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Published on: November 21, 2015
The Apoptotic Crypt Abscess: An Underappreciated Histologic Finding in Gastrointestinal Pathology
Geoffrey Talmon1, Tristan Manasek2, Ross Miller1
1Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha.
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.
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