The Apoptotic Crypt Abscess: An Underappreciated Histologic Finding in Gastrointestinal Pathology

Am J Clin Pathol. 2017 Nov 20;148(6):538-544. doi: 10.1093/ajcp/aqx100.

Abstract

Objectives: To differentiate apoptotic crypt abscesses (ACAs) from neutrophilic crypt abscesses (NCAs).

Methods: Cases with crypt abscesses were classified as containing ACAs, NCAs, or mixed crypt abscesses (MCAs) by H&E staining. Sections were stained with cleaved caspase 3 and myeloperoxidase and recategorized.

Results: Fifty-nine cases were reviewed: inflammatory bowel disease (IBD; n = 33), acute cellular rejection (n = 5), graft vs host disease (GVHD; n = 14), cytomegalovirus (n = 5), and drug reaction (n = 2). Concordance was seen in 59%, with most reclassifications resulting from a change of ACAs to MCAs. When cases were classified as having NCA vs those with apoptosis (ACA and MCA), there was 85% agreement (P < .01). NCAs were present in IBD (96%) and not in GVHD or drug injury. Crypt abscesses with apoptosis were seen in 18% of IBD and 96% of non-IBD cases.

Conclusions: ACAs and MCAs can be distinguished from NCAs and may be a diagnostically useful finding.

Keywords: Acute cellular rejection; Apoptosis; GVHD; Gastrointestinal pathology; Inflammatory bowel disease; Mycophenolate mofetil.

MeSH terms

  • Abscess*
  • Apoptosis / drug effects*
  • Apoptosis / physiology
  • Colitis / pathology
  • Colonoscopy / methods
  • Gastrointestinal Neoplasms / pathology*
  • Graft Rejection / pathology*
  • Graft vs Host Disease / diagnosis
  • Graft vs Host Disease / pathology
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Inflammatory Bowel Diseases / drug therapy
  • Inflammatory Bowel Diseases / pathology*
  • Intestinal Mucosa / pathology
  • Male

Substances

  • Immunosuppressive Agents