Difference between revisions of "Small intestine in celiac disease"
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==Microscopic evaluation== | ==Microscopic evaluation== | ||
| − | [[File:Histopathology of | + | [[File:Histopathology of intraepithelial lymphocytes of the duodenum, annotated.jpg|thumb|'''Intraepithelial lymphocytes''', in this case still less than <25 IELs/100 enterocytes.]] |
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. | ||
Revision as of 19:10, 20 September 2021
Author:
Mikael Häggström [note 1]
Contents
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.[1] The number of intraepithelial lymphocytes are classified as follows in the duodenum:[2][3]
- < 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.[3] In the jejunum, the cutoff is at over 40 IELs per 100 enterocytes.[3]
Suggestive but not specific findings for enterocytes are: decreased height, intracytoplasmic vacuolation and reduction or absence of the brush border.[2]
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.[4]
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Microscopy report
Example in an unremarkable specimen:
| Duodenal mucosa, negative for significant histopathologic changes. Negative for celiac disease. |
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
- ↑ 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.
- ↑ 2.0 2.1 Erdener Özer. Small intestine & ampulla, Malabsorption, Celiac sprue. Pathology Outlines. Topic Completed: 1 June 2017. Minor changes: 4 April 2020.
- ↑ 3.0 3.1 3.2 . 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
