Minimal Symptomatic Celiac Sprue (low grade enteropathy): This is a sub-entity of celiac disease where the villous architecture is normal and no crypt hyperplasia. The only abnormality noted in these patient is increased lymphocytes in certain areas of the villi, with increased CD 4 expression (by immunohistochemistry). Treatment of this entity with Gluten free diet is a cure to their symptoms. Because the changes are minimal, it can pass unnoticed by the pathologist for long time
:Apoptotic colopathy
This a newly described form of colitis. These patient present with long standing diarrhea , have normal colonoscopy, usually females (but not exclusively). The pathologic changes seen is increased apoptotic foci in the crypts with increased expression of ki-67 by immunohistochemistry
Superficial Crohn’s disease
In these cases, the patient present with minimal changes of chronic inflammatory bowel disease and the lesion is limited to the mucosa. Immunohistochemistry for the Integrins is markedly increased. Treatment and follow up of these cases is as usual Crohn’s disease
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.Dr. Hussam Abu- Farsakh, M.D
American boards of Anatomic, Clinical Pathology and Cytopathology