Colon non tumor
Colitis (non-infectious)
Graft versus host disease

Reviewer: Hanni Gulwani, M.D. (see Reviewers page)
Revised: 4 December 2015, last major update February 2013
Copyright: (c) 2003-2015, PathologyOutlines.com, Inc.
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

Hemorrhagic mucosa

Micro 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)
Micro Images

Case of the Week #372:



Apoptotic bodies in crypts


Apoptotic bodies in crypts

Molecular / Cytogenetics Images

H&E and FISH of GVHD-like pattern

Differential Diagnosis