<prompt> Histopathological findings in Whipples disease include all of the following Except:Marked increase in the number of macrophages in the mucosaMarked increase in the number of intraepethelial lymphocytesDilatation of Lymphatics in the mucosaLipid deposition in the mucosa  <response>: Answer is B Marked increase in the number of intraepethelial lymphocytes: The intraepethelial lymphocytes are usually, either decreased in number or normal. Marked increase in the number of intraepethelial lymhocytes is not seen and this is the single best answer of exclusion. The Hallmark of Whipples disease is a small intestinal mucosa laden with macrophages. Accompanying changes include lymphatic dilatation suggesting lymphatic blockage. The lymphatic blockage is believed to be responsible for lipid deposition in the villi - Robbins Histopathological findings in Whipples disease Characterisitc findings Specific finding Hallmark of disease Small intestinal mucosa laden with foamy macrophages in the lamina propria, which are characteristically, Periodic -Acid - Schiff PAS positive. These PAS positive macrophages monocytes also contain gram positive - acid fast bacillus T whipleiiQ. The substance in macrophages that stains positive with PAS is thought to be remnants of the cell wall of phagocytosed bacilli Note : PAS positive macrophages are not pathognomic for Whipples disease. They have also been isolated in other diseases eg. Mycobacterium Avail?, Intercellulare Mycobacterium Tuberculosis. Associated findings Villi may be thickenned, widened or blunted Small intestinal mucosal and submucosal lymphatic vessels are dilated Lipid droplets Lipid vacuoles Lipid deposition may be seen The number of lamina propria plasma cells, lymphocytes and eosinophills are decreased Samters Immunologic Diseases by Austen and Samter 2nd 704 The number of intraepethelial lymphocytes is not increased Sternbergs Diagnostic Surgical Pathology 4th1481 Disease that can be Diagnosed by Small-Intestinal Mucosal Biopsies Lesions Pathologic Findings Diffuse, specific Whipple .s disease Lamina propria contains macrophages containing PAS material .4gammaglobulinemia No plasma cells: either normal or absent villi flat mucosa Abetalipoproteinemia Normal villi; epithelial cells vacuolated with fat postprandially Patchy, specific Intestinal lymphoma Malignant cells in lamina propria and submucosa Intestinal lymphangiectasia Dilated lymphatics; clubbed villi Eosinophilic gastroenteritis Eosinophil infiltration of lamina propria and mucosa Amyloidosis Amyloid deposits Crohns disease Noncaseating granulomas Infection by one or more microorganisms Specific organisms Mastocvtosis Mast cell infiltration of lamina propria Diffuse, nonspecific Celiac sprue Sho or absent villi; mononuclear infiltrate; epithelial cell damage; hyperophy of crypts Tropical sprue Similar to celiac sprue Bacterial overgrowth Patchy damage to villi; lymphocyte Folate deficiency Sho villi; decreased mitosis in crypts; megalocytosis Vitamin B12 deficiency Similar to folate deficiency Radiation enteritis Similar to folate deficiency Zollinger - Ellison syndrome Mucosal ulceration and erosion from acid Protein -calorie malnutrition Villous atrophy; secondary bacterial overgrowth Drug-induced enteritis Variable histology 