ASSESSMENT OF HISTOPATHOLOGIC CHANGES IN THE COLONIC BIOPSY IN ACUTE GRAFT-VERSUS-HOST DISEASE

The authors reviewed 78 colonic biopsies from 63 patients undergoing b one marrow transplantation (BMT), 56 allogeneic and 7 autologous, to a ssess different morphologic changes related with intestinal acute graf t-versus-host disease (A-GVHD), Only five biopsies were done before th e 20th day after BMT. The authors studied the presence of ulcers and a trophy in the mucosa, the nuclear atypia, and inflammatory infiltrate in the surface epithelium, and the architectural abnormalities, as wel l as dilation of the glands, and the presence of crypt abscesses, The authors explored the glandular epithelium for apoptosis and intraepith elial lymphocytes. They examined the lamina propria for inflammatory i nfiltrate, especially for so-called ''focal periglandular infiltrate ( FPGI),'' edema, fibrosis, increase of capillary vessels and presence o f muciphages and clusters of enterochromaffin cells. Cases were groupe d according to clinical symptoms and histologic diagnosis of A-GVHD in skin or liver, Group A had 15 asymptomatic cases (control). Group B h ad 20 cases from asymptomatic patients with a histologically proven A- GVHD, Group C had 43 cases with gastrointestinal symptoms and histolog ically proven A-GVHD. Then, the relative frequency of every histologic feature previously described were compared in the different groups by means of an univariate analysis. Apoptosis of the glandular epitheliu m was found in 48 cases, two of them in patients carrying an auto-BMT. Focal periglandular infiltrate was found in 11 cases that was associa ted with apoptosis (P < .03, Fisher's exact test), In this series, the presence of FPGI was linked with finding apoptosis in a given specime n with a probability of 98%, Glandular architectural changes and dilat ion were also more frequent in group C than in groups A and B when com pared in the univariate analysis.