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Early Celiac Disease (Gluten Sensitive Enteropathy)
Discussion
Most pathologists are familiar with the advanced histopathologic stages of celiac sprue or gluten sensitive enteropathy. Less familiar and somewhat controversial, are the early histomorphologic findings. A recent paper examined small bowel biopsy specimens with architecturally normal villi from 78 adult patients with potential gluten sensitivity but with no prior diagnosis.
The key finding suggestive of a diagnosis of early sprue was an architecturally normal small bowel biopsy specimen with an appreciable, continuous, even distribution of intraepithelial lymphocytes (IELs) along the sides and tips of villi with a mean of 12 or more IELs in the tips of several villi. There was also an increase in crypt mitotic counts. The authors caution that there was significant histologic overlap between gluten sensitive patients and non-gluten sensitive patients and found this feature helpful only in cases where the IELs were markedly increased. This pattern contrasted with normal villi which exhibit a decrescendo, non-uniform pattern of IELs along the sides of villi.
Upon further discussion of this case with the treating gastroenterologist, it was revealed that this patient also had an elevated calcium-activated tissue transglutaminase autoantibody ELISA and elevated IgA antiendomysial antibody (EMA) test, both confirmatory tests for sprue.
References
Celiac Sprue
Goldstein NS and Underhill J. Morphologic Features Suggestive of Gluten Sensitivity in Architecturally Normal Duodenal Biopsy Specimens. Am J Clin Pathol 2001;116:63-71
Last Updated 11/4/2002
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