GVHD


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  • Clinical

    • bone marrow transplant

  • Histology

    • apoptosis at base of crypts
    • crypt drop out, replaced with endocrine cells

  • Grading

    • I: epithelial apoptosis
    • II: abscesses
    • III: crypt dropout, crypt necrosis
    • IV: total denudation

  • Ddx

    • infectious colitis
    • mucositis
    • mycophenolate mofetil colitis
      • has increased lamina propria eosinophils
      • lack endocrine cell aggregates or apoptotic microabscesses
    • NSAID colitis
    • sodium phosphate bowel prep

  • Signout

    • GVHD status, or hedge: focal pyknotic debris, indeterminate for low grade GVHD
    • no viral cytopathic effect identified
    • comment if on mycophenolate: MMF toxicity and GVHD have similar histology. The presence of apoptotic microabscesses, endocrine cell aggregates and the lack of significant lamina propria eosinophils favor GVHD.
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