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I think understanding biopsy reports is of great interest to people.  I
am translating the results line by line below, with commentary.

On Jun 20, 2005, at 4:04 PM, Automatic digest processor wrote:

> We are 2 in a family of eight who are diagnosed celiac through biopsy.
> My sister age 62 years has returned to Canada for a visit from New
> Guinea where she works as a missionary. While in Canada she was
> recently biopsied for celiac. Her GI doctor has told her that although
> she does not have celiac she will need to be observed closely.
> Considering the family history I wonder if someone with expertise
> could give me an explanation in common language about her biospy
> report which reads as follows. Also, would my sister benefit from
> going on the G/F diet at this time.
>
> MICROSCOPIC DESCRIPTION:
>
> Sections show fragments of duodenum that include the mucosa and the
> submucosa with Bruner's glands.

The tissue sent to the lab contained surface structures and subsurface
structures.  This means a good sample was obtained.  Brunner's glands,
which are a characteristic of the duodenum, were present, which
confirms the tissue was from the place the endoscopist said it was
from.

> There is preservation of the villous architecture.

The shape of the little fingers that are important for absorption were
normal in appearance, so that speaks against Celiac.

> There are no intraluminal protozoa.

No little parasite beasties were found, so Giardia is not seen.

> There is a marked increase in the number of intra epithelial
> lymphocytes particularly at the tips of the villi. There are no
> associated degenerative changes.  These changes are nonspecific but
> may be associated with celiac disease.

There are immune cells in increased number mixed in with the surface
cells of the sample.  But no change in structure is seen.  The
pathologist is signalling that this fits with Marsh I pattern of celiac
disease, but he knows well that once you say Marsh I everyone will
think that it is Celiac for sure.  There are a number os studies that
show that Marsh I is non-specific and is seen in normal people as well
as with other diseases, so Celiac maybe but not for sure.  Another test
would be of use.



That is it for the translation.  Here I would do a full Celiac panel,
or at least an IgA anti-TTG and an IgA anti-endomysial.  A total IgA
would be a good idea, too.  What you are looking for is some evidence
to swing the increased IELs in the epithelium to more or less likely to
be Celiac.  If celiac is strongly suspected even with negative
antibodies, then repeat EGD on a diet for 8 weeks to look for improved
histology may be needed.


Stephen Holland, M.D.

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