Can an Immunohistochemistry Method Differentiate Intestinal Tuberculosis from Crohn’s Disease in Biopsy Specimens?

İnce, Ali Tüzün; Güneş, Pembegül; Şenateş, Ebubekir; Sezıklı, Mesut; Tıftıkcı, Arzu; Ovunc, Oya

doi:10.1007/s10620-010-1399-7

Cited by 21 publications

(12 citation statements)

References 19 publications

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“…We propose to carry out further work in developing a species-specific monoclonal antibody to Ag85B. As the expression level of Ag85B is much higher than that of PstS1, and the expression patterns of these two antigens are quite different, detection of Ag85B has an advantages in disclosing TB cases 19 21 22…”

Section: Discussionmentioning

confidence: 99%

Double staining of bacilli and antigen Ag85B improves the accuracy of the pathological diagnosis of pulmonary tuberculosis

Che

Zhang

et al. 2015

J Clin Pathol

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Section: Discussionmentioning

confidence: 99%

Double staining of bacilli and antigen Ag85B improves the accuracy of the pathological diagnosis of pulmonary tuberculosis

Che

Zhang

et al. 2015

J Clin Pathol

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“…Except for traditional histological examinations, surface markers identified by immunohistochemistry or immunofluorescence also contribute to the differential diagnosis between CD and ITB. Anti‐VP‐M660, a specific monoclonal antibody targeting the antigen of M. tuberculosis complex was reported to have a sensitivity of 73% and a specificity of 93% for the diagnosis of ITB . Banerjee and colleagues found that M. tuberculosis evaded host immunity by recruiting CD73 + mesenchymal cells around the granulomas, a process that is absent in CD.…”

Section: Histological Featuresmentioning

confidence: 99%

“…Anti-VP-M660, a specific monoclonal antibody targeting the antigen of M. tuberculosis complex was reported to have a sensitivity of 73% and a specificity of 93% for the diagnosis of ITB. 41 Banerjee and colleagues 42 found that M. tuberculosis evaded host immunity by recruiting CD73 + mesenchymal cells around the granulomas, a process that is absent in CD. Therefore, the identification of CD73 expression can also be used in a diagnostic differentiation.…”

Section: Histological Featuresmentioning

confidence: 99%

Intestinal tuberculosis and Crohn's disease: challenging differential diagnosis

Jia¹,

Jin²,

Ran

2016

J of Digest Diseases

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Along with epidemiological changes in tuberculosis (TB) and an increased incidence of Crohn's disease (CD), the differential diagnosis of intestinal TB (ITB) and CD is of vital importance and has become a clinical challenge because treatment based on misdiagnosis may lead to fatal outcomes. In this study, we reviewed the similarities and differences in clinical, endoscopic, radiological and histological features of these two diseases. Concomitant pulmonary TB, ascites, night sweats, involvement of fewer than four segments of the bowel, patulous ileocecal valve, transverse ulcers, scars or pseudopolyps strongly indicate ITB. Bloody stools, perianal signs, chronic diarrhea, extraintestinal manifestations, anorectal lesions, longitudinal ulcers and a cobblestone appearance are all suggestive of CD. Significant differences in the size, number, location and patterns of granulomas in ITB and CD with regard to their histopathologic features have been noted. Immune stain of cell surface markers is also helpful. Interferon-γ release assay and polymerase chain reaction analysis have achieved satisfactory sensitivity and specificity in the diagnosis of ITB. Computed tomography enterographic findings of segmental small bowel or left colon involvement, mural stratification, the comb sign and fibrofatty proliferation are significantly more common in CD, whereas mesenteric lymph node changes (calcification or central necrosis) and focal ileocecal lesions are more frequently seen in ITB. A diagnosis should be carefully established before the initiation of the therapy. In suspicious cases, short-term empirical anti-TB therapy is quite efficient to further confirm the diagnosis.

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“…The identification of acid-fast bacilli on intestinal biopsies of ITB was 25–36% in the literature. 6,25–27 In the present cohort, all ITB specimens were negative for acid-fast staining. M. tuberculosis culture may take several weeks, resulting in delayed diagnostic confirmation and treatment initiation.…”

Section: Discussionmentioning

confidence: 57%

Granulomas as the Most Useful Histopathological Feature in Distinguishing between Crohn's Disease and Intestinal Tuberculosis in Endoscopic Biopsy Specimens

Lin

Cao

et al. 2015

Medicine

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The incidence of Crohn's disease (CD) is increasing in Chinese populations in whom intestinal tuberculosis (ITB) is prevalent.This study aimed to identify differential diagnostic microscopic and endoscopic characteristics of CD from those of ITB.Patients with CD (N = 52) and patients with ITB (N = 16) diagnosed between 2010 and 2013 were identified. Specimens obtained via endoscopy were analyzed microscopically by a pathologist. The relationship between endoscopic appearance and histopathological features was analyzed. The χ2 test, Fisher's exact probability test, and the Mann-Whitney U test were used.Granulomas were present in 81.3% of ITB cases and in 67.3% of CD cases (P = 0.36). Granulomas in ITB cases were denser than those in CD cases (mean 5.29 ± 4.30 vs. 2.46 ± 3.50 granulomas per 10 low power fields; each low power field = 3.80 mm2; P = 0.005). Granulomas in ITB cases were larger (mean widest diameter, 508 ± 314 μm; range, 100–1100 μm) than those in CD cases (mean widest diameter, 253 ± 197 μm; range, 50–800 μm). Basal plasmacytosis was more common in CD cases than in ITB cases (77.0% vs. 37.5%, P = 0.000). Endoscopy findings such as longitudinal ulcer, aphthous ulcer, and cobblestone appearance were only seen in CD cases (34.6%, 21.2%, and 23.1%, respectively). Granulomas were detected in the majority of cases with longitudinal ulcers (88.9%). Basal plasmacytosis was exclusively detected in cases with longitudinal ulcer and a cobblestone appearance.Characteristics of granulomas maybe the most important distinguishing features between CD and ITB. However, the histopathological characteristics of both diseases may overlap on endoscopic biopsy specimens. An accurate diagnosis should be made that considers clinical, endoscopic features, and pathologic findings.

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Can an Immunohistochemistry Method Differentiate Intestinal Tuberculosis from Crohn’s Disease in Biopsy Specimens?

Abstract: Immunohistochemical staining of biopsy specimens with anti-VP-M660 seems to be a simple and fast technique with 73% sensitivity and 93% specificity for establishing an earlier differentiation of M. tuberculosis from Crohn's disease.

Cited by 21 publications

References 19 publications

Double staining of bacilli and antigen Ag85B improves the accuracy of the pathological diagnosis of pulmonary tuberculosis

Double staining of bacilli and antigen Ag85B improves the accuracy of the pathological diagnosis of pulmonary tuberculosis

Intestinal tuberculosis and Crohn's disease: challenging differential diagnosis

Granulomas as the Most Useful Histopathological Feature in Distinguishing between Crohn's Disease and Intestinal Tuberculosis in Endoscopic Biopsy Specimens

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