Grading Villous Atrophy in a Small Bowel Biopsy

Description

Villous atrophy in a small bowel biopsy may range from mild to severe.

Histologic parameters:

(1) villous appearance

(2) surface epithelium

(3) inflammation

Villous Appearance	Surface Epithelium	Inflammation	Villous Atrophy
all or almost all long and slender	normal	not increased	absent (none)
some normal, some broad, short or fused	abnormal with loss of polarity	increased acute and chronic in lamina propria; some intra- epithelial lymphocytes	mild
most broad and short	cuboidal	intraepithelial lymphocytes; increased mononuclear cells	moderate
absent or almost absent	NA	marked mononuclear cell infiltrate	severe

where:

• The normal villous height is >= 3 times the length of the crypt.

Crypt atrophy may be accompanied by crypt hyperplasia or hypoplasia.

Differential diagnosis:

(1) poor sampling

(2) abnormal orientation to a villous, such as tangential sectioning

While villous atrophy is associated with celiac disease, other diseases (malnutrition, chemotherapy, radiation, endocrine disorders, etc) can also result in the change.

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Description

Specialty

ICD-10