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Histopathologic Features of Unmasked Inflammatory Bowel Disease Following Immune Checkpoint Inhibitor Therapy in Colon Biopsies.
Zhang, M Lisa; Algarrahi, Khalid; DiCarlo, Jamie; Elvin-Ivey, Abigail; Dougan, Michael; Mino-Kenudson, Mari.
Afiliación
  • Zhang ML; Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts.
  • Algarrahi K; Harvard Medical School, Boston, Massachusetts.
  • DiCarlo J; Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts.
  • Elvin-Ivey A; Harvard Medical School, Boston, Massachusetts.
  • Dougan M; Department of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts.
  • Mino-Kenudson M; Department of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts.
Gastro Hep Adv ; 3(7): 986-994, 2024.
Article en En | MEDLINE | ID: mdl-39296871
ABSTRACT
Background and

Aims:

Typical immune checkpoint inhibitor-induced colitis (T-ICI) has significant histomorphologic overlap with inflammatory bowel disease (IBD), a distinction further complicated in ICI-treated patients with pre-existing inflammatory bowel disease (P-IBD) and those with potentially "unmasked" inflammatory bowel disease (U-IBD) after ICI therapy. This study describes histopathologic findings seen in U-IBD colonic biopsies and assesses for distinguishing features from T-ICI and P-IBD biopsies.

Methods:

Initial colon biopsies after symptom onset from 34 patients on ICI therapy were reviewed, and histopathologic features were tabulated. U-IBD patients were identified clinically based on rapid toxicity development post-ICI treatment with multiple recurrences after immune suppression, frequently with regional colitis (versus pancolitis).

Results:

The study cohort was classified into T-ICI (n = 20), P-IBD (n = 9), and U-IBD (n = 5) groups. The predominant histological patterns were diffuse active colitis (35%) in the T-ICI, and chronic active colitis in both the P-IBD (67%) and U-IBD (60%) groups (overall P = .003, P > .05 between the two IBD groups). None of the T-ICI biopsies demonstrated chronicity features (ie, architectural distortion score 2, basal lymphoplasmacytosis, or Paneth cell metaplasia). Only U-IBD biopsies demonstrated basal lymphoplasmacytosis (60% vs 0% in T-ICI/P-IBD, P = .002). Among available follow-up biopsies, chronicity features were present in all (4/4) U-IBD patients, including those without chronicity seen in the initial biopsy, but none (0/7) of T-ICI patients.

Conclusion:

These early results show that no definite features of chronicity were seen in colon biopsies from T-ICI patients, suggesting that the presence of those features may be a clue to U-IBD in patients without a known IBD diagnosis. Frequent basal lymphoplasmacytosis seen in U-IBD may support a recent onset of mucosal injury and early architectural remodeling.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Gastro Hep Adv Año: 2024 Tipo del documento: Article Pais de publicación: Países Bajos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Gastro Hep Adv Año: 2024 Tipo del documento: Article Pais de publicación: Países Bajos