Small intestine in celiac disease: Difference between revisions
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→Microscopy report: +Celiac example |
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==Microscopic evaluation== | ==Microscopic evaluation== | ||
[[File:Histopathology of intraepithelial lymphocytes of the duodenum, annotated.jpg|thumb|'''Intraepithelial lymphocytes''', in this case still less than <25 IELs/100 enterocytes.]] | [[File:Histopathology of intraepithelial lymphocytes of the duodenum, annotated.jpg|thumb|'''Intraepithelial lymphocytes''', in this case still less than <25 IELs/100 enterocytes.]] | ||
[[File:Histopathology of villous atrophy in celiac disease.jpg|thumb|'''Villous atrophy''' is another sign of celiac disease. Normal villous:crypt ratio is 3:1. However, this assessment requires proper orientation of biopsies.<ref name=arshi>{{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.}} Last author update: 4 May 2022. Last staff update: 16 September 2022</ref>]] | |||
The main histologic feature of celiac disease is '''increased intraepithelial lymphocytes (IELs)''', with or without villous atrophy of the duodenal mucosa.<ref name="BrownSmith2012">{{cite journal|last1=Brown|first1=Ian S.|last2=Smith|first2=Jason|last3=Rosty|first3=Christophe|title=Gastrointestinal Pathology in Celiac Disease|journal=American Journal of Clinical Pathology|volume=138|issue=1|year=2012|pages=42–49|issn=0002-9173|doi=10.1309/AJCPE89ZPVJTSPWL}}</ref> The number of intraepithelial lymphocytes are classified as follows in the duodenum:<ref name=Özer>{{cite web|url=http://www.pathologyoutlines.com/topic/smallbowelceliacsprue.html|website=Pathology Outlines|author=Erdener Özer|title=Small intestine & ampulla, Malabsorption, Celiac sprue}} Topic Completed: 1 June 2017. Minor changes: 4 April 2020.</ref><ref name=stanford-celiac>{{cite web|url=http://surgpathcriteria.stanford.edu/gi/celiac-disease/printable.html|title=Celiac Disease|website=Stanford School of Medicine|accessdate=2021-03-11}}</ref> | The main histologic feature of celiac disease is '''increased intraepithelial lymphocytes (IELs)''', with or without villous atrophy of the duodenal mucosa.<ref name="BrownSmith2012">{{cite journal|last1=Brown|first1=Ian S.|last2=Smith|first2=Jason|last3=Rosty|first3=Christophe|title=Gastrointestinal Pathology in Celiac Disease|journal=American Journal of Clinical Pathology|volume=138|issue=1|year=2012|pages=42–49|issn=0002-9173|doi=10.1309/AJCPE89ZPVJTSPWL}}</ref> The number of intraepithelial lymphocytes are classified as follows in the duodenum:<ref name=Özer>{{cite web|url=http://www.pathologyoutlines.com/topic/smallbowelceliacsprue.html|website=Pathology Outlines|author=Erdener Özer|title=Small intestine & ampulla, Malabsorption, Celiac sprue}} Topic Completed: 1 June 2017. Minor changes: 4 April 2020.</ref><ref name=stanford-celiac>{{cite web|url=http://surgpathcriteria.stanford.edu/gi/celiac-disease/printable.html|title=Celiac Disease|website=Stanford School of Medicine|accessdate=2021-03-11}}</ref> | ||
*< 25 IELs/100 enterocytes: Negative for intraepithelial lymphocytosis. | *< 25 IELs/100 enterocytes: Negative for intraepithelial lymphocytosis. | ||
Latest revision as of 11:20, 9 December 2022
Author:
Mikael Häggström [note 1]
Gross processing
As per Small intestine.
Microscopic evaluation
The main histologic feature of celiac disease is increased intraepithelial lymphocytes (IELs), with or without villous atrophy of the duodenal mucosa.[2] The number of intraepithelial lymphocytes are classified as follows in the duodenum:[3][4]
- < 25 IELs/100 enterocytes: Negative for intraepithelial lymphocytosis.
- 25 to 29 IELs/100 enterocytes: borderline
- > 30 IEL/100 enterocytes: Pathological "lymphocytosis"
Alternative proposed methods is the presence of over 6-12 IELs per 20 enterocytes at the tips of duodenal villi.[4] In the jejunum, the cutoff is at over 40 IELs per 100 enterocytes.[4]
Suggestive but not specific findings for enterocytes are: decreased height, intracytoplasmic vacuolation and reduction or absence of the brush border.[3]
Differential diagnoses
If findings are suggestive of celiac disease, look for at least the following differential diagnoses:
-
Whipple's disease: The lamina propria contains swollen histiocytes and lipid vacuoles. -
![Giardia lamblia: Organisms shaped like teardropd or pears, with paired nuclei, seen in the lumen between villi.[5]](https://upload.wikimedia.org/wikipedia/commons/thumb/6/6a/Histopathology_of_giardiasis.jpg/500px-Histopathology_of_giardiasis.jpg?utm_source=commons.wikimedia.org&utm_campaign=imageinfo&utm_content=thumbnail)
Giardia lamblia: Organisms shaped like teardropd or pears, with paired nuclei, seen in the lumen between villi.[5]
.jpg)
![Giardia lamblia: Organisms shaped like teardropd or pears, with paired nuclei, seen in the lumen between villi.[5]](/File:Histopathology_of_giardiasis.jpg)
Microscopy report
Example in an unremarkable specimen:
| Small intestine, biopsy: Duodenal mucosa, negative for significant histopathologic changes. Negative for celiac disease. |
Example in suspected celiac disease:
 Marked villous atrophy with increased intraepithelial lymphocytes, consistent with celiac sprue. Correlation with serologic testing is recommended. |
Notes
- ↑ 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.
Main page
References
- ↑ Juwairiya Arshi, M.B.B.S., Aaron R. Huber, D.O.. Small intestine & ampulla - Malabsorption - Celiac sprue. Last author update: 4 May 2022. Last staff update: 16 September 2022
- ↑ Brown, Ian S.; Smith, Jason; Rosty, Christophe (2012). "Gastrointestinal Pathology in Celiac Disease ". American Journal of Clinical Pathology 138 (1): 42–49. doi:. ISSN 0002-9173.
- ↑ 3.0 3.1 Erdener Özer. Small intestine & ampulla, Malabsorption, Celiac sprue. Pathology Outlines. Topic Completed: 1 June 2017. Minor changes: 4 April 2020.
- ↑ 4.0 4.1 4.2 . Celiac Disease. Stanford School of Medicine. Retrieved on 2021-03-11.
- ↑ Hanni Gulwani. Small intestine & ampulla - Infectious disorders - Giardia lamblia. Pathology Outlines. Topic Completed: 1 August 2012. Minor changes: 3 March 2020
Image sources