Schaeffer David F, Walsh Joanna C, Tyler Andrea D, Ben-Bassat Ofer, Silverberg Mark S, Riddell Robert H, Kirsch Richard
Department of Laboratory Medicine and Pathology, Mount Sinai Hospital, Toronto, ON, Canada M5G 1X5; Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, BC V6T 2B5.
Department of Laboratory Medicine and Pathology, Mount Sinai Hospital, Toronto, ON, Canada M5G 1X5.
Hum Pathol. 2016 Aug;54:31-6. doi: 10.1016/j.humpath.2016.03.007. Epub 2016 Apr 8.
Following restorative proctocolectomy with an ileal pouch-anal anastomosis, the small bowel mucosa undergoes several specific histologic adaptions, which may be unrelated to the underlying disease or symptoms of pouchitis. An increase in intraepithelial lymphocytes (IELs) has not been described as part of this spectrum. Mucosal biopsies of the ileal pouch and afferent limb of 230 patients (mean age: 45.7y [18.3-74.7], gender [female/male]: 117/113) with a functioning ileal pouch-anal anastomosis (mean time since ileostomy closure: 10.8months) and associated clinically annotated outcome data were assessed for IELs/100 enterocytes. Forty-two patients (18.3%) showed an increase in IELs (≥20 IELs/100 enterocytes [range 20-39]), in pouch and/or afferent limb biopsies. Intraepithelial lymphocytosis was more commonly observed in afferent limb compared to pouch biopsies (18.8% vs 8.3%; P = .42) and in familial adenomatous polyposis compared to ulcerative colitis patients (16% vs 8%; P = 0.36), but neither difference reached statistical significance. No cases with increased IELs displayed severe villous blunting. Increased IELs were not significantly associated with age, sex, ethnicity, smoking history, time since ileostomy, use of antibiotics, biologic agents, anti-diarrheal agents or probiotics, C-reactive protein levels or differential white cell count. None of the 42 patients with increased IELs had positive celiac serology (anti-human tissue transglutaminase IgA [ELISA] with corresponding total serum IgA). Intraepithelial lymphocytosis in pouch biopsies may represent a subclinical response to an altered bacterial microenvironment. Pathologists should be aware that intraepithelial lymphocytosis is part of the spectrum of changes in pouch biopsies, and only rarely is due to celiac disease.
在进行回肠储袋肛管吻合术的恢复性直肠结肠切除术后，小肠黏膜会经历几种特定的组织学适应性变化，这些变化可能与潜在疾病或储袋炎症状无关。上皮内淋巴细胞（IELs）数量增加尚未被描述为这一系列变化的一部分。对230例（平均年龄：45.7岁[18.3 - 74.7岁]，性别[女性/男性]：117/113）行回肠储袋肛管吻合术且功能良好（回肠造口关闭后的平均时间：10.8个月）的患者的回肠储袋和输入袢进行黏膜活检，并评估其IELs/100个肠上皮细胞，同时收集相关的临床注释结局数据。42例患者（18.3%）在储袋和/或输入袢活检中显示IELs增加（≥20个IELs/100个肠上皮细胞[范围20 - 39]）。与储袋活检相比，输入袢中更常观察到上皮内淋巴细胞增多（18.8%对8.3%；P = 0.42），与溃疡性结肠炎患者相比，家族性腺瘤性息肉病患者中更常见（16%对8%；P = 0.36），但两者差异均未达到统计学意义。没有IELs增加的病例出现严重的绒毛变钝。IELs增加与年龄、性别、种族、吸烟史、回肠造口术后时间、抗生素使用、生物制剂、止泻药或益生菌、C反应蛋白水平或白细胞分类计数均无显著相关性。42例IELs增加的患者中，无一例乳糜泻血清学检查呈阳性（抗人组织转谷氨酰胺酶IgA[酶联免疫吸附测定法]及相应的总血清IgA）。储袋活检中的上皮内淋巴细胞增多可能代表对改变的细菌微环境的亚临床反应。病理学家应意识到上皮内淋巴细胞增多是储袋活检变化谱的一部分，且很少由乳糜泻引起。
