Is Single-Cell Apoptosis Sufficient for the Diagnosis of Graft-Versus-Host Disease in the Colon?

Abstract

Low-grade lesions of graft-versus-host disease (GVHD) in the colon are not uncommon. To determine if minimal diagnostic criteria can be established in such biopsies, we correlated histologic findings with clinical history and investigated the role of endoscopy and electron microscopy in establishing GVHD. About 85 colonic biopsies that were histologically consistent with GVHD from 47 bone-marrow transplant recipients were reviewed retrospectively. Of nine cases showing only a single apoptotic cell in the intestinal epithelium, only four lacked any confounding factors of GVHD. These cases, while too few to assess the utility of finding one apoptotic cell with statistical significance, appear to support the idea that in the appropriate clinical setting, a single apoptotic cell could be reported as possibly representing early GVHD. Endoscopic findings did not reliably correlate with histology. Although electron microscopy can be a useful adjunct, it does not contribute to the diagnosis of GVHD.

Pathology of graft-versus-host disease in the gastrointestinal tract

“…Most pathologists do not regard isolated epithelial surface apoptotic bodies, especially in the colon, as diagnostic of GVHD, because of the potential of apoptosis due to bowel preparatory regimens to mimic GVHD. However, a recent study suggests that up to 11% of biopsies considered GVHD in one series show only a single isolated crypt epithelial cell in only one level [35]. Although some of these patients also had concurrent skin GVHD and showed good response of symptoms to steroid therapy, others did not in this relatively small retrospective study, and the minimum threshold thus remains unclear.…”

Consensus diagnostic histopathological criteria for acute gastrointestinal graft versus host disease improve interobserver reproducibility

“…Consensus on criteria for a histological diagnosis of GvHD are particularly important when results from different institutions are compared, such as quantification-in order to establish a threshold for diagnosis-and grading [13]. Although correlation with the clinical course, which was not included in our study, Mucosal changes not accepted to be diagnostic for mucosa denudation (HE, original magnification a ×400, b ×1000, c ×250 with b showing a section of a.…”

Clinicopathologic Threshold of Acute Colorectal Graft-versus-Host Disease

“…In the appropriate clinical setting, colon biopsies are used to determine the presence and grade of GI GVHD based on the extent of crypt apoptosis and crypt loss. [1][2][3] The histologic diagnosis of GVHD is historically based on the 1974 Lerner et al 4 criteria that qualify grade 2 GVHD as destruction of crypts with apoptotic crypt abscesses, grade 3 GVHD as focal mucosal necrosis with denudation, and grade 4 GVHD as diffuse mucosal necrosis with denudation. The presence of single-cell crypt apoptosis, a relatively nonspecific finding, is designated as grade 1 GVHD (GVHD1).…”