Histopathology of "Cord Colitis Syndrome" in Umbilical Cord Blood Transplant Recipients
Andrew M Bellizzi, Gabriela Soriano, Alex F Herrera, Francisco M Marty, Jason L Hornick. University of Iowa Hospitals and Clinics, Iowa City; Brigham and Women's Hospital, Boston
Background: We recently described an antibiotic-responsive diarrheal syndrome in umbilical cord blood stem cell transplant recipients not attributable to acute graft-versus-host disease (GVHD), identifiable infection, or medication, which we termed "cord colitis syndrome" (CCS). This study describes the features (fxs) of endoscopic mucosal biopsy material from these patients.
Design: Existing diagnostic material from CCS patients, including H&E/histochemical/immunohistochemical-stained slides, was retrieved. Patient age/gender were recorded and the following assessed: activity (focal, mild, moderate, severe), lamina propria plasmacytic inflammation (for upper tract), basal plasmacytosis (colon), architectural distortion, Paneth cell/pyloric metaplasia, surface epithelial injury (SEI), viral cytopathic effect (VCE), granulomas (crypt/gland rupture, loose, Crohn-like), and GVHD-like fxs (apoptosis/dropout; graded 0-4). An overall pattern of injury (normal [nl], chronic and/or active disease, GVHD-like) was assigned to each biopsy.
Results: Forty-six biopsies (6 stomach, 6 duodenum, 3 terminal ileum [TI], 31 colon) from 11 patients (age 28-59; 5M, 6W) were reviewed. Four gastric biopsies demonstrated Helicobacter-negative chronic gastritis; 4 contained granulomas; GVHD-like fxs ranged from 0-1. One duodenal biopsy contained a granuloma and GVHD-like fxs ranged from 0-1; otherwise, the biopsies were nl. One TI biopsy displayed mild chronic active ileitis; GVHD-like fxs ranged from 0-1. Activity in the colon ranged from none to moderate-severe. Basal plasmacytosis was noted in 1 biopsy, and 1 patient demonstrated marked architectural distortion. Paneth cell metaplasia was common, present in 15 of 22 (68%) left-sided biopsies in 8 patients (73%). SEI was seen in 8 biopsies (26%). VCE was not seen, although rare CMV-positive cells were detected by immunostain in 1 biopsy (the only positive special study in the 46 biopsies). Granulomas were seen in 17 biopsies (55%). The median GVHD-like score was 1. Overall, granulomas were seen in 22/46 (48%) biopsies from 7/11 (64%) patients (crypt/gland rupture, loose, Crohn-like in 12, 9, and 6 biopsies, respectively).
Conclusions: The histopathology of CCS is typified by a chronic active colitis, often with a granulomatous component. Apoptosis is generally inconspicuous. Upper tract findings include non-specific chronic gastritis, and granulomas can be seen in otherwise normal biopsies. Recognition of this syndrome, and especially its distinction from GVHD, allows for initiation of appropriate antibiotic therapy.
Monday, March 19, 2012 1:00 PM
Poster Session II # 129, Monday Afternoon