Prospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 28, 2015; 21(24): 7553-7557
Published online Jun 28, 2015. doi: 10.3748/wjg.v21.i24.7553
Immunohistochemical CD3 staining detects additional patients with celiac disease
Amani Mubarak, Victorien M Wolters, Roderick HJ Houwen, Fiebo JW ten Kate
Amani Mubarak, Victorien M Wolters, Roderick HJ Houwen, Department of Pediatric Gastroenterology, University Medical Center Utrecht, Wilhelmina Children’s Hospital, 3508 AB Utrecht, The Netherlands
Fiebo JW ten Kate, Department of Pathology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
Author contributions: Mubarak A designed the study, included the patients, and wrote the article; Wolters VM edited the manuscript; Houwen RHJ designed the study, edited the manuscript; ten Kate FJW designed the study, edited the manuscript, and evaluated the histology.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Amani Mubarak, MD, PhD, Department of Pediatric Gastroenterology, University Medical Center Utrecht, Wilhelmina Children’s Hospital, PO BOX 85090, 3508 AB Utrecht, The Netherlands. dr.amani.mubarak@gmail.com
Telephone: +31-887-555555 Fax: +31-887-555347
Received: September 9, 2014
Peer-review started: September 10, 2014
First decision: October 14, 2014
Revised: December 2, 2014
Accepted: January 8, 2015
Article in press: January 8, 2015
Published online: June 28, 2015
Processing time: 292 Days and 22.1 Hours
Abstract

AIM: To investigate whether performing immunohistochemical CD3 staining, in order to improve the detection of intra-epithelial lymphocytosis, has an additional value in the histological diagnosis of celiac disease.

METHODS: Biopsies obtained from 159 children were stained by hematoxylin and eosin (HE) and evaluated using the Marsh classification. CD3 staining was subsequently evaluated separately and independently.

RESULTS: Differences in evaluation between the routine HE sections and CD3 staining were present in 20 (12.6%) cases. In 10 (6.3%) patients the diagnosis of celiac disease (Marsh II and III) changed on examination of CD3 staining: in 9 cases, celiac disease had initially been missed on the HE sections, while 1 patient had been over-diagnosed on the routine sections. In all patients, the final diagnosis based on CD3 staining, was concordant with serological results, which was not found previously. In the other 10 (12.3%) patients, the detection of sole intra-epithelial lymphocytosis (Marsh I) improved. Nine patients were found to have Marsh I on CD3 sections, which had been missed on routine sections. Interestingly, the only patient with negative serology had Giardiasis. Finally, in 1 patient with negative serology, in whom Marsh I was suspected on HE sections, this diagnosis was withdrawn after evaluation of the CD3 sections.

CONCLUSION: Staining for CD3 has an additional value in the histological detection of celiac disease lesions, and CD3 staining should be performed when there is a discrepancy between serology and the diagnosis made on HE sections.

Keywords: Celiac disease; Diagnosis; Intra-epithelial lymphocytosis; Histology; Marsh classification; CD3 staining

Core tip: Intra-epithelial lymphocytosis is considered to be the most important histological finding in celiac disease and therefore provides the key to a correct diagnosis. However, when evaluating the number of intra-epithelial lymphocytes on hematoxylin and eosin stained sections, the lack of contrast between the cells might cause diagnostic difficulties. In this study, we showed that performing CD3 staining improves the histological diagnosis of celiac disease. In fact, this study demonstrated that CD3 staining should be performed when there is a discrepancy between serology and the histological evaluation on routine sections.