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Histopathological Assessment of Celiac Disease

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Advances in Celiac Disease

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Abstract

Celiac Disease (CD) is an immune-mediated inflammatory disorder of the small intestine, affecting genetically susceptible individuals when exposed to gluten. Small intestinal biopsy interpretation has been the gold standard for the diagnosis of celiac disease (CD) for over 50 years. Despite today’s availability of sensitive and specific serological diagnostic tests, the histopathological features from mucosal biopsy continue to play a key role in the diagnostic approach when CD is suspected. Such a diagnostic approach requires a multidisciplinary team to optimize both tissue sampling and diagnostic interpretation, as long as interaction between the pathologist and the gastroenterologist is expected. The correct methodological approach, the morphological characteristics of CD, its complications and differential diagnosis have been discussed with attention also to a new entity as Non Celiac Gluten Sensitivity (NCGS). Moreover the use of anti-CD3 and anti-CD8 stains are recommended in patients not responding to the gluten -free diet (GFD), in order to confirm a diagnosis of Refractory Celiac Disease (RCD).

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References

  1. Robert ME, Crowe SE, Burgart L, Yantiss RK, Lebwohl B, Greenson JK, et al. Statement on best practices in the use of pathology as a diagnostic tool for celiac disease. Am J Surg Pathol. 2018;42:e44–58. https://doi.org/10.1097/pas.0000000000001107.

    Article  PubMed  Google Scholar 

  2. Lindfors K, Ciacci C, Kurppa K, Lundin KE, Makharia GK, Mearin ML, et al. Coeliac disease. Nat Rev Dis Prim. 2019;5:1–18. https://doi.org/10.1038/s41572-018-0054-z.

    Article  Google Scholar 

  3. Caio G, Volta U, Sapone A, Leffler DA, De Giorgio R, Catassi C, et al. Coeliac disease: a comprehensive current review. BMC Med. 2019;17:142. https://doi.org/10.1186/s12916-019-1380-z.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  4. Ludvigsson JF, Rubio-Tapia A, van Dyke CT, Melton JL, Zinsmeister AR, Lahr BD, et al. Increasing incidence of coeliac disease in a North American population. Am J Gastroenterol. 2013;108:818–24. https://doi.org/10.1038/ajg.2013.60.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Mustalahti K, Catassi C, Reunanen A, Fabiani E, Heier M, McMillan S, et al. The prevalence of coeliac disease in Europe: results of a centralized, international mass screening project. Ann Med. 2010;42:587–95. https://doi.org/10.3109/07853890.2010.505931.

    Article  PubMed  Google Scholar 

  6. Sanders DS, Patel D, Stephenson TJ, Ward AM, McCloskey EV, Hadjivassiliou M, et al. A primary care cross-sectional study of undiagnosed adult coeliac disease. Eur J Gastroenterol Hepatol. 2003;15:407–13. https://doi.org/10.1097/00042737-200304000-00012.

    Article  PubMed  CAS  Google Scholar 

  7. Sanders DS, Hurlstone DP, Stokes RO, Rashid F, Milford-Ward A, Hadjivassiliou M, et al. Changing face of adult coeliac disease: experience of a single university hospital in South Yorkshire. Postgrad Med J. 2002;78:31–3. https://doi.org/10.1136/pmj.78.915.31.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  8. West J, Fleming KM, Tata LJ, Card TR, Crooks CJ. Incidence and prevalence of celiac disease and dermatitis herpetiformis in the UK over two decades: population-based study. Am J Gastroenterol. 2014;109:757–68. https://doi.org/10.1038/ajg.2014.55.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lo W, Sano K, Lebwohl B, Diamond B, Green PHR. Changing presentation of adult celiac disease. Dig Dis Sci. 2003;48:395–8. https://doi.org/10.1023/a:1021956200382.

    Article  PubMed  Google Scholar 

  10. Husby S, Murray JA, Katzka DA. AGA clinical practice update on diagnosis and monitoring of celiac disease—changing utility of serology and histologic measures: expert review. Gastroenterology. 2019;156:885–9. https://doi.org/10.1053/j.gastro.2018.12.010.

    Article  PubMed  Google Scholar 

  11. Rubio-Tapia A, Hill ID, Kelly CP, Calderwood AH, Murray JA. ACG clinical guidelines: diagnosis and management of celiac disease. Am J Gastroenterol. 2013;108:656–76. https://doi.org/10.1038/ajg.2013.79.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  12. Husby S, Koletzko S, Korponay-Szabó IR, Mearin ML, Phillips A, Shamir R, et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr. 2012;54:136–60. https://doi.org/10.1097/mpg.0b013e31821a23d0.

    Article  PubMed  CAS  Google Scholar 

  13. Hill ID, Dirks MH, Liptak GS, Colletti RB, Fasano A, Guandalini S, et al. Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2005;40:1–19. https://doi.org/10.1097/00005176-200501000-00001.

    Article  PubMed  Google Scholar 

  14. Serra S, Jani PA. An approach to duodenal biopsies. J Clin Pathol. 2006;59:1133–50. https://doi.org/10.1136/jcp.2005.031260.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  15. Pais WP, Duerksen DR, Pettigrew NM, Bernstein CN. How many duodenal biopsy specimens are required to make a diagnosis of celiac disease? Gastrointest Endosc. 2008;67:1082–7. https://doi.org/10.1016/j.gie.2007.10.015.

    Article  PubMed  Google Scholar 

  16. Latorre M, Lagana SM, Freedberg DE, Lewis SK, Lebwohl B, Bhagat G, et al. Endoscopic biopsy technique in the diagnosis of celiac disease: one bite or two? Gastrointest Endosc. 2015;81:1228–33. https://doi.org/10.1016/j.gie.2014.10.024.

    Article  PubMed  Google Scholar 

  17. Bonamico M, Thanasi E, Mariani P, Nenna R, Luparia RP, Barbera C, et al. Duodenal bulb biopsies in celiac disease: a multicenter study. J Pediatr Gastroenterol Nutr. 2008;47:618–22. https://doi.org/10.1097/mpg.0b013e3181677d6e.

    Article  PubMed  Google Scholar 

  18. Evans KE, Aziz I, Cross SS, Sahota GR, Hopper AD, Hadjivassiliou M, et al. A prospective study of duodenal bulb biopsy in newly diagnosed and established adult celiac disease. Am J Gastroenterol. 2011;106:1837–2742. https://doi.org/10.1038/ajg.2011.171.

    Article  PubMed  Google Scholar 

  19. Gonzalez S, Gupta A, Cheng J, Tennyson C, Lewis SK, Bhagat G, et al. Prospective study of the role of duodenal bulb biopsies in the diagnosis of celiac disease. Gastrointest Endosc. 2010;72:758–65. https://doi.org/10.1016/j.gie.2010.06.026.

    Article  PubMed  Google Scholar 

  20. De Leo L, Villanacci V, Ziberna F, Vatta S, Martelossi S, Di Leo G, et al. Immunohistologic analysis of the duodenal bulb: a new method for celiac disease diagnosis in children. Gastrointest Endosc. 2018;88:521–6. https://doi.org/10.1016/j.gie.2018.05.014.

    Article  PubMed  Google Scholar 

  21. Villanacci V, Ceppa P, Tavani E, Vindigni C, Volta U, Gruppo Italiano Patologi Apparato Digerente (GIPAD), et al. Coeliac disease: the histology report. Dig Liver Dis. 2011;43 Suppl 4:S385–95. https://doi.org/10.1016/S1590-8658(11)60594-X.

  22. Hayat M, Cairns A, Dixon M, O’Mahony S. Quantitation of intraepithelial lymphocytes in human duodenum: what is normal? J Clin Pathol. 2002;55:393–4. https://doi.org/10.1136/jcp.55.5.393.

  23. Veress B, Franzén L, Bodin L, Borch K. Duodenal intraepithelial lymphocyte-count revisited. Scand J Gastroenterol. 2004;39:138–44. https://doi.org/10.1080/00365520310007675.

    Article  PubMed  CAS  Google Scholar 

  24. Marsh MN. Grains of truth: evolutionary changes in small intestinal mucosa in response to environmental antigen challenge. Gut. 1990;31:111–4. https://doi.org/10.1136/gut.31.1.111.

  25. Oberhuber G, Granditsch G, Vogelsang H. The histopathology of coeliac disease: time for a standardized report scheme for pathologists. Eur J Gastroenterol Hepatol. 1999;11:1185–94. https://doi.org/10.1097/00042737-199910000-00019.

    Article  PubMed  CAS  Google Scholar 

  26. Corazza GR, Villanacci V. Coeliac disease. J Clin Pathol. 2005;58:573–4. https://doi.org/10.1136/jcp.2004.023978.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  27. Corazza GR, Villanacci V, Zambelli C, Milione M, Luinetti O, Vindigni C, et al. Comparison of the interobserver reproducibility with different histologic criteria used in celiac disease. Clin Gastroenterol Hepatol. 2007;5:838–43. https://doi.org/10.1016/j.cgh.2007.03.019.

    Article  PubMed  Google Scholar 

  28. Villanacci V. The histological classification of biopsy in celiac disease: time for a change? Dig Liver Dis. 2015;47:2–3. https://doi.org/10.1016/j.dld.2014.09.022.

    Article  PubMed  Google Scholar 

  29. Shidrawi RG, Przemioslo R, Davies DR, Tighe MR, Ciclitira PJ. Pitfalls in diagnosing coeliac disease. J Clin Pathol. 1994;47:693–4. https://doi.org/10.1136/jcp.47.8.693.

  30. Eigner W, Wrba F, Chott A, Bashir K, Primas C, Eser A, et al. Early recognition of possible pitfalls in histological diagnosis of celiac disease. Scand J Gastroenterol. 2015;50:1088–93. https://doi.org/10.3109/00365521.2015.1017835.

    Article  PubMed  Google Scholar 

  31. Freeman HJ. Pearls and pitfalls in the diagnosis of adult celiac disease. Can J Gastroenterol. 2008;22:273–80. https://doi.org/10.1155/2008/905325.

  32. Ravelli A, Villanacci V. Tricks of the trade: How to avoid histological pitfalls in celiac disease. Pathol Res Pract. 2012;208:197–202. https://doi.org/10.1016/j.prp.2012.01.008.

    Article  PubMed  Google Scholar 

  33. Fasano A, Sapone A, Zevallos V, Schuppan D. Nonceliac gluten sensitivity. Gastroenterology. 2015;148:1195–204. https://doi.org/10.1053/j.gastro.2014.12.049.

    Article  PubMed  CAS  Google Scholar 

  34. Zanini B, Villanacci V, Marullo M, Cadei M, Lanzarotto F, Bozzola A, et al. Duodenal histological features in suspected non-celiac gluten sensitivity: new insights into a still undefined condition. Virchows Arch. 2018;473:229–34. https://doi.org/10.1007/s00428-018-2346-9.

  35. Kakar S, Nehra V, Murray JA, Dayharsh GA, Burgart LJ. Significance of intraepithelial lymphocytosis in small bowel biopsy samples with normal mucosal architecture. Am J Gastroenterol. 2003;98:2027–33. https://doi.org/10.1111/j.1572-0241.2003.07631.x.

    Article  PubMed  Google Scholar 

  36. Memeo L, Jhang J, Hibshoosh H, Green PH, Rotterdam H, Bhagat G. Duodenal intraepithelial lymphocytosis with normal villous architecture: common occurrence in H. pylori gastritis. Mod Pathol. 2005;18:1134–44. https://doi.org/10.1038/modpathol.3800404.

  37. Yousef MM, Yantiss RK, Baker SP, Banner BF. Duodenal intraepithelial lymphocytes in inflammatory disorders of the esophagus and stomach. Clin Gastroenterol Hepatol. 2006;4:631–4. https://doi.org/10.1016/j.cgh.2005.12.028.

    Article  PubMed  Google Scholar 

  38. Brown I, Mino-Kenudson M, Deshpande V, Lauwers GY. Intraepithelial lymphocytosis in architecturally preserved proximal small intestinal mucosa: an increasing diagnostic problem with a wide differential diagnosis. Arch Pathol Lab Med. 2006;130:1020–5.

    Article  Google Scholar 

  39. Biagi F, Bianchi PI, Campanella J, Badulli C, Martinetti M, Klersy C, et al. The prevalence and the causes of minimal intestinal lesions in patients complaining of symptoms suggestive of enteropathy: a follow-up study. J Clin Pathol. 2008;61:1116–8. https://doi.org/10.1136/jcp.2008.060145.

    Article  PubMed  CAS  Google Scholar 

  40. Dai Y, Zhang Q, Olofson AM, Jhala N, Liu X. Celiac disease: updates on pathology and differential diagnosis. Adv Anat Pathol. 2019;26:292–312. https://doi.org/10.1097/pap.0000000000000242.

    Article  PubMed  CAS  Google Scholar 

  41. Bjarnason I, Zanelli G, Smith T, Prouse P, Williams P, Smethurst P, et al. Nonsteroidal antiinflammatory drug-induced intestinal inflammation in humans. Gastroenterology. 1987;93:480–9. https://doi.org/10.1016/0016-5085(87)90909-7.

    Article  PubMed  CAS  Google Scholar 

  42. Louie CY, DiMaio MA, Matsukuma KE, Coutre SE, Berry GJ, Longacre TA. Idelalisib-associated enterocolitis: clinicopathologic features and distinction from other enterocolitides. Am J Surg Pathol. 2015;39:1653–60. https://doi.org/10.1097/pas.0000000000000525.

    Article  PubMed  Google Scholar 

  43. Gonzalez RS, Salaria SN, Bohannon CD, Huber AR, Feely MM, Shi C. PD-1 inhibitor gastroenterocolitis: case series and appraisal of ‘immunomodulatory gastroenterocolitis.’ Histopathology. 2017;70:558–67. https://doi.org/10.1111/his.13118.

    Article  PubMed  Google Scholar 

  44. Rubio-Tapia A, Herman ML, Ludvigsson JF, Kelly DG, Mangan TF, Wu TT, et al. Severe spruelike enteropathy associated with olmesartan. Mayo Clin Proc. 2012;87:732–8. https://doi.org/10.1016/j.mayocp.2012.06.003.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  45. Ensari A. Gluten-sensitive enteropathy (celiac disease): controversies in diagnosis and classification. Arch Pathol Lab Med. 2010;134:826–36. https://doi.org/10.1043/1543-2165-134.6.826.

    Article  PubMed  Google Scholar 

  46. Koot BG, ten Kate FJ, Juffrie M, Rosalina I, Taminiau JJ, Benninga MA. Does Giardia lamblia cause villous atrophy in children?: a retrospective cohort study of the histological abnormalities in giardiasis. J Pediatr Gastroenterol Nutr. 2009;49:304–8. https://doi.org/10.1097/mpg.0b013e31818de3c4.

    Article  PubMed  Google Scholar 

  47. Hanevik K, Wik E, Langeland N, Hausken T. Transient elevation of anti-transglutaminase and anti-endomysium antibodies in Giardia infection. Scand J Gastroenterol. 2018;53:809–12. https://doi.org/10.1080/00365521.2018.1481522.

    Article  PubMed  CAS  Google Scholar 

  48. King CE, Toskes PP. Small intestine bacterial overgrowth. Gastroenterology. 1979;76:1035–55.https://doi.org/10.1016/s0016-5085(79)91337-4.

  49. Bianchi A, Chipman DW, Dreskin A, Rosensweig NS. Nutritional folic acid deficiency with megaloblastic changes in the small-bowel epithelium. New Engl J Med. 1970;282:859–61. https://doi.org/10.1056/nejm197004092821510.

    Article  PubMed  CAS  Google Scholar 

  50. Maguire AA, Greenson JK, Lauwers GY, Ginsburg RE, Williams GT, Brown IS, et al. Collagenous sprue: a clinicopathologic study of 12 cases. Am J Surg Pathol. 2009;33:1440–9. https://doi.org/10.1097/pas.0b013e3181ae2545.

    Article  PubMed  Google Scholar 

  51. Vakiani E, Arguelles-Grande C, Mansukhani MM, Lewis SK, Rotterdam H, Green PH, et al. Collagenous sprue is not always associated with dismal outcomes: a clinicopathological study of 19 patients. Mod Pathol. 2009;23:12–26. https://doi.org/10.1038/modpathol.2009.151.

    Article  PubMed  Google Scholar 

  52. Daniels JA, Lederman HM, Maitra A, Montgomery EA. Gastrointestinal tract pathology in patients with common variable immunodeficiency (CVID): a clinicopathologic study and review. Am J Surg Pathol. 2007;31:1800–12. https://doi.org/10.1097/pas.0b013e3180cab60c.

    Article  PubMed  Google Scholar 

  53. Malamut G, Verkarre V, Suarez F, Viallard JF, Lascaux AS, Cosnes J, et al. The enteropathy associated with common variable immunodeficiency: the delineated frontiers with celiac disease. Am J Gastroenterol. 2010;105:2262–75. https://doi.org/10.1038/ajg.2010.214.

    Article  PubMed  CAS  Google Scholar 

  54. Biagi F, Bianchi PI, Zilli A, Marchese A, Luinetti O, Lougaris V, et al. The significance of duodenal mucosal atrophy in patients with common variable immunodeficiency. Am J Clin Pathol. 2012;138:185–9. https://doi.org/10.1309/ajcpeiilh2c0wfye.

    Article  PubMed  Google Scholar 

  55. Akram S, Murray JA, Pardi DS, Alexander GL, Schaffner JA, Russo PA, et al. Adult autoimmune enteropathy: Mayo Clinic Rochester experience. Clin Gastroenterol Hepatol. 2007;5:1282–90. https://doi.org/10.1016/j.cgh.2007.05.013.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Masia R, Peyton S, Lauwers GY, Brown I. Gastrointestinal biopsy findings of autoimmune enteropathy. Am J Surg Pathol. 2014;38:1319–29. https://doi.org/10.1097/pas.0000000000000317.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Villanacci V, Lougaris V, Ravelli A, Buscarini E, Salviato T, Lionetti P, et al. Clinical manifestations and gastrointestinal pathology in 40 patients with autoimmune enteropathy. Clin Immunol. 2019;207:10–7. https://doi.org/10.1016/j.clim.2019.07.001.

    Article  PubMed  CAS  Google Scholar 

  58. Schiepatti A, Sanders DS, Aziz I, De Silvestri A, Goodwin J, Key T, et al. Clinical phenotype and mortality in patients with idiopathic small bowel villous atrophy: a dual-centre international study. Eur J Gastroenterol Hepatol. 2020;32:938–49. https://doi.org/10.1097/meg.0000000000001726.

    Article  PubMed  Google Scholar 

  59. Malamut G, Afchain P, Verkarre V, Lecomte T, Amiot A, Damotte D, et al. Presentation and long-term follow-up of refractory celiac disease: comparison of type I with type II. Gastroenterology. 2009;136:81–90. https://doi.org/10.1053/j.gastro.2008.09.069.

    Article  PubMed  Google Scholar 

  60. Hujoel IA, Murray JA. Refractory celiac disease. Curr Gastroenterol Rep. 2020;22:18. https://doi.org/10.1007/s11894-020-0756-8.

    Article  PubMed  Google Scholar 

  61. Rowinski SA, Christensen E. Epidemiologic and therapeutic aspects of refractory coeliac disease—a systematic review. Dan Med J. 2016;63:A5307.

    PubMed  Google Scholar 

  62. Eigner W, Bashir K, Primas C, Kazemi-Shirazi L, Wrba F, Trauner M, et al. Dynamics of occurrence of refractory coeliac disease and associated complications over 25 years. Aliment Pharmacol Ther. 2017;45:364–72. https://doi.org/10.1111/apt.13867.

    Article  PubMed  CAS  Google Scholar 

  63. Hussein S, Gindin T, Lagana SM, Arguelles-Grande C, Krishnareddy S, Alobeid B, et al. Clonal T cell receptor gene rearrangements in coeliac disease: implications for diagnosing refractory coeliac disease. J Clin Pathol. 2018;71:825–31. https://doi.org/10.1136/jclinpath-2018-205023.

    Article  PubMed  CAS  Google Scholar 

  64. Celli R, Hui P, Triscott H, Bogardus S, Gibson J, Hwang M, et al. Clinical insignficance of monoclonal T-cell populations and duodenal intraepithelial T-cell phenotypes in celiac and nonceliac patients. Am J Surg Pathol. 2019;43:151–60. https://doi.org/10.1097/PAS.0000000000001172.

    Article  PubMed  Google Scholar 

  65. Cheminant M, Bruneau J, Malamut G, Sibon D, Guegan N, van Gils T, et al. NKp46 is a diagnostic biomarker and may be a therapeutic target in gastrointestinal T-cell lymphoproliferative diseases: a CELAC study. Gut. 2019;68:1396–405. https://doi.org/10.1136/gutjnl-2018-317371.

    Article  PubMed  CAS  Google Scholar 

  66. Al-Toma A, Verbeek WH, Hadithi M, von Blomberg BM, Mulder CJ. Survival in refractory coeliac disease and enteropathy-associated T-cell lymphoma: retrospective evaluation of single-centre experience. Gut. 2007;56:1373–8. https://doi.org/10.1136/gut.2006.114512.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  67. West J. Celiac disease and its complications: a time traveller’s perspective. Gastroenterology. 2009;136:32–4. https://doi.org/10.1053/j.gastro.2008.11.026.

    Article  PubMed  Google Scholar 

  68. Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, et al. WHO classification of tumours of haematopoietic and lymphoid tissues, vol. 2, Revised 4th ed. Lyon: IARC; 2017.

    Google Scholar 

  69. Lenti MV, Biagi F, Lucioni M, Di Sabatino A, Paulli M, Corazza GR. Two cases of monomorphic epitheliotropic intestinal T-cell lymphoma associated with coeliac disease. Scand J Gastroenterol. 2019;54:965–8. https://doi.org/10.1080/00365521.2019.1647455.

    Article  PubMed  CAS  Google Scholar 

  70. Nijeboer P, Malamut G, Mulder CJ, Cerf-Bensussan N, Sibon D, Bouma G, et al. Enteropathy-associated T-cell lymphoma: improving treatment strategies. Dig Dis. 2015;33:231–5. https://doi.org/10.1159/000369542.

    Article  PubMed  CAS  Google Scholar 

  71. Potter DD, Murray JA, Donohue JH, Burgart LJ, Nagorney DM, van Heerden JA, et al. The role of defective mismatch repair in small bowel adenocarcinoma in celiac disease. Cancer Res. 2004;64:7073–7. https://doi.org/10.1158/0008-5472.can-04-1096.

    Article  PubMed  CAS  Google Scholar 

  72. Vanoli A, Di Sabatino A, Furlan D, Klersy C, Grillo F, Fiocca R, et al. Small bowel carcinomas in coeliac or Crohn’s disease: clinico-pathological, molecular, and prognostic features. A study from the small bowel cancer Italian consortium. J Crohns Colitis. 2017;11:942–53. https://doi.org/10.1093/ecco-jcc/jjx031.

  73. Vanoli A, Di Sabatino A, Martino M, Klersy C, Grillo F, Mescoli C, et al. Small bowel carcinomas in celiac or Crohn’s disease: distinctive histophenotypic, molecular and histogenetic patterns. Mod Pathol. 2017;30:1453–66. https://doi.org/10.1038/modpathol.2017.40.

    Article  PubMed  CAS  Google Scholar 

  74. Giuffrida P, Arpa G, Grillo F, Klersy C, Sampietro G, Ardizzone S, et al. PD-L1 in small bowel adenocarcinoma is associated with etiology and tumor-infiltrating lymphocytes, in addition to microsatellite instability. Mod Pathol. 2020;33:1398–409. https://doi.org/10.1038/s41379-020-0497-0.

    Article  PubMed  CAS  Google Scholar 

  75. Majumdar K, Sakhuja P, Puri AS, Gaur K, Haider A, Gondal R. Coeliac disease and the liver: spectrum of liver histology, serology and treatment response at a tertiary referral centre. J Clin Pathol. 2018;71:412–9. https://doi.org/10.1136/jclinpath-2017-204647.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Institute of Pathology Spedali Civili, Piazzale Spedali Civili 1, 25123, Brescia, Italy

    Villanacci Vincenzo, Simoncelli Gloria & Monica Melissa

  2. University Hospital “San Giovanni di Dio e Ruggi D’Aragona”, Salerno, Italy

    Caputo Alessandro

  3. Department of Medicine and Surgery, Section of Anatomic Pathology and Histology, Medical School, University of Perugia, Perugia, Italy

    Del Sordo Rachele

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  1. Department of Pediatrics, São João University Hospital, Porto, Portugal

    Jorge Amil-Dias

  2. Department of Pediatrics, Autonoma University , Madrid, Spain

    Isabel Polanco

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Vincenzo, V., Gloria, S., Melissa, M., Alessandro, C., Rachele, D.S. (2022). Histopathological Assessment of Celiac Disease. In: Amil-Dias, J., Polanco, I. (eds) Advances in Celiac Disease . Springer, Cham. https://doi.org/10.1007/978-3-030-82401-3_7

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