CD10 immunohistochemistry stains enteric mucosa, but negative staining is unreliable in the setting of active enteritis

Abstract

Ileal pouch-anal anastomosis is the definitive therapy for ulcerative colitis that is refractory to medical treatment or that has developed neoplasia. Patients with this procedure are routinely followed using directed endoscopic biopsies to monitor for dysplasia in the rectal cuff, residual/recurrent ulcerative colitis, and nonspecific acute inflammation of the ileal pouch (pouchitis), which have different clinical management and outcomes. Thus, accurate localization of mucosal biopsies is crucial to a definitive histological diagnosis, but is complicated by overlapping clinical presentations of pouchitis and ulcerative colitis, post-surgical and inflammatory changes to the mucosa, and altered endoscopic anatomy, resulting in difficulty determining whether a mucosal biopsy is ileal or rectal in origin for both the endoscopist and the pathologist. We explored the utility of CD10 immunohistochemistry to aid diagnosis in this clinical setting by highlighting the enteric mucosa, based on previous studies showing its utility in brush border staining and in the diagnosis of microvillous inclusion disease. We found uniformly positive CD10 immunostaining in normal enteric mucosa, but variable loss of expression in the setting of active enteritis. Specifically, CD10 staining was lost in up to 10% of the mucosa in 1/12 ileostomies and 4/13 enteric anastomoses, in 10-80% of the mucosa in 9/10 cases of Crohn's ileitis, in 10-60% of the mucosa in 7/16 ileal pouches, and in 20-90% of the mucosa in 6/8 cases of backwash ileitis, usually in the presence of active inflammation. There was no CD10 expression by normal or diseased colonic mucosa. Therefore, while CD10 immunostaining identifies normal enteric mucosa with 100% specificity, negative staining does not definitively exclude small intestinal mucosa in the setting of active enteritis, a common condition in ileal pouch mucosa.

Childhood chronic gastritis and duodenitis: Role of altered sensory neuromediators

“…NEP may have a role in the growth and differentiation of intestinal epithelial cells, and it has been used in support of diagnoses of microvilli inclusion disease using light microscopy[ 37 , 39 - 41 ]. In a study of ulcerative colitis patients, a regular staining pattern was detected in healthy ileal mucosa, but no staining was observed in inflamed mucosa[ 42 ], and changes in NEP expression were reported in a patient with intestinal metaplasia accompanied by gastric adenocarcinoma[ 43 ]. Moreover, we observed a more prominent diffuse CD10 staining pattern in the duodenal mucosa of patients without duodenitis than in those with duodenitis.…”

Profound loss of neprilysin accompanied by decreased levels of neuropeptides and increased CRP in ulcerative colitis

“…Although NEP may act as an important anti-inflammatory molecule, its role in inflammatory bowel diseases such as in UC is not well explored. Loss of NEP immunoreactivity in a limited number of patients (n = 18) with this disease was demonstrated in a recent study by Lloyd and Owens [ 3 ].…”

“…All patients were informed of the study protocol verbally and in writing regarding the aim of the study, possible outcomes and adverse events that may occur during, and after, the procedure, with a signed informed consent. Sample size was calculated based on a study conducted by Lloyd and Owens [ 3 ], where NEP expression was lost by 20–80% in patients with UC. Sample size was calculated as twenty three patients per group, with an expected 50% loss of NEP expression in patients with UC (90% power and %95 confidence levels).…”

CD10 inhibits cell motility but expression is associated with advanced stage disease in colorectal cancer

“…It is expressed in bone marrow lymphoid stem cells, pro-B lymphoblasts, and mature neutrophils and it is used for classification of leukaemias and malignant lymphomas (Lu et al 2016). It is also seen in the endometrial stroma and, with regards to the epithelium, it is found to be expressed in the lumina of renal tubules, hepatic sinusoids and the microvilli of the small intestine (Lloyd & Owens 2011;Iwase et al 2014;Katano et al 2017).…”