Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
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        Estimated Villous Tip Score & Protein Sensitive Enteropathies

We have been performing an IHC amplified IEL check on adult duodenal (no pediatric cases in our workload) biopsies since about 2000, often as a formal analysis by manual quantitative ( often using expert "eyeballing" calculation). This is our most sensitive and global test for protein sensitive enteropathies (PSEs) of all types. Increased IELs suggest presence of a PSE. We now routinely use a CD3-amplified villus tip score (VTS)...or variation, a manual quantitative IHC analysis when reported as a "score" (the average number of villus tip IELs per 20 villous tip epithelial cells...ten cells on each side of the very apex of the villus tip). The villus tip is in the most intimate contact with any ingested luminal-contents protein antigen capable of causing a protein sensitive enteropathy (PSE). Unless the patient (in the case, for example, of gluten-sensitive type celiac PSE) has ceased intake of the offending protein for an interval prior to EGD and duodenal biopsy, increased IELs expressed as a VTS (or as IELs per 100 villus epithelials) have been a sensitive screen for ALL PSEs (not just celiac). Serology only detects the celiac gluten (protein) sensitive enteropathy (GSE). Other proteins are such as are presumed in tropical sprue, egg protein PSE, cow milk PSE, soy PSE, and who knows what all others? See the thought process, below:

About gluten sensitive & protein sensitive enteropathies HERE.


  1. Histopathology 54(7):783-795 (photos clearly showing advantage of counting with CD3), June 2009.
  2. Biagi F, et. al., "Intraepithelial lymphocytes in the villous tip: do they indicate potential coeliac disease?", J Clin Pathol, 57:835-839, 2004. (the use & advantage of CD3 amplification)
  3. 2002 editor letter noting our use of LCA HERE.

(original flow chart dated 9 June 2009 [revised chart 1/3/2013]; began to post 9/14/2009; latest addition 2 January 2013)

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