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Multicenter Study
. 2014 Oct;38(10):1319-29.
doi: 10.1097/PAS.0000000000000317.

Gastrointestinal biopsy findings of autoimmune enteropathy: a review of 25 cases

Affiliations
Multicenter Study

Gastrointestinal biopsy findings of autoimmune enteropathy: a review of 25 cases

Ricard Masia et al. Am J Surg Pathol. 2014 Oct.

Abstract

Autoimmune enteropathy (AIE) is a rare disorder characterized by severe diarrhea and small intestinal mucosal atrophy resulting from immune-mediated injury. It remains a challenging diagnosis because of its clinicopathologic variability. To better understand its histopathologic features, we describe the gastrointestinal biopsy findings of 25 patients, including children and adults. The most common finding on small intestinal biopsy (13/25 cases, 52%) was villous blunting, expansion of the lamina propria by mixed but predominantly mononuclear inflammation, and neutrophilic cryptitis with or without crypt microabscesses. In 5 cases (20%), the duodenum exhibited changes indistinguishable from celiac disease, with villous blunting and intraepithelial lymphocytosis. Increased crypt apoptosis with minimal inflammation, resembling acute graft-versus-host disease, was observed in 4 cases (16%). The remaining 3 cases (12%) exhibited a mixture of 2 or more of the above patterns. Mucosal abnormalities outside the small intestine were present in all 24 cases with available biopsies (100%), with the stomach most commonly affected (19/22 cases, 86%), followed by the colon (14/22, 64%) and esophagus (5/18, 28%). Findings in non-small intestinal sites were variable and included mixed active and chronic inflammation, chronic inflammation alone, intraepithelial lymphocytosis, and increased apoptosis resembling acute graft-versus-host disease. In summary, AIE most commonly presents as an active enteritis with villous blunting and expansion of the lamina propria by mixed inflammation. Mucosal abnormalities are frequently seen elsewhere in the gut. AIE may thus be better regarded as a pan-gastrointestinal autoimmune disorder, and biopsies from sites other than the small intestine may greatly facilitate its diagnosis.

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Figures

Figure 1
Figure 1. Active chronic duodenitis
This pattern is characterized by moderate to severe villous blunting, expansion of the lamina propria by a mixed but predominantly mononuclear inflammatory infiltrate, and neutrophilic cryptitis; crypt epithelial apoptosis may be increased. Hematoxylin and eosin.
Figure 2
Figure 2. Neutrophilic crypt microabscess in active chronic duodenitis
Hematoxylin and eosin.
Figure 3
Figure 3. Celiac disease-like pattern
This pattern is largely indistinguishable from celiac disease, and is characterized by villous blunting and increased intraepithelial lymphocytes in surface epithelium. Hematoxylin and eosin.
Figure 4
Figure 4. Graft-versus-Host Disease-like pattern
This pattern is characterized by villous blunting with increased crypt epithelial apoptosis and minimal inflammation, mimicking acute Graft-versus-Host Disease. Hematoxylin and eosin.
Figure 5
Figure 5. Increased crypt epithelial apoptosis in Graft-versus-Host Disease-like pattern
Hematoxylin and eosin.
Figure 6
Figure 6. Mixed/no predominant pattern
This pattern consists of features that do not allow classification into the previous 3 patterns, and typically exhibits villous blunting with a mixed, predominantly mononuclear inflammatory infiltrate in the lamina propria. Hematoxylin and eosin.
Figure 7
Figure 7. Active chronic gastritis involving the gastric antrum
Hematoxylin and eosin.
Figure 8
Figure 8. Atrophic gland with luminal debris in the gastric body/fundus
This pattern of gastric involvement mimics acute Graft-versus-Host Disease. Hematoxylin and eosin.
Figure 9
Figure 9. Colitis with lymphoplasmacytic expansion of the lamina propria and neutrophilic cryptitis
Hematoxylin and eosin.
Figure 10
Figure 10. Colon with strikingly increased apoptosis in crypt epithelium
This pattern of colonic involvement mimics acute Graft-versus-Host Disease. Hematoxylin and eosin.

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References

    1. Unsworth DJ, Walker-Smith JA. Autoimmunity in diarrhoeal disease. J Pediatr Gastroenterol Nutr. 1985;4:375–380. - PubMed
    1. Gentile NM, Murray JA, Pardi DS. Autoimmune enteropathy: a review and update of clinical management. Curr Gastroenterol Rep. 2012;14:380–385. - PMC - PubMed
    1. Montalto M, D'Onofrio F, Santoro L, et al. Autoimmune enteropathy in children and adults. Scand J Gastroenterol. 2009;44:1029–1036. - PubMed
    1. Akram S, Murray JA, Pardi DS, et al. Adult autoimmune enteropathy: Mayo Clinic Rochester experience. Clin Gastroenterol Hepatol. 2007;5:1282–1290. - PMC - PubMed
    1. Barzaghi F, Passerini L, Bacchetta R. Immune dysregulation, polyendocrinopathy, enteropathy, x-linked syndrome: a paradigm of immunodeficiency with autoimmunity. Front Immunol. 2012;3:211. - PMC - PubMed

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