Patholines - Pathology Guidelines

Small intestine in celiac disease

Author: Mikael Häggström [note 1]

Gross processing

As per Small intestine.

Microscopic evaluation

Histopathology of intraepithelial lymphocytes of the duodenum, annotated.jpg
Histopathology of villous atrophy in celiac disease
Villous atrophy is another sign of celiac disease. Normal villous:crypt ratio is 3:1. However, this assessment requires proper orientation of biopsies.[1]

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.
    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]
    Giardia lamblia: Organisms shaped like teardropd or pears, with paired nuclei, seen in the lumen between villi.[5]

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:

Histopathology of duodenal intra-epithelial lymphocytes
Small intestine, biopsy:
Marked villous atrophy with increased intraepithelial lymphocytes, consistent with celiac sprue.
Correlation with serologic testing is recommended.

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.

Main page

References

  1. ↑ 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
  2. ↑ Brown, Ian S.; Smith, Jason; Rosty, Christophe (2012). "Gastrointestinal Pathology in Celiac Disease ". American Journal of Clinical Pathology 138 (1): 42–49. doi:10.1309/AJCPE89ZPVJTSPWL. ISSN 0002-9173. 
  3. ↑ 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. ↑ 4.0 4.1 4.2 . Celiac Disease. Stanford School of Medicine. Retrieved on 2021-03-11.
  5. ↑ Hanni Gulwani. Small intestine & ampulla - Infectious disorders - Giardia lamblia. Pathology Outlines. Topic Completed: 1 August 2012. Minor changes: 3 March 2020

Image sources