Crypt apoptotic body counts in normal ileal biopsies overlap with graft-versus-host disease and acute cellular rejection of small bowel allografts

• Published in: Human pathology Vol. 56; pp. 89 - 92
• Main Authors: Sung, Diana, Iuga, Alina C., Kato, Tomoaki, Martinez, Mercedes, Remotti, Helen E., Lagana, Stephen M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2016; Elsevier Limited
• Subjects: Acute cellular rejection; Acute Disease; Allografts; Apoptosis; Biopsy; Colonoscopy; Consortia; Crypt apoptosis; Databases, Factual; Disease; Extracellular Vesicles - immunology; Extracellular Vesicles - pathology; Female; Graft Rejection - immunology; Graft Rejection - pathology; Graft vs Host Disease - immunology; Graft vs Host Disease - pathology; Graft-versus-host disease; Humans; Ileal biopsy; Ileum - immunology; Ileum - pathology; Ileum - transplantation; Immunity, Cellular; Infections; Intestinal Mucosa - immunology; Intestinal Mucosa - pathology; Intestinal Mucosa - transplantation; Intestinal transplant; Male; Middle Aged; Mortality; Motility; Organ Transplantation - adverse effects; Pathology; Predictive Value of Tests; Small intestine; Transplants & implants; Treatment Outcome; Tumors; Graft-versus-host disease; Intestinal transplant; Crypt apoptosis; Ileal biopsy; Acute cellular rejection
• ISSN: 0046-8177; 1532-8392; 1532-8392
• DOI: 10.1016/j.humpath.2016.05.017

Crypt apoptosis in intestinal epithelium is an important diagnostic feature of graft-versus-host disease (GVHD) and acute cellular rejection (ACR) of intestinal transplants (ITx). In ITx pathology, 2 or fewer apoptotic bodies in 10 consecutive crypts are considered normal, whereas 6 or more is consistent with mild ACR. The presence of 3 to 5 apoptotic bodies is problematic and is often classified as indeterminate for ACR. The minimum diagnostic threshold for GVHD is controversial but also depends on the apoptotic body count (ABC). We investigated how many crypt apoptotic bodies could be identified in histologically normal ileal biopsies from healthy subjects (native intestines, no bone marrow transplant) who underwent screening colonoscopy and had ileal biopsy to confirm complete colonoscopy. We recorded the number of biopsy pieces per specimen and the maximum ABC in 10 consecutive crypts. Twenty-six of 40 patients (65%) had an ABC of 3 or more in 10 crypts, thus only 35% were “normal.” Four (10%) had an ABC of ≥6 (positive for ACR). Twenty-two (55%) had 3–5 (indefinite for ACR). Depending on the criteria, up to 60% of the cases could be diagnosed as positive for GVHD.