Small intestine in celiac disease

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Author: Mikael Häggström [note 1]

Contents

Gross processing

As per Small intestine.

Microscopic evaluation

 
Intraepithelial lymphocytes, in this case still less than <25 IELs/100 enterocytes.
 
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:

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:

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