title: Immunohistochemical CD3 staining detects additional patients with celiac disease.
abstract: OBJECTIVE
  To investigate whether performing immunohistochemical CD3 staining, in order to improve the detection of intra-epithelial lymphocytosis, has an additional value in the histological diagnosis of celiac disease.
  
  
  METHODS
  Biopsies obtained from 159 children were stained by hematoxylin and eosin (HE) and evaluated using the Marsh classification. CD3 staining was subsequently evaluated separately and independently.
  
  
  RESULTS
  Differences in evaluation between the routine HE sections and CD3 staining were present in 20 (12.6%) cases. In 10 (6.3%) patients the diagnosis of celiac disease (Marsh II and III) changed on examination of CD3 staining: in 9 cases, celiac disease had initially been missed on the HE sections, while 1 patient had been over-diagnosed on the routine sections. In all patients, the final diagnosis based on CD3 staining, was concordant with serological results, which was not found previously. In the other 10 (12.3%) patients, the detection of sole intra-epithelial lymphocytosis (Marsh I) improved. Nine patients were found to have Marsh I on CD3 sections, which had been missed on routine sections. Interestingly, the only patient with negative serology had Giardiasis. Finally, in 1 patient with negative serology, in whom Marsh I was suspected on HE sections, this diagnosis was withdrawn after evaluation of the CD3 sections.
  
  
  CONCLUSIONS
  Staining for CD3 has an additional value in the histological detection of celiac disease lesions, and CD3 staining should be performed when there is a discrepancy between serology and the diagnosis made on HE sections.
authors.affiliation: Amani Mubarak, Victorien M Wolters, Roderick HJ Houwen, Department of Pediatric Gastroenterology, University Medical Center Utrecht, Wilhelmina Children's Hospital, 3508 AB Utrecht, The Netherlands.
authors.forename: Amani
authors.initials: A
authors.lastname: Mubarak
authors.affiliation: Amani Mubarak, Victorien M Wolters, Roderick HJ Houwen, Department of Pediatric Gastroenterology, University Medical Center Utrecht, Wilhelmina Children's Hospital, 3508 AB Utrecht, The Netherlands.
authors.forename: Victorien M
authors.initials: VM
authors.lastname: Wolters
authors.affiliation: Amani Mubarak, Victorien M Wolters, Roderick HJ Houwen, Department of Pediatric Gastroenterology, University Medical Center Utrecht, Wilhelmina Children's Hospital, 3508 AB Utrecht, The Netherlands.
authors.forename: Roderick H J
authors.initials: RH
authors.lastname: Houwen
authors.affiliation: Amani Mubarak, Victorien M Wolters, Roderick HJ Houwen, Department of Pediatric Gastroenterology, University Medical Center Utrecht, Wilhelmina Children's Hospital, 3508 AB Utrecht, The Netherlands.
authors.forename: Fiebo J W
authors.initials: FJ
authors.lastname: ten Kate
mesh_terms: D000293:Adolescent; D001323:Autoantibodies / Q000097:blood; D015415:Biomarkers / Q000032:analysis; D001706:Biopsy; D017252:CD3 Complex / Q000032:analysis*; D002446:Celiac Disease / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003951:Diagnostic Errors / Q000517:prevention & control; D004386:Duodenum / Q000276:immunology* / Q000473:pathology; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007223:Infant; D007413:Intestinal Mucosa / Q000276:immunology* / Q000473:pathology; D008218:Lymphocytosis / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012698:Serologic Tests
chemical_list: D001323:Autoantibodies; D015415:Biomarkers; D017252:CD3 Complex
keywords: CD3 staining; Celiac disease; Diagnosis; Histology; Intra-epithelial lymphocytosis; Marsh classification