Adults with Celiac Disease: Histopathological and Immunohistochemical Analysis of Small Intestinal Biopsies

Abstract

In this study, we evaluated the immunohistochemical and micromorphological techniques for analyzing small intestinal biopsies from adults suspected of celiac disease. Methods: The study was carried out at the Department of Histopathology, Lady Reading Hospital, Peshawar, from December 2018 to August 2019. Fifty (50) specimens of small intestinal mucosal biopsies were examined in adult celiac disease patients over the age of 14 years. Modified Marsh Criteria were used to record their histomorphology data. Immunohistochemistry was used to determine the kind of intraepithelial lymphocytes. H&E staining and CD3 and CD20 immunostaining were used to count intraepithelial lymphocytes. Results: Seventin (34%) of patients were between the ages of 21 and 30 years, and 22% were between the ages of 41 and 50. Out of total 50 cases, males were 42 (84%). Thirteen (26%) of the cases had focal villous atrophy, 32 (64% of the cases) had partial villous atrophy, and 5 (10%) had total villous atrophy. Antibody to tissue transglutaminase was found to be positive in 21 (42%) of the patients. In all 50 cases, the CD3 immunomarker indicated intraepithelial lymphocytes, while the CD20 immunomarker showed localized positivity in lymphoid follicle development. On both H&E stain and immunostaining CD3 and CD20, the number of intraepithelial lymphocytes was determined to be nearly identical (with a difference of 3 - 4 lymphocytes). Conclusion: Males between the ages of 21 and 30 were the most affected. Partial villous atrophy and lymphocytic enteritis were the most common histological changes. All intraepithelial lymphocytes were distributed in a crescendo-like manner.