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

Abstract

Summary In this paper, we will continue the description of histological findings of infantile and paediatric small bowel alterations with the main clinical pictures and differential diagnosis. We emphasise once again the need to evaluate the biopsies in an adequate clinical contest and with a systematic approach, including epithelial alterations, lamina propria changes, mucosal architecture, and the distribution of inflammation, together with other morphological signs more specific of certain diseases. We describe the histological findings of coeliac and Crohn’s disease, gastrointestinal food allergic diseases, Langerhans cell histiocytosis, nutritional deficiencies and infections. Finally, we suggest the principal issues in the drafting the pathological report for appropriate interpretation and usefulness in clinical practice.

Immunohistochemistry and real-time Polymerase Chain Reaction: importance in the diagnosis of intestinal tuberculosis in a Peruvian population

“…10) Lymphoid follicles or lymphoid aggregated, the first defined as aggregates of lymphocytes with germinal center, and the lymphoid aggregated defined as a collection of lymphocytes and plasma cells without a germinal center [ 22 ]. 11) Villus atrophy (evaluated only in the small bowel): It is defined as the decrease in villous height, loss of the normal crypt/villous ratio (3:1), until the complete flattening of the villi [ 23 , 24 ]. 12) Pyloric metaplasia: Defined as glands in the intestinal mucosa with the characteristics of mucin-secreting distal stomach glands [ 25 ].…”

Pediatric autoimmune disorders with gastrointestinal expressions: from bench to bedside

“…The differential diagnoses of pediatric AIE include other immune-mediated disorders, such as food sensitivity enteropathies (e.g. cow’s milk intolerance and celiac disease) 12 , VEO-IBD 11 and graft-versus-host disease 5 . In older patients, celiac disease is the first condition that should be ruled out, particularly refractory celiac disease which is a form no longer responsive to a gluten free diet 32 .…”

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

“…The fact that the two disorders arise in the same age group, and the difficulty in confirming the coeliac disease diagnosis through anti-gliadin and endomysial IgA measurements in CVID patients, further complicate the differential diagnosis, and despite absence of plasma cells and response to a gluten-free diet orient the diagnosis towards CVID, sometimes histology cannot help differentiating between a refractory coeliac disease and CVID 41 . Coeliac disease will be discussed more in detail in part II of this review 42 . Nodular lymphoid hyperplasia (NLH) is another histological finding of CVID in small bowel biopsies, with hyperplastic lymphoid nodules found in the lamina propria and submucosa probably as a result of chronic antigen stimulation; also in this case, plasma cells are absent from the extramantle zone of the nodule, in contrast with NLH in immunocompetent patients.…”