Celiac disease: histology-differential diagnosis-complications. A practical approach

Abstract

Summary Celiac disease is a multi-factorial chronic inflammatory intestinal disease, characterized by malabsorption resulting from mucosal injury after ingestion of wheat gluten or related rye and barley proteins. Inappropriate T-cell-mediated immune response against ingested gluten in genetically predisposed people, leads to characteristic histological lesions, as villous atrophy and intraepithelial lymphocytosis. Nevertheless, celiac disease is a comprehensive diagnosis with clinical, serological and genetic characteristics integrated with histological features. Biopsy of duodenal mucosa remains the gold standard in the diagnosis of celiac disease with the recognition of the spectrum of histological changes and classification of mucosa damage based on updated Corazza-Villanacci system. Appropriate differential diagnosis evaluation and clinical context also for the diagnosis of complications is, moreover, needed for correct histological features interpretation and clinical management.

Clinical and gastro-duodenal histopathological features of enteropathy due to angiotensin II receptor blockers

“…Duodenal biopsies were assessed for the following histologic parameters: presence and grade of VA (using both the Marsh-Oberhuber and the Corazza-Villanacci classification) [26][27][28][29] ; crypt hyperplasia, crypt apoptotic bodies, neutrophilic cryptitis, sub-epithelial collagen, loss of plasma cells, Paneth cells, goblet cells or neuroendocrine cells, the latter were also evaluated by using chromogranin-A immunostaining. Intraepithelial T lymphocytes (IELs) were stained using CD3 antibodies, and counted on 300 consecutive epithelial cells and were recorded as mean number of IELs/100 epithelial cells [30] . They were considered increased (i.e.…”

Histopathology of intestinal villi in neonatal and paediatric age: main features with clinical correlation - Part II

“…The application of immunohistochemistry in CD diagnosis can be helpful to clearly identify the lymphocytosis condition. Albeit the increase of intraepithelial T lymphocyte can be observed also on haematoxylin-eosin stain, we suggest, especially in the easly forms, the use of CD3 monoclonal antibodies for a more accurate evaluation of the epithelial lyphocytosis 2 , 5 . CD8 monoclonal antibodies can be useful in elderly patients, in order to exclude a refractory form of CD, not responsive to a gluten-free diet.…”

“…Unfortunately none of the above mentioned characteristics is pathognomonic for CD; for an accurate diagnosis the histological pattern has to be integrated with clinical, serological and genetic data 5 .…”

“…In order to achieve a correct diagnosis, it is essential to examine the patients while they are still exposed to gluten. In fact, a gluten-free diet may alter the clinical, serological and histological features of CD, making it unrecognisable 5 .…”

Histological Features of Celiac-Disease-like Conditions Related to Immune Checkpoint Inhibitors Therapy: A Signal to Keep in Mind for Pathologists

“…The most important serological investigations in the diagnosis of CD are IgA class antitransglutaminase antibodies (TTGA) with the highest sensitivity (98%) and specificity estimated at around 90%, and IgA class antiendomysial antibodies (EMA), this test having a lower sensitivity compared to IgA-class TTGA (90% vs. 98%) but showing an almost absolute specificity for CD. Moreover, CD is closely associated with histocompatibility antigens (HLA) DQ2 and DQ8 [ 36 ]. Endoscopic features of CD include a paucity or loss of mucosal folds, effacement of folds with oedema, presence of a mosaic pattern, scalloping, nodularity, and increased visibility of the vasculature.…”