{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T08:28:17Z","timestamp":1787646497467,"version":"build-2736575974"},"reference-count":19,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2024,6,20]],"date-time":"2024-06-20T00:00:00Z","timestamp":1718841600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Int J Surg Pathol"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:p>\n                    <jats:italic toggle=\"yes\">Objective.<\/jats:italic>\n                    Whipple disease, caused by\n                    <jats:italic toggle=\"yes\">Tropheryma whipplei<\/jats:italic>\n                    , is a rare infectious condition primarily presenting with malabsorptive diarrhea. Small bowel biopsies typically reveal foamy macrophages containing periodic acid\u2013Schiff-positive\/diastase (PAS\/D) resistant\n                    <jats:italic toggle=\"yes\">T. whipplei<\/jats:italic>\n                    bacilli, and PAS(D) staining is occasionally requested by clinicians in duodenal biopsies, which are often histologically unremarkable. The yield of PAS(D) staining in such biopsies has never been reported to our knowledge.\n                    <jats:italic toggle=\"yes\">Methods.<\/jats:italic>\n                    The anatomic pathology database was searched for all specimens of duodenal biopsies stained with PAS(D) from 1993 to 2021. Specimens were categorized by the following histomorphologic features: unremarkable, nonspecific changes, or expansion of the lamina propria by aggregates of foamy histiocytes. Follow-up information was collected, including microbiologic confirmatory testing.\n                    <jats:italic toggle=\"yes\">Results.<\/jats:italic>\n                    There was a total of 193 specimens of duodenal biopsies stained with PAS(D). Biopsies lacking foamy histiocytes on H&amp;E (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    \u2009=\u2009158) were never PAS-positive. Thirteen biopsies contained PAS-positive histiocytes; 9 out of the 13 PAS-positive specimens were subsequently confirmed to be\n                    <jats:italic toggle=\"yes\">T. whipplei<\/jats:italic>\n                    . Of the 193 specimens, 124 specimens had a clinical request for PAS(D) staining. Only 3 of the 124 (2.4%) specimens showed foamy histiocytes containing PAS-positive granules, all of which were confirmed positive for\n                    <jats:italic toggle=\"yes\">T. whipplei<\/jats:italic>\n                    .\n                    <jats:italic toggle=\"yes\">Conclusion.<\/jats:italic>\n                    PAS(D) staining is unnecessary to exclude Whipple disease in duodenal biopsies without foamy macrophage aggregates, regardless of clinical suspicion. Clinical suspicion-driven biopsies often yield negative results for Whipple disease.\n                  <\/jats:p>","DOI":"10.1177\/10668969241260818","type":"journal-article","created":{"date-parts":[[2024,6,20]],"date-time":"2024-06-20T08:58:40Z","timestamp":1718873920000},"page":"318-322","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Is PAS Stain Necessary to Exclude Whipple Disease in Duodenal Biopsies?"],"prefix":"10.1177","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0511-3958","authenticated-orcid":false,"given":"Ahmed","family":"Bakhshwin","sequence":"first","affiliation":[{"name":"King Abdulaziz University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6866-6760","authenticated-orcid":false,"given":"Lauren Ashley","family":"Duckworth","sequence":"additional","affiliation":[{"name":"Cleveland Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"Toro Castano","sequence":"additional","affiliation":[{"name":"Cleveland Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0177-9074","authenticated-orcid":false,"given":"Mohamed","family":"El Hag","sequence":"additional","affiliation":[{"name":"Cleveland Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Plesec","sequence":"additional","affiliation":[{"name":"Cleveland Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,6,20]]},"reference":[{"issue":"198","key":"e_1_3_2_2_2","first-page":"382","article-title":"A hitherto undescribed disease characterized anatomically by deposits of fat and fatty acids in the intestinal and mesenteric lymphatic tissues","volume":"18","author":"Whipple GH","year":"1907","unstructured":"Whipple GH. A hitherto undescribed disease characterized anatomically by deposits of fat and fatty acids in the intestinal and mesenteric lymphatic tissues. Bull Johns Hopkins Hosp. 1907;18(198):382-391.","journal-title":"Bull Johns Hopkins Hosp"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5085(19)36367-X"},{"key":"e_1_3_2_4_2","first-page":"80","article-title":"Combined electron and light microscopy in Whipple\u2019s disease: demonstration of \u201cbacillary bodies\u201d in the intestine","volume":"109","author":"Yardley JH","year":"1961","unstructured":"Yardley JH, Hendrix TR. Combined electron and light microscopy in Whipple\u2019s disease: demonstration of \u201cbacillary bodies\u201d in the intestine. 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