[644] 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.
Category: Gastrointestinal

Monday, March 19, 2012 1:00 PM

Poster Session II # 129, Monday Afternoon

 

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