Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States of America.
Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States of America.
Ann Diagn Pathol. 2024 Aug;71:152327. doi: 10.1016/j.anndiagpath.2024.152327. Epub 2024 May 11.
Characterize the clinicopathologic features of liver biopsies from patients with celiac disease (CD).
Single center, retrospective search for liver biopsies from patients with CD.
36 unique patients were included, median age of 46 years (range: 2-75), including 5 pediatric patients, with an overall female predominance (25, 69 %) but in in children a male predominance was seen (p = 0.023). Most cases (75 %) had an underlying condition including autoimmune hepatitis (AIH) (11 %), AIH/primary biliary cholangitis (PBC) overlap (3 %) and PBC (3 %). The median body mass index was 28, with 4 (11 %) underweight and 22 (61 %) overweight/obese patients. The most common histologic pattern was steatosis (18, 50 %), considered severe in 5 (14 %) and in 7 (19 %) regarded as steatohepatitis. The other histologic patterns included a nonspecific portal and/or lobular inflammation ("celiac hepatitis") in 9 cases (25 %), autoimmune hepatitis (3, 8 %), chronic cholestatic pattern (3, 8 %), chronic hepatitis (1, 3 %), acute lobular hepatitis (1, 3 %) and stablished cirrhosis (1, 3 %). Additionally, 2 of the cases with steatosis show cirrhosis.
The biopsy findings from patients with CD are heterogenous and in most represent a concomitant underlying disease, particularly metabolic dysfunction-associated steatotic liver disease. Additionally, CD injury should remain in the differential diagnosis in liver biopsies with a nonspecific portal and/or lobular inflammation.
描述乳糜泻患者肝活检的临床病理特征。
单中心、回顾性搜索乳糜泻患者的肝活检。
共纳入 36 例患者，中位年龄 46 岁（范围：2-75 岁），包括 5 例儿科患者，总体上以女性为主（25 例，69%），但在儿童中以男性为主（p=0.023）。大多数病例（75%）存在潜在疾病，包括自身免疫性肝炎（AIH）（11%）、AIH/原发性胆汁性胆管炎（PBC）重叠（3%）和 PBC（3%）。中位体重指数为 28，其中 4 例（11%）体重不足，22 例（61%）超重/肥胖。最常见的组织学模式是脂肪变性（18 例，50%），5 例（14%）认为严重，7 例（19%）认为是脂肪性肝炎。其他组织学模式包括 9 例非特异性门脉和/或肝小叶炎症（“乳糜泻性肝炎”）（25%）、自身免疫性肝炎（3 例，8%）、慢性胆汁淤积模式（3 例，8%）、慢性肝炎（1 例，3%）、急性肝小叶肝炎（1 例，3%）和肝硬化（1 例，3%）。此外，2 例脂肪变性病例伴有肝硬化。
乳糜泻患者的活检结果表现为异质性，在大多数情况下代表并存的潜在疾病，特别是代谢功能障碍相关的脂肪性肝病。此外，在具有非特异性门脉和/或肝小叶炎症的肝活检中，应将 CD 损伤保留在鉴别诊断中。
