AbdullGaffar Badr, Farhan Rabiah
Pathology section, Dubai hospital, United Arab Emirates.
Histology unit, Dubai hospital, United Arab Emirates.
Ann Diagn Pathol. 2023 Jun;64:152133. doi: 10.1016/j.anndiagpath.2023.152133. Epub 2023 Mar 30.
Similar to celiac disease, inflammatory bowel disease frequently manifests in the duodenum. Histopathologic studies focused on mucosal alterations with little attention to submucosal Brunner glands. Recently, several studies have demonstrated overlapping features between Crohn's disease and celiac disease suggesting a putative link. However, histopathologic studies evaluating this possible link are limited, and those that are focused on Brunner glands are lacking. The present study aims to explore whether Crohn's disease and celiac disease display shared or overlapping inflammatory changes in Brunner glands. We performed a retrospective review study over 17-years retrieving duodenal biopsy specimens containing Brunner gland lobules in patients with Crohn's disease, celiac disease, and ulcerative colitis. We found 10 out of 126 duodenal biopsies (8 %) in patients with Crohn's disease and 6 out of 134 (4.5 %) duodenal biopsies in patients with celiac disease sharing inflammatory patterns in duodenal Brunner gland lobules. Both diseases showed interstitial intralobular and interlobular mixed chronic inflammation with variable fibrosis. Focally enhanced active inflammation of Brunner gland lobules was more characteristic of Crohn's disease. Intralobular epithelioid granulomas and multinucleated giant cells were specific to Crohn's disease. Ulcerative colitis patients did not show similar features. The interstitial focally enhanced chronic inflammatory pattern was significantly (p < 0.05) associated with both diseases, while the other inflammatory patterns were not (p > 0.05). This overlapping inflammatory pattern in Brunner glands in patients with Crohn's disease and celiac disease is supportive of the previously reported link between the two diseases. Pathologists should pay more attention to Brunner glands when evaluating duodenal biopsies. Further studies are warranted to validate these observations and their relevance in the pathogenesis of autoinflammatory gastrointestinal diseases.
与乳糜泻相似，炎症性肠病常累及十二指肠。组织病理学研究主要关注黏膜改变，而对黏膜下的布伦纳腺关注较少。最近，多项研究表明克罗恩病和乳糜泻存在重叠特征，提示可能存在某种联系。然而，评估这种可能联系的组织病理学研究有限，且专注于布伦纳腺的研究更是缺乏。本研究旨在探讨克罗恩病和乳糜泻在布伦纳腺中是否存在共同或重叠的炎症变化。我们进行了一项为期17年的回顾性研究，收集了克罗恩病、乳糜泻和溃疡性结肠炎患者含有布伦纳腺小叶的十二指肠活检标本。我们发现，126例克罗恩病患者的十二指肠活检标本中有10例（8%），134例乳糜泻患者的十二指肠活检标本中有6例（4.5%），其十二指肠布伦纳腺小叶存在共同的炎症模式。两种疾病均表现为小叶内和小叶间间质混合性慢性炎症，并伴有不同程度的纤维化。布伦纳腺小叶局部活动性炎症增强更具克罗恩病特征。小叶内上皮样肉芽肿和多核巨细胞是克罗恩病所特有的。溃疡性结肠炎患者未表现出类似特征。间质局部慢性炎症增强模式与两种疾病均显著相关（p<0.05），而其他炎症模式则不然（p>0.05）。克罗恩病和乳糜泻患者布伦纳腺中这种重叠的炎症模式支持了此前报道的两种疾病之间的联系。病理学家在评估十二指肠活检时应更多关注布伦纳腺。有必要进一步开展研究以验证这些观察结果及其在自身炎症性胃肠疾病发病机制中的相关性。
