Summary Neutrophils are detected in inflamed colon in Crohn’s disease (CD). However, whether the frequency and/or activation of circulating or gut tissue neutrophils correlate with endoscopic severity remains to be investigated. A cohort of 73 CD patients was prospectively enrolled according to endoscopic severity and treatment history. Individuals with active disease were stratified using the Montreal classification. Harvey–Bradshaw Index (HBI) and Simple Endoscopic Score for Crohn’s Disease (SES‐CD) were performed at the time of ileocolonoscopy. Frequency of neutrophils and their expression of CD66b and CD64 were assessed in paired blood and colonic biopsies using flow cytometry. The percentage of neutrophils increased in inflamed colon and correlated with SES‐CD in the entire cohort of patients examined, as well as in the subgroup with inflammatory (B1) active disease. SES‐CD further correlated with neutrophil CD66b expression in mucosa but not blood and, conversely, with neutrophil CD64 expression in blood but not mucosa. However, the evaluation of neutrophil activation in mucosa when compared to blood reflected disease activity more clearly. Finally, a neutrophil activation power index (CD66b in mucosa X CD64 in blood) that correlated with SES‐CD discriminated between patients with mild and severe disease. In conclusion, the frequency and activation of colonic neutrophils correlated with SES‐CD, highlighting that mucosal neutrophils are associated with disease severity in CD.

Abstract Background The liver and celiac disease (CeD) share a complex relationship. While in some patients, isolated hypertransaminasemia is the only manifestation of CeD, liver diseases (LD) may also be associated with the presence of isolated tissue transglutaminase antibodies IgA (tTG IgA) without histologic evidence of CeD. Aims To examine the yield of tTG IgA testing (a) in the workup for chronic liver disease (CLD) or cytolysis and (b) to identify biopsy-confirmed CeD (BxCeD) among patients with concomitant LD. Methods Retrospective study including two cohorts. Cohort 1 represented 444 consecutive individuals without known CeD for which liver specialists requested tTG IgA. Incidence of positive tTG and BxCeD was evaluated. Cohort 2 included 212 consecutive individuals with positive tTG IgA and subsequent duodenal biopsies. The frequency and clinical characteristics of individuals without BxCeD were examined, with and without concurrent LD. Results The rate of first time positive tTG IgA among the tests requested by a liver specialist (cohort 1) was 2.0% (n = 9). However, 33.0% (n = 3) of these patients did not have BxCeD. Cohort 2 included 33 individuals with coexisting LD, of which 42.4% did not have BxCeD, compared with 16.2% of the patients without LD (P < 0.001). The majority of the patients without BxCeD (65.1%) showed an increase < 3 times upper limit of normal of tTG IgA. Conclusions Although there is clinical value in testing for CeD in the context of LD, there could be a high rate of positive CeD serology unaccompanied by histologic signs in patients with coexisting LD.

A retrospective study of 23 cases of nonlymphoblastic T cell lymphomas with no features of either mycosis fungoides (MF) or Sézary syndrome (SS) was carried out. 6 patients exhibited cutaneous (or mucous) lesions and are presented herein. There was no detectable visceral or node involvement except in 1 patient. 3 cases were immunologically proven to be of peripheral T cell origin. Except T cell lymphomas in Japan and in the Caribbean area, the frequency of prevalent skin involvement is reportedly very low in non-MF/SS non lymphoblastic T cell lymphomas. However, it is likely that this frequency has been underestimated in Western countries. The histologic features of our cases run the heterogeneous spectrum of recently described node-based forms of peripheral T cell lymphomas: ‘angioimmunoblastic lymphadenopathy with dysproteinemia’ -like lymphoma, large T cell lymphoma, multilobulated cell lymphoma, T zone lymphoma. The histologic pattern of skin infiltration was different from that of MF/SS. One case was initially suggestive of a pseudolymphoma and had a prolonged evolution but the other patients suffered from rapid extracutaneous involvement and fatal evolution with resistance to treatment. Cutaneous plasmocytomas were seen in 1 case. Hence, certain cutaneous T cell lymphomas exhibit histologic, immunological and developmental features similar to those of node-based peripheral T cell lymphomas but different from those of MF/SS.

Linked ContentThis article is linked to Banaszkiewicz et al paper. To view this article visit https://doi.org/10.1111/apt.13789.

Background: Tissue transglutaminase antibodies(tTG) is a first step for detection of celiac disease(CeD). However, in a pediatric population, an increase of <3 times UNL was poorly predictive of CeD. In adults, discrepancies between tTG and histology were reported with liver disorders and how these and other comorbidities influence the performance of tTG remains unknown. Aims: To determine the positive predictive value(PPV) of the degree of increase of tTG for newly diagnosed biopsy-proven CeD(BxCeD) in adults with and without other comorbidities. Methods: Retrospective study based on chart review from August 2003 to June 2016. Inclusion criteria: all patients with a dosage of tTG at the Centre Hospitalier de l'Université de Montréal and duodenal biopsies done three months before to six months after tTG. Exclusion criteria: inadequate histologic specimen, CeD already known or being on a gluten free diet. Patients were identified as BxCeD if histology corresponded to Marsh type 1 up to 3c. Medical records were reviewed for comordibities at the time of the dosage of tTG, namely liver disorders, autoimmune, infectious diseases and inflammatory states. Patients with and without these comorbidities were classified as Dis+ or Dis-groups. ROC curve analysis was performed to determine the UNL threshold where sensitivity(Sn) and specificity(Sp) are optimized for diagnosis of BxCeD in both groups. PPVs below and above these thresholds were calculated and compared with Fisher's exact tests. Results: 206 patients were included; 63% of women; mean age(±SD) 48(±16)years. BxCeD was identified in 80% of patients(n=164). Overall, 73 patients were found with ≥1 relevant comorbidities(Dis+ group), mainly liver diseases(n=32), connective tissue diseases(n=11), and inflammatory bowel diseases(n=7). BxCeD was found in 60% of them while this proportion was of 90% in the Dis-group. ROC curve in the Dis-group revealed that Sp/Sn were optimized at 2.74 times UNL. When PPV were calculated according to this threshold (Table), PPVs were significantly lower in the Dis+ group vs. the Dis-group. In the Dis+ group, the threshold optimizing the Sp/Sn of the tTg test was 3.83 times UNL, which increased the PPV to 88%