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. 2003 Mar 27:3:5.
doi: 10.1186/1471-230x-3-5.

Colon biopsies for evaluation of acute graft-versus-host disease (A-GVHD) in allogeneic bone marrow transplant patients

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Colon biopsies for evaluation of acute graft-versus-host disease (A-GVHD) in allogeneic bone marrow transplant patients

Vinod B Shidham et al. BMC Gastroenterol. .

Abstract

Background: Proper histomorphological interpretation of intestinal acute graft versus host disease (A-GVHD) associated with allogeneic bone marrow transplantation (BMT) is critical for clinical management. However, studies methodically evaluating different histomorphological features of A-GVHD are rare.

Methods: Colonic biopsies from 44 allogeneic BMT patients having biopsy-proven cutaneous A-GVHD were compared with colon biopsies from 48 negative controls.

Results: A-GVHD showed intra-cryptal apoptosis in 91% and pericryptal apoptosis in adjacent lamina propria in 70% (p < 0.002). Nonspecific apoptosis along the surface epithelium was observed in all groups with comparable frequency. The number of apoptotic cells in mucosa were approximately four times (5.3 per 10 HPF) the negative controls (p < 0.002) in A-GVHD group. 48% of cases with A-GVHD showed decreased number of lymphocytes in lamina propria. Some features, including intraepithelial lymphocytes in surface or crypt epithelium; and neutrophils, eosinophils, and edema in lamina propria, did not demonstrate significant difference in A-GVHD and negative controls. Pericryptal apoptosis, dilated crypts, irregular distribution of crypts, decreased lymphocytes, increased microvessel network, focal fibrosis, presence of muciphages, reactive changes in surface epithelium with mucin depletion, mucosal ulceration, and/or reduced mucosal thickness showed higher association with A-GVHD group.

Conclusions: Intracyptal apoptosis is a reliable indicator of A-GVHD. Its diagnostic significance was improved if intracyptal apoptosis was associated with features which were observed more frequently in A-GVHD group as mentioned above.

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Figures

Figure 1
Figure 1
Colonic biopsy with GVHD. A. Colonic mucosa with apoptotic bodies in crypts. Inset- Crypts show many apoptotic bodies (for higher magnification of the crypt with arrow see figure 1B). B. Magnified crypt shown in the inset of figure 1A: The crypt shows "popcorn" lesions (arrows) with occasional muciphages (arrowhead) in LP.
Figure 2
Figure 2
A. Colonic biopsy with GVHD- Focal crypt abnormalities (crypt size variation and irregular crypt distribution) with decreased mucosal thickness (x). Inset: Ectatic vessels (y) and slightly dilated crypt (z) with mild decrease in number of lymphocytes in LP. B. Colonic biopsy with GVHD (higher magnification of area adjacent to 'x' in figure 2A) – Crypt abnormalities with focal ulceration (A), focal reactive surface epithelium (b), focal fibrosis (C), and many apoptotic cells in crypts (d).

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