small intestinal mucosa with histologic changes consistent with chronic peptic injury.
*(Negative for celiac disease.)
|}
{{Bottom}}
{{Bottom}}

Latest revision as of 11:41, 27 November 2023

Author: Mikael Häggström [note 1]

Endoscopic biopsies   edit
Mostly:

Common requests

Microscopic examination

Generally look for:

  • Signs of peptic duodenitis
  • Intra-epithelial lymphocytes
  • Tumors
  • Giardia organisms

Peptic injury

Peptic injury[note 2] typically showing the following:[1]

  • Brunner gland hyperplasia shows as Brunner glands above the muscularis mucosae.
    Brunner gland hyperplasia shows as Brunner glands above the muscularis mucosae.

Others

  • Intra-epithelial lymphocytes (IELs) is the main finding in celiac disease (even in earliest stage)[2],[images 1] and is best evaluated at tips of villi[3]. 25 - 29 IEL/100 enterocytes is considered borderline.[4] > 30 IEL/100 enterocytes represents a pathological lymphocytosis.[4]
    Intra-epithelial lymphocytes (IELs) is the main finding in celiac disease (even in earliest stage)[2],[images 1] and is best evaluated at tips of villi[3].
    25 - 29 IEL/100 enterocytes is considered borderline.[4]
    > 30 IEL/100 enterocytes represents a pathological lymphocytosis.[4]
  • Tumors (leiomyoma pictured): evaluate as per intestine with tumor
    Tumors (leiomyoma pictured): evaluate as per intestine with tumor
  • The addition of a neutrophilic infiltrate in case of peptic injury confers a diagnosis of chronic active duodenitis
    The addition of a neutrophilic infiltrate in case of peptic injury confers a diagnosis of chronic active duodenitis
  • Also take a quick look in crypts for any Giardia organisms.
    Also take a quick look in crypts for any Giardia organisms.

Report

Example in a normal case:

(Duodenum, biopsy:)
  • Duodenal mucosa without significant histopathologic changes.
  • (Negative for celiac disease.)

Example in (chronic) peptic injury:

(Small bowel, biopsy:)
  • Small intestinal mucosa with histologic changes consistent with chronic peptic injury.
  • (Negative for celiac disease.)

Notes

  1. ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.
  2. ↑ Peptic injury is also called peptic duodenitis, but "duodenitis" may be reserved for cases with an inflammatory infiltrate.

Main page

References

  1. ↑ Hasan Samra, M.D., Mohamed Mostafa, M.D.. Small intestine & ampulla - Inflammatory disorders - Peptic duodenitis. Pathology Outlines. Topic Completed: 13 April 2020. Minor changes: 13 April 2020
  2. ↑ "Gluten, major histocompatibility complex, and the small intestine. A molecular and immunobiologic approach to the spectrum of gluten sensitivity ('celiac sprue') ". Gastroenterology 102 (1): 330–54. 1992. doi:10.1016/0016-5085(92)91819-p. PMID 1727768. 
  3. ↑ Biagi F, Luinetti O, Campanella J, Klersy C, Zambelli C, Villanacci V (2004). "Intraepithelial lymphocytes in the villous tip: do they indicate potential coeliac disease? ". J Clin Pathol 57 (8): 835-9. doi:10.1136/jcp.2003.013607. PMID 15280404. PMC: 1770380. Archived from the original. . 
  4. ↑ 4.0 4.1 Juwairiya Arshi, M.B.B.S., Aaron R. Huber, D.O.. Small intestine & ampulla. Malabsorption. Celiac sprue. Pathology Outlines. Retrieved on 2022-04-04.

Image sources

  1. ↑ "Gluten, major histocompatibility complex, and the small intestine. A molecular and immunobiologic approach to the spectrum of gluten sensitivity ('celiac sprue') ". Gastroenterology 102 (1): 330–54. 1992. doi:10.1016/0016-5085(92)91819-p. PMID 1727768. 
    - Figure 2- available via license: Creative Commons Attribution 2.0 Generic license.
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