CONTEXT: An increased intraepithelial lymphocyte density in an architecturally normal proximal small intestinal mucosal biopsy is a common finding facing surgical pathologists dealing with gastrointestinal biopsy specimens. Approximately 1% to 2% of all proximal small intestinal biopsies will show this change. It is increasingly recognized by surgical pathologists that gluten-sensitive enteropathy is an important cause of this pattern; however, gluten-sensitive enteropathy accounts for the minority of all cases. A wide variety of immunologic stimuli can raise intraepithelial lymphocyte numbers. Among the other common associations are enteric infection, autoimmune disease, drugs, and gastric Helicobacter infection. OBJECTIVE: To outline the causes of intraepithelial lymphocytosis, to highlight the importance and the difficulties faced in establishing gluten-sensitive enteropathy as the cause, and to aid the surgical pathologist in the routine sign out of these cases. DATA SOURCES: A review of the literature detailing the causes or associations of proximal small intestinal intraepithelial lymphocytosis is presented. CONCLUSIONS: Increased lymphocyte numbers in the epithelium of architecturally preserved proximal small intestinal biopsies is a morphologic feature associated with a broad differential diagnosis.
CONTEXT: An increased intraepithelial lymphocyte density in an architecturally normal proximal small intestinal mucosal biopsy is a common finding facing surgical pathologists dealing with gastrointestinal biopsy specimens. Approximately 1% to 2% of all proximal small intestinal biopsies will show this change. It is increasingly recognized by surgical pathologists that gluten-sensitive enteropathy is an important cause of this pattern; however, gluten-sensitive enteropathy accounts for the minority of all cases. A wide variety of immunologic stimuli can raise intraepithelial lymphocyte numbers. Among the other common associations are enteric infection, autoimmune disease, drugs, and gastric Helicobacter infection. OBJECTIVE: To outline the causes of intraepithelial lymphocytosis, to highlight the importance and the difficulties faced in establishing gluten-sensitive enteropathy as the cause, and to aid the surgical pathologist in the routine sign out of these cases. DATA SOURCES: A review of the literature detailing the causes or associations of proximal small intestinal intraepithelial lymphocytosis is presented. CONCLUSIONS: Increased lymphocyte numbers in the epithelium of architecturally preserved proximal small intestinal biopsies is a morphologic feature associated with a broad differential diagnosis.
Authors: Benjamin Lebwohl; Martin J Blaser; Jonas F Ludvigsson; Peter H R Green; Andrew Rundle; Amnon Sonnenberg; Robert M Genta Journal: Am J Epidemiol Date: 2013-10-11 Impact factor: 4.897
Authors: Kamran Rostami; David Aldulaimi; Geoffrey Holmes; Matt W Johnson; Marie Robert; Amitabh Srivastava; Jean-François Fléjou; David S Sanders; Umberto Volta; Mohammad H Derakhshan; James J Going; Gabriel Becheanu; Carlo Catassi; Mihai Danciu; Luke Materacki; Kamran Ghafarzadegan; Sauid Ishaq; Mohammad Rostami-Nejad; A Salvador Peña; Gabrio Bassotti; Michael N Marsh; Vincenzo Villanacci Journal: World J Gastroenterol Date: 2015-03-07 Impact factor: 5.742
Authors: M M Walker; N J Talley; M Prabhakar; C J Pennaneac'h; P Aro; J Ronkainen; T Storskrubb; W S Harmsen; A R Zinsmeister; L Agreus Journal: Aliment Pharmacol Ther Date: 2009-01-17 Impact factor: 8.171