ROC-king onwards: intraepithelial lymphocyte
counts, distribution and role in coeliac disease mucosal interpretation.
Roy, "Cytokine production by intestinal intraepithelial lymphocyte
subsets in celiac disease," Digestive Diseases and Sciences, vol.
Endoscopic biopsy results obtained during the previous 2 years showed continued villous atrophy with intraepithelial lymphocytes
. Shortly before the patient's referral, repeat biopsies showed villous blunting with increased chronic inflammation, findings confirmed by a gastrointestinal pathologist at our institution.
In addition, the villous/crypt ratio was evaluated (reference values in our laboratory [greater than or equal to] 2.5 for children, [greater than or equal to] 3 for adults), and the number of intraepithelial lymphocytes
(IELs) per 100 villous epithelial cells was assessed as described by Ferguson and Murray (15); the upper limit of the reference values in our laboratory is 30 IELs/100 epithelial cells.
RCD can be divided in two types based on the absence (type I) or presence (type II) of an abnormal intraepithelial lymphocyte
population that is generally clonal in nature.
Endoscopic and histopathologic findings of CD patients Endoscopic findings (n*) Nodularity in bulbus and duodenal mucosa 16 Scalloping fold 13 Normal mucosa 5 Histopathologic findings n* Total villous atrophy 10 Subtotal + partial villous atrophy 24 Intraepithelial lymphocyte
infiltration 34 (n*) number of cases
Isaacson and Du (20) and Ashton-Key and associates (83) have demonstrated that EATL may be preceded by refractory celiac disease frequently associated with ulcers and referred to as "ulcerative jejunitis." Polymerase chain reaction and sequence analysis showed that ulcerative lesions and unremarkable, normal-appearing intraepithelial lymphocytes
share the identical monoclonal T-cell receptor rearrangement as the adjacent lymphoma.
Such cases require vigorous histopathologic evaluation, as the findings may occur along a spectrum of normal mucosa with increased numbers of intraepithelial lymphocytes
(IELs) to flat mucosa, and they should not be missed since patients still remain predisposed to cancer or lymphoma by virtue of chronic gluten ingestion.
An unexplained excess of intraepithelial lymphocytes
was noted in the otherwise normal jejunal mucosa of many patients undergoing bariatric surgery involving Roux-en-Y gastric and segmental jejunal resections.
Histopathological examination: increased intraepithelial lymphocytes
, cryptal hyperplasia and loss of villi (a: HE, x50; b: HE, x100).
(1989) Immunobiology and Immunopathology of Human Gut Mucosa: Humoral Immunity and Intraepithelial Lymphocytes
. Gastroenterology 97:1562-1584.
The intraepithelial lymphocytes
in the adjacent mucosa had identical immunophenotype with tumor cells.