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Difficulty: EasyPathology and Biopsy Interpretation

A 32-year-old woman presents to the clinic for evaluation of a 6-month history of chronic diarrhea, abdominal bloating, and generalized fatigue. She reports that her symptoms are somewhat worse after eating pasta or bread. Vital signs are within normal limits. Laboratory studies are notable for a hemoglobin of 10.2 g/dL and a mean corpuscular volume (MCV) of 74 fL. Due to her persistent symptoms and laboratory abnormalities, an upper gastrointestinal endoscopy is performed. Biopsy specimens obtained from the second portion of the duodenum demonstrate marked villous blunting, crypt hyperplasia, and a prominent increase in intraepithelial lymphocytes. Based on these histopathologic findings, which of the following is the most likely diagnosis?

  1. Celiac diseaseAnswer
  2. B
    Crohn disease
  3. C
    Whipple disease
  4. D
    Giardiasis
  5. E
    Ulcerative colitis

Answer

Celiac disease
The correct answer is Celiac disease because the patient's duodenal biopsy reveals the pathognomonic histologic triad for this condition: villous atrophy (blunting), crypt hyperplasia, and increased intraepithelial lymphocytes. These findings, particularly in a patient presenting with classic symptoms of malabsorption (diarrhea, bloating, iron-deficiency anemia), firmly establish the diagnosis.

Step-by-Step Solution

1
Identify the patient's primary clinical syndrome.
The patient has chronic diarrhea, bloating, and microcytic anemia, which is highly suggestive of a malabsorption syndrome.
Establishing the clinical context helps narrow the differential diagnosis of gastrointestinal disorders.
2
Analyze the provided histopathologic biopsy results.
The duodenal biopsy shows villous blunting (atrophy), crypt hyperplasia, and increased intraepithelial lymphocytes.
Biopsy interpretation is the definitive step in distinguishing the various causes of malabsorption.
3
Correlate the histologic findings with the correct disease entity.
The combination of villous atrophy, crypt hyperplasia, and intraepithelial lymphocytosis is the hallmark diagnostic histologic triad for Celiac disease.
Matching pathognomonic histologic features to the disease ensures an accurate final diagnosis.

Key Concept

The diagnosis of Celiac disease is confirmed by duodenal biopsy demonstrating a classic histologic triad: villous atrophy, crypt hyperplasia, and increased intraepithelial lymphocytes.
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Topics

Pathology and Biopsy Interpretation

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