Colon nontumor
Colitis (noninfectious)
Graft versus host disease

Topic Completed: 1 December 2015

Revised: 5 September 2019

Copyright: (c) 2003-2018,, Inc.

PubMed Search: graft versus host disease[title] colon

Hanni Gulwani, M.B.B.S.
Page views in 2018: 3,421
Page views in 2019 to date: 1,588
Cite this page: Gulwani H. Graft versus host disease. website. Accessed October 22nd, 2019.
Definition / general
  • Acute GVHD is defined as symptoms (abrupt onset of severe watery diarrhea) and histologic evidence of GVHD within 100 days of transplant or donor lymphocyte infusion (Curr Opin Gastroenterol 2005;21:64, eMedicine)
  • Chronic GVHD rarely affects colon and causes submucosal fibrosis, mucosal calcification, focal fibrosis of lamina propria; may also have architectural glandular distortion similar to inflammatory bowel disease (Mod Pathol 1998;11:513)

  • Acute GVHD grading:
    1. Apoptosis (collection of eosinophilic globules and nuclear debris)
    2. Apoptosis and crypt abscesses
    3. Total necrosis of individual crypts
    4. Total denudation of areas of bowel

  • Distal colon is optimal biopsy site (Bone Marrow Transplant 2006;38:371, Dig Dis Sci 2012;57:720, Am J Gastroenterol 2008;103:982)
Case reports
Gross images

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Hemorrhagic mucosa

Microscopic (histologic) description
  • Focal crypt cell necrosis / apoptosis (intracryptal apoptosis is specific, BMC Gastroenterol 2003;3:5)
  • Minimal inflammation; when severe, see sloughing of mucosa, sepsis, hemorrhage; may form inflammatory polyps (Hum Pathol 2009;40:909)
  • Often sparing of endocrine cells (J Clin Pathol 1981;44:86)

  • Indeterminate for GVHD: identification of 6 or fewer crypt apoptotic bodies in colon biopsies; this is a heterogenous group and synthesis of clinical, endoscopic and pathologic information, including the status of infection, coexisting GVHD involvement in the other organs and medication, is essential to confirm GVHD diagnosis (Am J Surg Pathol 2013;37:539)
Microscopic (histologic) images

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Case of the Week #372:

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Apoptotic bodies in crypts

Apoptotic bodies in crypts

Molecular / cytogenetics images

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H&E and FISH of GVHD-like pattern

Differential diagnosis
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