Splenic Hypofunction and the Spectrum of Autoimmune and Malignant Complications in Celiac Disease  Antonio Di Sabatino, Maria Manuela Rosado, Paolo Cazzola, Roberta Riboni, Federico Biagi, Rita Carsetti, Gino Roberto Corazza  Clinical Gastroenterology and Hepatology  Volume 4, Issue 2, Pages 179-186 (February 2006) DOI: 10.1016/S1542-3565(05)00982-1 Copyright © 2006 American Gastroenterological Association Institute Terms and Conditions

Figure 1 (A) Posteroanterior and (B) laterolateral 99mTc splenic scan in a patient with CD complicated by ulcerative jejunoileitis and splenic atrophy. Arrows indicate the small-sized spleen (3.3 × 2.5 cm). Clinical Gastroenterology and Hepatology 2006 4, 179-186DOI: (10.1016/S1542-3565(05)00982-1) Copyright © 2006 American Gastroenterological Association Institute Terms and Conditions

Figure 2 Percentages of pitted red cells in 29 patients who had a splenectomy, 10 patients with complicated CD, 27 celiac patients with AID, 36 celiac patients without AID, 34 nonceliac patients with AID, and 35 healthy volunteers. ▴, Patients with complicated CD affected by enteropathy-associated T-cell lymphoma; ■, patients affected by refractory sprue and ulcerative jejunoileitis with a monoclonal rearrangement of the TCR-γ; , patients with complicated CD and concomitant splenic atrophy. The dashed line indicates the upper limit of the control range (4%). Clinical Gastroenterology and Hepatology 2006 4, 179-186DOI: (10.1016/S1542-3565(05)00982-1) Copyright © 2006 American Gastroenterological Association Institute Terms and Conditions

Figure 3 Phenotypic analysis of B cells in the peripheral blood of a (A, B) splenectomized patient, (C, D) a hyposplenic celiac patient, and (E, F) a healthy volunteer. Peripheral blood mononuclear cells were stained with antibodies to CD22, CD27, IgM, and IgD and were analyzed by 4-color flow cytometry. Data are shown as density plots and are representative of all patients and controls. (A, C, E) Two populations of CD22+ cells were identified: CD27+ memory B cells (upper rectangles) and CD27− mature B cells (lower rectangles). The numbers indicate the frequency of memory B cells, calculated as a percentage of CD22+ B cells. (B, D, F) Two populations of memory B cells were identified: IgMbright IgDdull IgM memory B cells (upper right rectangles) and switched memory B cells (lower left rectangles) lacking both IgM and IgD. The numbers indicate the frequency of IgM memory B cells, calculated as a percentage of CD22+ B cells. Clinical Gastroenterology and Hepatology 2006 4, 179-186DOI: (10.1016/S1542-3565(05)00982-1) Copyright © 2006 American Gastroenterological Association Institute Terms and Conditions

Figure 4 Correlation between the percentage of pitted red cells and the percentage of IgM memory B cells in all 73 celiac patients. Patient with complicated CD (▴); celiac patients with AID (•); and celiac patients without AID (○). rs = −.34; P = .001. Clinical Gastroenterology and Hepatology 2006 4, 179-186DOI: (10.1016/S1542-3565(05)00982-1) Copyright © 2006 American Gastroenterological Association Institute Terms and Conditions