All my biopsy results - help with interpretation?

[WendyM]

Kind of long - but here is the full report from my biopsies. I think I "get" most of it, but still wouldn't mind hearing your thoughts, as I know you are all much more experienced with these terms....

Thanks!

FINAL PATHOLOGIC DIAGNOSIS
1. Duodenum, endoscopic biopsy: Mild to moderate villous atrophy with
villous intraepithelial lymphocytes.
2. Gastric antrum, endoscopic biopsy: Antral mucosa with no significant
histopathology.
3. Terminal ileum, endoscopic biopsy: Small intestinal mucosa with no
significant histopathology.
4. Colon, random endoscopic biopsies: Mild lymphocytic colitis.




keg/3/5/2009
**Electronically Signed Out By**
Gary K. Ludwig, M.D.

______________________________________________________________________



CLINICAL HISTORY
PREOPERATIVE DIAGNOSIS: Diarrhea, celiac disease
OPERATIVE PROCEDURE: Esophagogastroduodenoscopy, colonoscopy
POSTOPERATIVE DIAGNOSIS: 1.) Rule out celiac 2.) Rule out H. pylori 3.) Rule
out Crohn' s, 4.) Rule out microscopic colitis


GROSS DESCRIPTION
1. DUODENAL BIOPSY COLD:
Specimen #1 received in formalin labeled with the patient's name and
"duodenal biopsy cold, rule out celiac" consists of three strips of tan soft
tissue ranging from 0.3 cm to 0.5 cm. The specimen is submitted in toto in
one cassette.

2. ANTRUM BIOPSY COLD:
Specimen #2 received in formalin labeled with the patient's name and "antrum
biopsy cold, rule out H. pylori" consists of two
0.4 cm strips of tan soft tissue. The specimen is submitted in toto in one
cassette.

3. TERMINAL ILEUM BIOPSY:
Specimen #3 received in formalin labeled with the patient's name and
"terminal ileum biopsy cold, rule out Crohn' s" consists of two 0.2 cm tan
soft tissue fragments. The specimen is submitted in toto in one cassette.

4. RANDOM COLON BIOPSIES:
Specimen #4 received in formalin labeled with the patient's name and "random
colon cold biopsies, rule out microscopic colitis" consists of six tan soft
tissue fragments averaging 0.2 cm. The specimen is submitted in toto in one
cassette.


keg/3/4/2009
Bill Racine, MHS



MICROSCOPIC DESCRIPTION
1. The endoscopic biopsies of the duodenum are small intestinal type mucosa.
There is a villous architecture, but there may be mild to moderate
shortening of the villi. An immunohistochemical stain for CD3 was prepared.
This immunostain demonstrates increased numbers of intraepithelial
lymphocytes within the surface epithelium covering the villi. This may be
evidence of gluten intolerance, or may be a nonspecific reactive change.

2. The endoscopic biopsy of the gastric antrum is portions of antral mucosa
in transition with body type mucosa. There is no significant inflammatory
cellular infiltrate. I do not detect the presence of any organisms
resembling Helicobacter pylori within this H&E stained preparation.

3. The endoscopic biopsy of the terminal ileum is portions of small
intestinal mucosa. There is a normal villous architecture where the planes
of sectioning are optimal. Reactive nodular lymphoid aggregates are within
the mucosa which is a normal finding. No significant histopathology is seen.

4. The random endoscopic biopsies of the colon are colonic mucosa with a
normal crypt architecture. There may be increased intraepithelial
lymphocytes within surface and crypt epithelium. An immunohistochemical
stain for CD3 was prepared. This immunostain demonstrates increased numbers
of intraepithelial lymphocytes within surface epithelium. Increased numbers
of intraepithelial lymphocytes are also evident within some crypt epithelium.
The findings are consistent with a mild lymphocytic (microscopic) colitis.


keg/3/5/2009
Gary K. Ludwig, M.D.

[tex]

Hi Wendy,

Looking at the entire report, and noting that the pathologist was only instructed to look for:

1: Evidence of celiac sprue in the three samples from the duodenum, (the upper third of the small intestine).

2: Evidence of H. pylori in the two samples from the lower portion of the stomach, (the gastric antrum).

3: Evidence of Crohn's disease in the two samples from the terminal ileum, (the lower end of the small intestine).

4: Evidence of Microscopic Colitis in the six samples from the colon.


Here's what the pathologist found, and my observations are included in parentheses:

1: Damage to the upper small intestinal villi is moderate, (there is no question that you have celiac disease, but your villi are not completely flattened, so you do not have a major malabsorption problem at this point. The increased numbers of intraepithelial lymphocytes within the surface epithelium covering the villi, (as mentioned in the MICROSCOPIC DESCRIPTION), implies that your small intestine shows the same type of inflammation pattern as your colon, which, IMO, is related to MC, not celiac disease).

2: No evidence of H. pylori in the lower portion of the stomach, (nor any other obvious pathogen).

3: No evidence of Crohn's disease in the lower portion of the small intestine, (nor any other obvious changes to the epithelia, or sub-epithelia in the terminal ileum).

4: A moderate increase in the number of intraepithelial lymphocytes, (some are always present, in a normal sample), suggests a mild case of LC, (I note that the pathologist did not do a complete job of searching for MC, since he did not check for thickened collagen deposits in the lamina propria, (or if he did, he failed to mention it in the report). If this is the case, then he failed to look for CC, though that is not a big issue, since the treatment is the same, regardless of the form of MC present).

The comment that I made in number 1:

your small intestine shows the same type of inflammation pattern as your colon, which, IMO, is related to MC, not celiac disease

amounts to a paradox, because by definition, MC cannot occur in the small intestine, (IOW, both the description and the name of microscopic colitis refers to the colon, only). IOW, IMO, MC is incorrectly described, and incorrectly named, because of this discrepancy, but I doubt that this error will ever be corrected in the medical journals. From a histopathology viewpoint, though, the inflammation is of the same type, so if it quacks like a duck, etc.

I hope this helps.

Tex

[WendyM]

Thanks for the information.... You *very* eloquently described what I am coming to understand in many fewer words. That is:
*Celiac Disease and Microcolitis are, in a sense, one in the same for me.
*One led to the other, but who knows what happened first.
*I definitely have Celiac, so I need to watch my children (4 year old will be screened at the next well child visit).

It's all fitting together. Like a puzzle.


Thanks for the help! This forum has been so informative for me!

[tex]

You're most welcome. I hope that this forum can provide the support and information that you need, to help you fine-tune your treatment program, so that you will soon be symptom-free, and you will be able to stay that way.

Tex