The Utility and Validation of Intraepithelial Lymphocyte Count in Duodenal Biopsies in A Tertiary Care Centre in South India

Priyavadhana Balasubramanian,Pazhanivel Mohan,Rajesh Nachiappa Ganesh,Lakshmi C Panicker,Bhawana Ashok Badhe

doi:10.21276/apalm.2511

Abstract

Background: Intraepithelial lymphocytes (IELs) are seen in between the epithelial cells in small and large intestine with the functions of immune surveillance and activation. Increased IELs can be the sole histological finding in latent celiac disease (CD). Aims: To study the utility and clinical relevance of IELs in diagnosing non-neoplastic lesions of duodenum and to determine a cut off for IEL to differentiate CD from other conditions. Materials & methods: This was a prospective descriptive study. Duodenal biopsies from 106 patients with symptoms of malabsorption were studied. Informed written consent was taken. Clinical details were collected. Histomorphological parameters were studied on hematoxylin and eosin stained sections. Intraepithelial lymphocyte counts were done on CD3, CD4 and CD8 IHC stained sections. Statistical analysis was done using IBM- SPSS software version 21. P value <0.05 was considered statistically significant. The threshold score of IELs with maximum sensitivity and specificity was validated using the Receiver operator characteristic curve to distinguish CD from non-celiac disease conditions. Results: We studied 101 duodenal biopsies. Our spectrum included 16 patients of CD (15.8%), 15 of autoimmune duodenitis (14%), 13 of nutritional deficiency associated duodenitis (12.8%), 5 of infectious duodenitis (5%) and 41 patients of non-specific duodenitis (40.6%). The threshold levels were 5/20 villous tip IELs, 24 IELs/100 enterocytes on H& E and >31 IELs by CD3 IHC staining. Conclusion: Our study proposes IEL counts of >31/100 enterocytes in CD3 IHC staining to be significant in South Indian population to differentiate CD from other conditions.

Highlights

Intraepithelial lymphocytes (IELs) are seen in between the epithelial cells in small and large intestine with the functions of immune surveillance and activation
Our study proposes IEL counts of >31/100 enterocytes in CD3 IHC staining to be significant in South Indian population to differentiate celiac disease (CD) from other conditions
All patients of CD had increased IEL counts in the range of 25-45 IEL per 100 enterocytes and mean IEL counts of 28.2±7.7

Summary

Introduction

Intraepithelial lymphocytes (IELs) are seen in between the epithelial cells in small and large intestine with the functions of immune surveillance and activation. Majority of them are T-cell type and express predominantly surface alpha/ beta T cell receptors. About 5% of the normal IELs express surface gamma/delta T-cell receptors which become the predominant population in celiac disease (CD). Increased IELs can be the sole histological finding in latent CD.[1]. Intraepithelial lymphocytes (IELs) are seen in between the epithelial cells in small and large intestine with the functions of immune surveillance and activation.Increased IELs can be the sole histological finding in latent celiac disease (CD)

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Discussion

Conclusion