Table 5: Histopathology of mucosal malabsorption syndromes

Condition

Histological Characteristics

Normal

Villus to crypt ratio 3 to 4:1, columnar epithelial cells, scattered mononuclear cells in the lamina propria

Disorders in which small intestinal biopsy is diagnostic

Whipple’s disease

Hypogammaglobulinemia

Abetalipoproteinemia

Amyloidosis

Blunting of villi, PAS-positive macrophages in the lamina propria; bacteria by electron microscopy

Partial villus atrophy; lack of plasma cells and lymphocytic infiltrate in lamina propria; sometimes nodular lymphoid hyperplasia

Enterocytes filled with lipid droplets

Amyloid deposition in the mucosa and submucosa

Disorders in which small intestinal biopsy may be diagnostic

Celiac sprue

Intestinal lymphangiectasia

Intestinal lymphoma

Crohn’s disease

Parasitic infestations

Radiation enteritis

Eosinophilic gastroenteritis

Most common cause of total villus atrophy, crypt hyperplasia, lymphocytic infiltration of lamina propria

Dilated lymphatics in the lamina propria

Infiltration of laminal propria and displacement of crypts with malignant lymphocytes

Fissuring, ulcerations, noncaseating granulomas

Giardia or cryptosporidia trophozoites attached to epithelial cells; invasive isospora

Partial villus atrophy, no crypt hyperplasia, decreased mitoses in crypts

Blunting of villi or normal, eosinophils and neutrophils infiltrate mucosa