Histopathological diagnosis and differential diagnosis of celiac disease: a review for gastroenterologists

Česká verzia

Authors: M. Švajdler Jr ¹; P. Bohuš ²; B. Rychlý ³
Authors place of work: Oddelenie patológie FN L. Pasteura, Košice2Cytolab s. r. o., Košice3Cytopathos s. r. o., Bratislava ¹
Published in the journal: Gastroent Hepatol 2010; 64(3): 24-30
Category: IBD: Aktuální přehled

Summary

Although morphological changes of celiac disease are considered typical, they are non-specific. The final diagnosis is clinico-pathological. Moreover, there are several unresolved issues in the morphology of celiac disease, namely the number of intraepithelial lymphocytes, villous to crypt ratio or biopsy site. This review aims to discuss these issues in the context of routine clinical practice.

Key words:
celiac disease – diagnosis – differential diagnosis – histopathology

Zdroje

1. Lowichik A, Book L. Pediatric celiac disease: clinicopathologic and genetic aspects. Pediatr Dev Pathol 2003; 6(6): 470–483.

2. Ciclitira PJ. AGA Technical review on celiac sprue. Gastroenterology 2001; 120(6): 1526–1540.

3. Hill ID, Dirks MH, Liptak GS et al. Guideline for the Diagnosis and Treatment of Celiac Disease in Children: Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2005; 40(1): 1–19.

4. Ravikumara M, Tuthill DP, Jenkins HR. The changing clinical presentation of coeliac disease. Arch Dis Child 2006; 91(12): 969–971.

5. van Heel DA, West J. Recent advances in coeliac disease. Gut 2006; 55(7): 1037–1046.

6. Shidrawi RG, Przemioslo R, Davies DR et al. Pitfalls in diagnosing coeliac disease. J Clin Pathol 1994; 47(8): 693–694.

7. Marsh MN, Crowe PT. Morphology of the mucosal lesion in gluten sensitivity. Baillieres Clin Gastroenterol 1995; 9(2): 273–293.

8. Dickson BC, Streutker CJ, Chetty R. Coeliac disease: an update for pathologists. J Clin Pathol 2006; 59(10): 1008–1016.

9. Ferguson A, Murray D. Quantitation of intraepithelial lymphocytes in human jejunum. Gut 1971; 12(12): 988–94.

10. Hayat M, Cairns A, Dixon MF et al. Quantitation of intraepithelial lymphocytes in human duodenum: what is normal? J Clin Pathol 2002; 55(5): 393–394.

11. Mahadeva S, Wyatt JI, Howdle PD. Is a raised intraepithelial lymphocyte count with normal duodenal villous architecture clinically relevant? J Clin Pathol 2002; 55(6): 424–428.

12. Biagi F, Luinetti O, Campanella J et al. Intraepithelial lymphocytes in the villous tip: do they indicate potential coeliac disease? J Clin Pathol 2004; 57(8): 835–839.

13. Goldstein NS, Underhill J. Morphologic features suggestive of gluten sensitivity in architecturally normal duodenal biopsy specimens. Am J Clin Pathol 2001; 116(1): 63–71.

14. Goldstein NS. Proximal small-bowel mucosal villous intraepithelial lymphocytes. Histopathology 2004; 44(3): 199–205.

15. Mino M, Lauwers GY Role of Lymphocytic immunophenotyping in the diagnosis of gluten-sensitive enteropathy with Preserved villous architecture. Am J Surg Pathol 2003; 27(9): 1237–1242.

16. Przemioslo R, Wright NA, Elia G et al. Analysis of crypt cell proliferation in coeliac disease using MI-B 1 antibody shows an increase in growth fraction. Gut 1995; 36: 22–27.

17. Segal GH, Petras RE. Small intestine. In: Sternberg SS, ed. Histology for pathologists. New York, Raven Press 1992: 547–572.

18. Drut R, CuetoRúa E. The histopathology of pediatric celiac disease: order must prevail out of chaos. Int J Surg Pathol 2001; 9(4): 261–264.

19. Rosekrans PC, Meijer CJ, Polanco I et al. Long-term morphological and immunohistochemical observations on biopsy specimens of small intestine from children with gluten-sensitive enteropathy. J Clin Pathol 1981; 34(2): 138–144.

20. Grefte JM, Bouman JG, Grond J et al. Slow and incomplete histological and functional recovery in adult gluten sensitive enteropathy. J Clin Pathol 1988; 41(8): 886–891.

21. Bardella MT, Velio P, Cesana BM et al. Coeliac disease: a histological follow-up study. Histopathology 2007; 50(4): 465–471.

22. Kaukinen K, Sulkanen S, Maki M et al. IgA class transglutaminase antibodies in evaluating the efficacy of gluten-free diet in coeliac disease. Eur J Gastroenterol Hepatol 2002; 14(3): 311–315.

23. Marsh MN. Grains of truth: evolutionary changes in small intestinal mucosa in response to environmental antigen challenge. Gut 1990; 31(1): 111–114.

24. Marsh MN. Gluten, major histocompatibility complex and the small intestine. A molecular and immunobiologic approach to the spectrum of gluten sensitivity (celiac sprue). Gastroenterology 1992; 102(1): 330–354.

25. Oberhuber G, Granditsch G, Vogelsang H. The histopathology of coeliac disease: time for a standardized report scheme for pathologists. Eur J Gastroenterol Hepatol 1999; 11(10): 1185–1194.

26. Corazza GR, Villanacci V. Coeliac disease. J Clin Pathol 2005; 58(6): 573–574.

27. Drut R, Rúa EC. Histopathologic diagnosis of celiac disease in children without clinical evidence of malabsorption. Int J Surg Pathol 2007; 15(4): 354–357.

28. Nahon S, Patey-Mariaud De Serre N, Lejeune O et al. Duodenal intraepithelial lymphocytosis during Helicobacter pylori infection is reduced by antibiotic treatment. Histopathology 2006; 48(4): 417–423.

29. Jeffers MD, Hourihane DO‘B. Coeliac disease with histological features of peptic duodenitis: Value of assessment of intraepithelial lymphocytes. J Clin Pathol 1993; 46(5): 420–424.

30. Leonard N, Feighery CF, Hourihane DO‘B. Peptic duodenitis-does it exist in the second part of the duodenum? J Clin Pathol 1997; 50(1): 54–58.

31. Augustin M, Karttunen T, Kokkonen J. TIA1 and mast cell tryptase in food allergy of children: increase of intraepithelial lymphocytes expresing TIA1 associates with allergy. J Pediatr Gastroenterol Nutr 2001; 32(1): 11–18.

32. Owens SR, Greenson JK. The pathology of malabsorption: current concepts. Histopathology 2007; 50(1): 64–82.

33. Oberhuber G, Stolte M. Giardiasis: analysis of histological changes in biopsy specimens of 80 patients. J Clin Pathol 1990; 43(8): 641–643.

34. Brown I, Mino-Kenudson M, Deshpande V et al. Intraepithelial lymphocytosis in architecturally preserved proximal small intestinal mucosa. An increasing diagnostic problem with a wide differential diagnosis. Arch Pathol Lab Med 2006; 130(7): 1020–1025.

35. Russo PA, Brochu P, Seidman EG et al. Autoimmune enteropathy. Pediatr Dev Pathol 1999; 2(1): 65–71.

36. Groisman GM, Amar M, Livne E. CD10. A valuable tool for the light microscopic diagnosis of microvillous inclusion disease (familial microvillous atrophy). Am J Surg Pathol 2002; 26(7): 902–907.

37. Washington K. Immunodeficiency disorders of the GI tract. In: Odze R, Goldblum J, Crawford J. Surgical pathology of the GI tract, liver, biliary tract, and pancreas, Philadelphia, Saunders 2003, 57–72.

38. Valdez R, Appelman HD, Bronner MP et al. Diffuse duodenitis associated with ulcerative colitis. Am J Surg Pathol 2000; 24(10): 1407–1413.