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Apoptotic colopathy: a pragmatic approach to diagnosis
  1. Dipti M Karamchandani1,
  2. Runjan Chetty2
  1. 1 Division of Anatomic Pathology, Department of Pathology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
  2. 2 Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
  1. Correspondence to Dr Dipti M Karamchandani, Division of Anatomic Pathology, Department of Pathology, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, H179 Hershey, PA 17033, USA; dkaramchandani{at}


‘Apoptotic colopathy’ is an umbrella term signifying a pattern of injury where the gastrointestinal biopsy shows a colitic picture with apoptosis as the predominant histological feature. Although the entities within apoptotic colopathy share a common histological feature— ‘apoptosis’, there is a list of varied clinical differential diagnoses that produce this similar histological pattern of injury. These include graft-versus-host disease, drug-induced injury due to multiple drugs (in particular, mycophenolate mofetil, check point inhibitor therapy and some others), infections (particularly cytomegalovirus, adenovirus and some others), immune disorders and other miscellaneous causes. However, the management of these varied differentials is strikingly different, thus necessitating an algorithmic approach for accurate diagnosis and optimal patient management. A definitive diagnosis requires interpretation of varied histological findings in the appropriate clinical context including clinical history, drug history and laboratory findings. This review will focus on the histopathological findings of varied entities that can manifest as ‘apoptotic colopathy’ on assessment of colonic biopsies.

  • transplantation
  • surgical pathology
  • cryptosporidium
  • colon
  • apoptosis

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  • Handling editor Cheok Soon Lee.

  • Contributors The authors participated actively in this manuscript and can take public responsibility for the content of this paper. All authors critically revised the paper for intellectual content and have approved the final version of the manuscript.

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  • Competing interests None declared.

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  • Provenance and peer review Commissioned; internally peer reviewed.