Get email alerts Get Celiac.com E-mail Alerts  




Celiac.com Sponsor:
Celiac.com Sponsor:




Ads by Google:






   Get email alerts  Subscribe to FREE Celiac.com email alerts

Biopsy Results-Celiac &/or Lymphoma
0

12 posts in this topic

Hello, my husband has been sick for 2 yrs with extreme fatigue, weight loss, nausea, abd pain, diarrhea and constipation. Had a colonoscopy and EGD 6 weeks ago and we got the biopsy results yesterday. GI doc said he was puzzled and needed to consult with "someone smarter than me". Is sending slides to Mayo Clinic. I have a copy of the pathology report and have spent many, many hours researching every word of it...appears to be pointing to celiac disease that may have already progressed to lymphoma...wanted to get the opinion of others who have been down this road before. Here is what the path report says (kind of long, sorry!):

"Diagnosis: small bowel bx-lymphocytic enteritis with partial loss of villi. Stomach-lymphocytic gastritis, no h-pylori. Esophagus-squamous mucosa with changes of reflux. Cecum-colonic mucosa with non-specific changes of mild injury and non-specific lamina propria. Trans colon-colonic mucosa with non-specific changes of mild injury and non-specific lamina propria. Sigmoid colon- colonic mucosa with non-specific changes of mild injury and non-specific lamina propria hemorrhage, no submucosa. Rectum-colonic mucosa with non-specific changes of mild injury and non-specific lamina propria hemorrhage, no submucosa. Microscopic description: Small bowel-Villi, some with loss of height and flattening, bear excess intraepithelial lymphocytes, CD3 positive, over 40 per 100 enterocytes. In stroma strew lymphocytes and plasma cells, some about non-dilated lymphatics. Stomach-Sydney score: Antrum/Fundus. Foveolar hyperplasia: none. Neutrophils: none. Mononuclear cells: Moderate. Atrophy:none. Extravasated erythrocytes:none. Increased epithelial cellularity requiring CD3 stain: Present. Dilated pits:none. Stains with good control: PAS AB-no signet ring cells or intestinal metaplasia; IHC for h-pylori-no organisms; IHC for CD3-increased intraepithelial lymphocytes. Esophagus-squamous epithelium with basal layer hyperplasia, papillary thickening, rare intraepithelial eosinophils and balloon cells tops stroma strewn with chronic inflammitory cells. Cecum- a wavy luminal border lacking its usual mucin tops focally edematous mucosa with focal pooling of extravasated erythrocytes and lymphoid aggregates in lamina propria. Lacking are other inflammatory and neoplastic changes and submucosa. Transverse colon- a wavy luminal border lacking its usual mucin tops focally edematous mucosa with focal pooling of extravasated erythrocytes and lymphoid aggregates in lamina propria. Lacking are other inflammatory and neoplastic changes and submucosa. Sigmoid colon-a wavy luminal border lacking its usual mucin tops focally edematous mucosa with focal pooling of extravasated erythrocytes and lymphoid aggregates in lamina propria. Lacking are other inflammatory and neoplastic changes and submucosa. Rectum- a wavy, partly avulsed luminal border lacking its usual mucin tops edematous mucosa with focal pooling of extravasated erythrocytes and lymphoid aggregates in lamina propria. Lacking are other inflammatory and neoplastic changes and submucosa."

So....any thoughts? What does all this mean? Is this a typical biopsy for celiacs or are we probably looking at something else?

Thank you for your input!

0

Share this post


Link to post
Share on other sites


Ads by Google:

What is it about the report that makes you think that it's already progressed to Lymphoma?

I have yet to have my biopsy, but I am a medical professional (not a doctor). I am used to reading reports, and based on the overall diagnosis listed, it sounds like inflammed bowel with signs of celiac to me. "Lymphocytic enteritis" is an inflammation of the bowel, and from what I understand the damage to the villi is a sign of Celiac.

There is alot of verbage there that discribes in detail what is seen, and most of it is just a standard form of text that is used to make writing reports easier. The important things are typically listed in the diagnosis or impression sections of a report, in my experiance.

It will be interesting to see what the Mayo guys say. Good luck!

0

Share this post


Link to post
Share on other sites

Please copy and paste which part suggests your husband has lymphoma. The only places I see the prefix "lymph" is when speaking of lymphocytes.

0

Share this post


Link to post
Share on other sites

What is it about the report that makes you think that it's already progressed to Lymphoma?

I have yet to have my biopsy, but I am a medical professional (not a doctor). I am used to reading reports, and based on the overall diagnosis listed, it sounds like inflammed bowel with signs of celiac to me. "Lymphocytic enteritis" is an inflammation of the bowel, and from what I understand the damage to the villi is a sign of Celiac.

There is alot of verbage there that discribes in detail what is seen, and most of it is just a standard form of text that is used to make writing reports easier. The important things are typically listed in the diagnosis or impression sections of a report, in my experiance.

It will be interesting to see what the Mayo guys say. Good luck!

What made me think possible NHL was the lack of submucosa combined with lymphoid aggregates in the lamina propria. I forgot to include the pathologist's comments from the report:

"Changes in the small bowel specimen may represent Marsh type II sprue, but other etiologies can exhibit increased intraepithelial lymphocytes in the small bowel, including infections (Giardia, Helicobacter, Cryptosporidium, viruses), food allergy, drug reactions and immune system abnormalities; artifactual focal villous flattening can occur. Correlation with serologic findings is important."

0

Share this post


Link to post
Share on other sites

Also the part about "lacking its usual mucin tops focally edematous mucosa with focal pooling of extravasated erythrocytes and lymphoid aggregates in the lamina propria"...

When we talked to the GI doc, he mentioned lymphoma as one of the many possible diagnoses and said that the biopsy was not "cut and dry" for celiac disease...

So, what parts of the pathology results are not typically seen with celiacs and which parts are??? I'm so confused and worried!

0

Share this post


Link to post
Share on other sites




Lymphoma is a cancer of the blood and lymphatics system.

Lymphoid aggregates in the lamina could be read in layman's terms,

Forget it. lymphoid aggregates are common and need no treatment. I see nothing that makes me suspect lymphoma.

0

Share this post


Link to post
Share on other sites

I am certainly not a doctor and do not understand the findings; however, the pathologist suggested several other causes for the findings, none of which mention lymphoma. He said that correlation with serologic findings was important. Did your GI suggest doing the celiac blood panel for celiac correlation?

0

Share this post


Link to post
Share on other sites

Lymphoma is a cancer of the blood and lymphatics system.

Lymphoid aggregates in the lamina could be read in layman's terms,

Forget it. lymphoid aggregates are common and need no treatment. I see nothing that makes me suspect lymphoma.

MALT Lymphoma of the colon and intestinal lymphoma were the types that my research pointed to and they have pathology results very similar to what my husbands showed AND the GI dr mentioned intestinal lymphoma yesterday as a possible diagnosis...

0

Share this post


Link to post
Share on other sites

I am certainly not a doctor and do not understand the findings; however, the pathologist suggested several other causes for the findings, none of which mention lymphoma. He said that correlation with serologic findings was important. Did your GI suggest doing the celiac blood panel for celiac correlation?

The GI dr did not suggest any further testing at this time...we are to call him back towards the end of next week, after he has had the chance to talk to the people at the Mayo Clinic.

0

Share this post


Link to post
Share on other sites

The GI dr did not suggest any further testing at this time...we are to call him back towards the end of next week, after he has had the chance to talk to the people at the Mayo Clinic.

Call the doc and tell him you want a celiac panel done if it hasn't been done already. The doctor works for you and with the Marsh scale being mentioned in the report he should have already done it. I am not a doctor but from what I have seen on scope reports it looks much more likely that what you are dealing with is celiac not lymphoma. It is good that he is consulting with other doctors on this as yours may not be all that familiar with the findings of celiac.

0

Share this post


Link to post
Share on other sites

Here is what the report is talking about, note it said more than 40 IEL per 100

http://www.thefooddoc.com/celiac_biopsies_photos

"Lymphocytes are a type of white blood cell important in immune function. The typically appear as purplish circles on standard H&E type stain of intestinal tissue obtained from biopsy.

· Specialized lymphocytes are present in the intestine lining.

· The intestinal lining cells are called enterocytes and are a type of epithelial cell.

· The intestinal lining is an epithelial lining.

· Lymphocytes that are activated and migrated up from crypts at the base of the intestine villi to the tip are called intra-epithelial lymphocytes.

· Normally, there are much fewer than 25-30 lymphocytes per 100 enterocytes in each villous or < 9 per villous tip.

· For thirty years, more than 40 IEL’s/100 enterocytes was considered abnormal and diagnostic of Celiac in the context of appropriate history and abnormal celiac blood tests. It is the number still used by many pathologists.

· More recently, 30 intra-epithelial lymphocytes per 100 enterocytes (6 or more IEL’s per 20 enterocytes) became the accepted criteria for intra-epithelial lymphocytosis and diagnosis of Celiac disease when villous blunting or atrophy are absent but blood tests are positive.

· IEL’s are easier to see and count with special immune chemistry stains.

· See the special stain photograph above showing increase IEL’s in a villous tip in Celiac disease. The IEL’s are brownish red with this particular stain whereas normal intestinal cell nuclei are purplish.

· Sometimes this stain is necessary to determine IEL’s from normal intestinal nuclei and better determine the number, especially if someone has already restricted gluten in their diet.

Studies have shown that apparently normal appearing small intestine biopsies when stained with special stains for IEL’s reveal abnormal numbers as the earliest sign of gluten injury, especially in high risk individuals like family members of people with Celiac disease"

and more here:

http://www.thefooddoc.blogspot.com/

note there is something about eosinophils too.

There have been several reports of ee together with celiac here.

0

Share this post


Link to post
Share on other sites

I am not a doctor either but it sure sounds to me like the report suggests celiac and not lymphoma. If you google some of the terms they used it might help explain. Like lamina propria or muscosa and neoplasmatic. The report said no nespasmatic signs so that is good, as the nesplasma is a :

Neoplasm is an abnormal mass of tissue as a result of neoplasia. Neoplasia ("new growth" in Greek) is the abnormal proliferation of cells. The report said no neoplasma and that is good.

Neoplasm

The Marsh scale is used to evaluate the amount of damage to villi in the intestine. Damage to the villi is associated with celiac disease.

0

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!


Register a new account

Sign in

Already have an account? Sign in here.


Sign In Now
0

  • Forum Statistics

    • Total Topics
      104,684
    • Total Posts
      921,741
  • Posts

    • Hello, I have frequent canker sores (roughly comes back every couple of months). Some blood test results are as following. Component Your Value Standard Range TISSUE TRANSGLUTAMINASE IgG 0.31 Index <=0.90 Index Tissue transglutaminase IgA 0.96 Index <=0.90 Index My doctor said that result is unspecific, and I unlikely have celiac disease, since I do not have other abdominal symptoms. For reference, I do have frequent constipation, excessive gas, frequent canker sore, etc. Do you think an upper endoscopy is recommended? I am a little hesitate considering the risk of this procedure and the fact that my symptoms are not that bad. I appreciate all suggestions.  
    • Hello, I see you posted this a long while ago, and perhaps--I hope-- it's no longer a matter of concern, but I thought I'd mention that shortly before I was diagnosed for celiac's, I had distinct yellow blotches on the corners of my eyelids toward my nose. Some months after I had stopped eating gluten, the yellow gradually went away, and--as it just reappeared now several years later, I googled the issue again.  I am only speculating here, but I do believe it is related to liver problems, which, in turn, are related to celiac's. I don't think liver function tests cover all aspects of liver health. I say this because when I was pregnant I developed a temporary liver condition called interhepatic colestasis of pregnancy (ICP), but my liver function tests had been fine. (The condition is diagnosed based on bile levels in the blood, not on liver function). I discovered upon some research that (of course!) ICP  can be associated with celiac's disease.  My hunch is this-- that celiac's presents two problems to the liver: 1) the malabsorption of nutrients--esp. Vit. K2-- that are vital liver health; 2) since gluten registers as a toxin to the immune system (I think?), perhaps the liver gets overloaded processing so much toxic material. Or perhaps there's some other reason. At any rate, poor liver health and celiac's do seem to be linked, according to a few articles I've found. Anyway, hope your problems are resolved now.  
    • my daughter did stool test from enterolab but this gluten sensitive blood test is from http://requestatest.com/tests/search    
    • OK, was your daughter tested by a doctor or did you do one of these order online stool tests? And the same question goes for your tests. Can you give a link to the company?
    • NO. Approx. 1/3 of the population carries the genes for celiac but that does NOT mean they will ever present with celiac. Only a small percentage of them will. A gene test is really used more to rule out celiac rather than to diagnose it. What I meant was that since your daughter is diagnosed and IF you carry one or both of the celiac genes then there is a greater chance you are celiac or "early stages" especially in light of your symptoms. All 3 of those factors weighed together was what I was referring to.
  • Upcoming Events

  • Blog Entries

  • Recent Status Updates

  • Who's Online (See full list)

  • Member Statistics

    • Total Members
      61,685
    • Most Online
      3,093

    Newest Member
    jhc
    Joined