cryptic apoptotic bodies

Images

 colorectal GVHD

• https://twitter.com/Pathologists/status/742099178583515137
• https://twitter.com/stephen_lagana/status/736578297153327104

Histopathology assessment is crucial for the diagnosis of graft versus host disease (GVHD), as the presence of crypt apoptosis is the cardinal criterion required.

However, crypt apoptosis is not limited to GVHD; it also occurs in other conditions such as infection, drug reaction, or inflammatory reactions unrelated to GVHD.

Identifying 6 or fewer crypt apoptotic bodies in colon biopsies from HSCT patients is worth reporting in order to alert the clinicians of the possibility of GVHD but not sufficient to render a diagnosis on the pathologic grounds alone. (23211294)

The colon biopsies containing 6 or fewer apoptotic bodies represent a heterogenous group. (23211294)

This group should be classified as "indeterminate for GVHD", instead of diagnosing GVHD outright. (23211294)

Synthesis of all clinical, endoscopic, and pathologic information, including the status of infection, coexisting GVHD involvement in the other organs, and medication, is essential for confirmation of the diagnosis of GVHD. (23211294)

Synopsis

 apoptotic epithelial cells

• colonic GVHD
• colon allograft rejection

 apoptotic inflammatory cells

• acute colitis
• active colitis

Etiology

 GVHD
 infection
 drug reaction
 inflammatory reaction

References

 Is the Presence of 6 or Fewer Crypt Apoptotic Bodies Sufficient for Diagnosis of Graft Versus Host Disease? A Decade of Experience at a Single Institution. Lin J, Fan R, Zhao Z, Cummings OW, Chen S. Am J Surg Pathol. 2012 Dec 1. PMID: 23211294