Skip to main content
PMC home page
Journal of Clinical Pathology logoLink to Journal of Clinical Pathology
. 1982 May;35(5):517–525. doi: 10.1136/jcp.35.5.517

Studies of intestinal lymphoid tissue. IV--The predictive value of raised mitotic indices among jejunal epithelial lymphocytes in the diagnosis of gluten-sensitive enteropathy.

M N Marsh
PMCID: PMC497709  PMID: 7085895

Abstract

It has been established that considerable blast-transformation and mitotic activity occurs among epithelial lymphocytes of untreated coeliac mucosa. This paper is concerned solely with the proliferative activity of epithelial lymphocytes (expressed as percentage "mitotic index") in the prospective diagnosis of coeliac disease, in comparison with other conditions such as lymphoma. Crohn's disease and immunodeficiency which are often associated with malabsorption and flattening of jejunal mucosa. The results demonstrate that a high mitotic index (greater than 0.2%) clearly distinguishes, and hence predicts, gluten-associated enteropathies (including dermatitis herpetiformis and malignant histiocytosis) from others in which gluten plays no aetiological role and where the mitotic index differs insignificantly from normal control mucosae (much less than 0.2%). Furthermore, it has been demonstrated that the mitotic index is raised in so-called "non-responsive coeliacs," thus suggesting that such patients may also be gluten-sensitive despite their subsequent failure to respond morphologically to dietary gluten restriction.

Full text

PDF
523

Images in this article

521Image
on p.521
521Image
on p.521

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. A case of adult coeliac disease resistant to treatment. Br Med J. 1968 Jun 15;2(5606):678–684. doi: 10.1136/bmj.2.5606.678. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. ANDERSON C. M. Histological changes in the duodenal mucosa in coeliac disease. Reversibility during treatment with a wheat gluten free diet. Arch Dis Child. 1960 Oct;35:419–427. doi: 10.1136/adc.35.183.419. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Ament M. E., Rubin C. E. Relation of giardiasis to abnormal intestinal structure and function in gastrointestinal immunodeficiency syndromes. Gastroenterology. 1972 Feb;62(2):216–226. [PubMed] [Google Scholar]
  4. Ament M. E., Rubin C. E. Soy protein--another cause of the flat intestinal lesion. Gastroenterology. 1972 Feb;62(2):227–234. [PubMed] [Google Scholar]
  5. Austad W. I., Cornes J. S., Gough K. R., McCarthy C. F., Read A. E. Steatorrhea and malignant lymphoma. The relationship of malignant tumors of lymphoid tissue and celiac disease. Am J Dig Dis. 1967 May;12(5):475–490. doi: 10.1007/BF02233180. [DOI] [PubMed] [Google Scholar]
  6. Baker A. L., Rosenberg I. H. Refractory sprue: recovery after removal of nongluten dietary proteins. Ann Intern Med. 1978 Oct;89(4):505–508. doi: 10.7326/0003-4819-89-4-505. [DOI] [PubMed] [Google Scholar]
  7. Barry R. E., Morris J. S., Read A. E. A case of small-intestinal mucosal atrophy. Gut. 1970 Sep;11(9):743–747. doi: 10.1136/gut.11.9.743. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Booth C. C. The enterocyte in coeliac disease. Br Med J. 1970 Oct 3;4(5726):14–17. doi: 10.1136/bmj.4.5726.14. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. CAMERON A. H., ASTLEY R., HALLOWELL M., RAWSON A. B., MILLER C. G., FRENCH J. M., HUBBLE D. V. Duodeno-jejunal biopsy in the investigation of children with coeliac disease. Q J Med. 1962 Jan;31:125–140. [PubMed] [Google Scholar]
  10. Cooke W. T., Asquith P. Coeliac disease. Introduction and definition. Clin Gastroenterol. 1974 Jan;3(1):3–10. [PubMed] [Google Scholar]
  11. Doe W. F., Evans D., Hobbs J. R., Booth C. C. Coeliac disease, vasculitis, and cryoglobulinaemia. Gut. 1972 Feb;13(2):112–123. doi: 10.1136/gut.13.2.112. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. GOUGH K. R., READ A. E., NAISH J. M. Intestinal reticulosis as a complication of idiopathic steatorrhoea. Gut. 1962 Sep;3:232–239. doi: 10.1136/gut.3.3.232. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Hermans P. E., Diaz-Buxo J. A., Stobo J. D. Idiopathic late-onset immunoglobulin deficiency. Clinical observations in 50 patients. Am J Med. 1976 Aug;61(2):221–237. doi: 10.1016/0002-9343(76)90173-x. [DOI] [PubMed] [Google Scholar]
  14. Hodges J. R., Isaacson P., Smith C. L., Sworn M. J. Malignant histiocytosis of the intestine. Dig Dis Sci. 1979 Aug;24(8):631–638. doi: 10.1007/BF01333708. [DOI] [PubMed] [Google Scholar]
  15. Isaacson P., Wright D. H. Malignant histiocytosis of the intestine. Its relationship to malabsorption and ulcerative jejunitis. Hum Pathol. 1978 Nov;9(6):661–677. doi: 10.1016/s0046-8177(78)80049-5. [DOI] [PubMed] [Google Scholar]
  16. Johnson R. L., VanArsdel P. P., Jr, Tobe A. D., Ching Y. Adult hypogammaglobulinemia with malabsorption and iron deficiency anemia. Am J Med. 1967 Dec;43(6):935–943. doi: 10.1016/0002-9343(67)90252-5. [DOI] [PubMed] [Google Scholar]
  17. Marsh M. N. Studies of intestinal lymphoid tissue. I. Electron microscopic evidence of 'blast transformation' in epithelial lymphocytes of mouse small intestinal mucosa. Gut. 1975 Sep;16(9):665–674. doi: 10.1136/gut.16.9.665. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Marsh M. N. Studies of intestinal lymphoid tissue. II. Aspects of proliferation and migration of epithelial lymphocytes in the small intestine of mice. Gut. 1975 Sep;16(9):674–682. doi: 10.1136/gut.16.9.674. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Marsh M. N. Studies of intestinal lymphoid tissue. III. Quantitative analyses of epithelial lymphocytes in the small intestine of human control subjects and of patients with celiac sprue. Gastroenterology. 1980 Sep;79(3):481–492. [PubMed] [Google Scholar]
  20. Marsh M. N. Studies of intestinal lymphoid tissue: the cytology and electron microscopy of gluten-sensitive enteropathy, with particular reference to its immunopathology. Scand J Gastroenterol Suppl. 1981;70:87–106. [PubMed] [Google Scholar]
  21. Marsh M. N. The small intestine: mechanisms of local immunity and gluten sensitivity. Clin Sci (Lond) 1981 Nov;61(5):497–503. doi: 10.1042/cs0610497. [DOI] [PubMed] [Google Scholar]
  22. Non-responsive coeliac disease. Br Med J. 1972 Sep 9;3(5827):624–631. [PMC free article] [PubMed] [Google Scholar]
  23. Novis B. H., Bank S., Marks I. N., Selzer G., Kahn L., Sealy R. Abdominal lymphoma presenting with malabsorption. Q J Med. 1971 Oct;40(160):521–540. [PubMed] [Google Scholar]
  24. Pink I. J., Creamer B. Response to a gluten-free diet of patients with the coeliac syndrome. Lancet. 1967 Feb 11;1(7485):300–304. doi: 10.1016/s0140-6736(67)91238-x. [DOI] [PubMed] [Google Scholar]
  25. Pittman F. E., Tripathy K., Isobe T., Bolaños O. M., Osserman E. F., Pittman J. C., Lotero H. R., Duque E. E. IgA heavy chain disease. A case detected in the western hemisphere. Am J Med. 1975 Mar;58(3):424–430. doi: 10.1016/0002-9343(75)90609-9. [DOI] [PubMed] [Google Scholar]
  26. RUBIN C. E., BRANDBORG L. L., PHELPS P. C., TAYLOR H. C., Jr Studies of celiac disease. I. The apparent identical and specific nature of the duodenal and proximal jejunal lesion in celiac disease and idiopathic sprue. Gastroenterology. 1960 Jan;38:28–49. [PubMed] [Google Scholar]
  27. SHINER M., DONIACH I. Histopathologic studies in steatorrhea. Gastroenterology. 1960 Mar;38:419–440. [PubMed] [Google Scholar]
  28. TRUMP B. F., SMUCKLER E. A., BENDITT E. P. A method for staining epoxy sections for light microscopy. J Ultrastruct Res. 1961 Aug;5:343–348. doi: 10.1016/s0022-5320(61)80011-7. [DOI] [PubMed] [Google Scholar]
  29. WILLIAMS E. I. Hodgkin's disease arising primarily in the jejunum. Br Med J. 1962 Jan 20;1(5272):158–158. doi: 10.1136/bmj.1.5272.158. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Watson A. J., Wright N. A. Coeliac disease. Morphology and cell kinetics of the jejunal mucosa in untreated patients. Clin Gastroenterol. 1974 Jan;3(1):11–31. [PubMed] [Google Scholar]
  31. Webster A. D., Slavin G., Shiner M., Platts-Mills T. A., Asherson G. L. Coeliac disease with severe hypogammaglobulinaemia. Gut. 1981 Feb;22(2):153–157. doi: 10.1136/gut.22.2.153. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Whitehead R. Primary lymphadenopathy complicating idiopathic steatorrhoea. Gut. 1968 Oct;9(5):569–575. doi: 10.1136/gut.9.5.569. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Williams S. E. An unusual inflammatory lesion of the jejunum in a patient with late onset immunoglobulin deficiency. Postgrad Med J. 1980 Feb;56(652):128–132. doi: 10.1136/pgmj.56.652.128. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Journal of Clinical Pathology are provided here courtesy of BMJ Publishing Group

RESOURCES