Focal Duodenal Intraepithelial Lymphocytosis and Underlying Lymphoid Aggregates: The Utility of Deeper Histologic Sections
RM Najarian, D Leffler, JD Goldsmith. Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA
Background: The diagnosis of isolated duodenal intraepithelial lymphocytosis is being increasingly rendered. Although it may be seen in celiac disease, this finding is non-specific. This study was performed to determine if focal increases in intraepithelial lymphocytes (IELs) may be associated with underlying lymphoid aggregates.
Design: Thirty-eight cases were identified with focal duodenal intraepithelial lymphocytosis, defined as greater than 30 IELs/100 enterocytes in 3 contiguous villi with normal findings in the remainder of the biopsy. Biopsies in which increased IELs were diffusely present were excluded from the analysis. One surface recut and five levels were then obtained for each biopsy and the presence of lymphoid aggregates or other histologic findings were noted. Indications for biopsy, final pathologic diagnosis, associated comorbidities, and documented serologic and histologic evidence of known causes of increased duodenal IELs were obtained from the medical record.
Results: Thirty-eight duodenal biopsies were reviewed in 38 patients ranging from 24 to 88 years of age (mean 51 years; 74% female) with focal intraepithelial lymphocytosis (mean of 41 7.4 IELs). In deeper histologic sections, lymphoid aggregates were present in 19 biopsies (50%); 14 of these biopsies showed that the lymphoid aggregate(s) were either directly subjacent or within 3 villi of the focus of increased IELs. In the remaining 5 biopsies, the exact relationship of the lymphoid aggregate to the focus of increased IELs was not evaluable. A history of celiac disease was noted in 2 patients in the non-lymphoid aggregate group; whereas no patients with celiac disease were seen in the lymphoid aggregate group. Otherwise, there were no statistical differences in associated medical conditions and serologic status between the two groups.
Conclusions: Focal duodenal intraepithelial lymphocytosis is a non-specific finding. Half of the cases were found to be non-pathologic, as the focus of intraepithelial lymphocytosis was related to an adjacent lymphoid aggregate. Thus, multiple step sections are needed to exclude a normal finding.
Monday, March 9, 2009 9:30 AM
Poster Session I Stowell-Orbison/Autopsy Award # 101, Monday Morning