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August 4, 1962

Clinical Science

JAMA. 1962;181(5):396-403. doi:10.1001/jama.1962.03050310036008

Whipple's Disease: Pathogenetic Considerations 

Electron Microscopic and Histochemical Observations  Edwin R. Fisher, M.D., PittsburghIN 1907, WHIPPLE1 described the features of an unusual gastrointestinal disorder which now bears his name. Whipple, as well as many subsequent investigators, considered the pathologic changes, notably the large, lipid-laden cystic spaces observed in the mucosa of the small intestine and regional lymph nodes, to be the result of a primary lipodystrophy. However, recent observers have been more impressed with the possible pathogenic implications of the abundant mucopolysaccharide present within the ubiquitous histiocytes observed in these lesions. The mucopolysaccharide has been variably defined histochemically as either neutral2-4 or acidic5 in type, and may be readily appreciated in tissue sections by the use of the periodic acid-Schiff staining technique.6 More recently, Sieracki and associates7-9 have called attention to the peculiar disposition of this material within these histiocytes in the form of