Home   Chapter Home   Jobs   Conferences   Fellowships   Books



Advertisement

Skin-nontumor

Other dermatoses

Graft versus host disease


Reviewer: Mowafak Hamodat MB.CH.B, MSc., FRCPC, Eastern Health, St. Johns (Canada) (see Reviewers page)
Revised: 30 July 2011, last major update July 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.

Clinical features
=========================================================================

● Important cause of post-bone marrow transplant morbidity; usually occurs 10-30 days after allogeneic bone marrow transplant
● Due to immunocompetent donor lymphocytes reacting against recipient tissues, causing cutaneous, hepatic and intestinal lesions
● Prognosis is related to amount of inflammation
● Initially is a pruritic maculopapular skin rash, often on acral surfaces and pinnae
● May progress to diffuse eruption on trunk and extremities with oral mucosal stomatitis and ulceration
Chronic GVHD: develops 100 days after transplant (DermNetNZ)

Micro description
=========================================================================

Early - basal layer vacuolization and necrosis, spongiosis, apoptosis, acantholysis, chronic inflammation of upper dermis with perivascular lymphocytic infiltrate and intraepidermal lymphocytes; follicular involvement is a common feature
Late stage - lichenoid type: hyperkeratosis, hypergranulosis, irregular acanthosis, basal cell hydropic changes, cytoid body formation, pigment incontinence, and band like lymphohistiocytic infiltrate; in contrast to idiopathic lichen planus, satellite cell necrosis is often present in the early phase of chronic GVHD, and the infiltrate sometimes contains plasma cells and eosinophils
Late stage of chronic GVHD: characterized by epidermal atrophy, with abolition of ridge pattern and scarring of superficial and deep dermis, with loss of adnexal structures; features are similar to scleroderma

Micro images
=========================================================================



Contributed by Dr. Amy Lynn, Toledo, Ohio

   
Acute GVHD - various images


Chronic GVHD - various images

Positive stains
=========================================================================

● IgM deposition (granular or linear) in basement membrane zone

Differential diagnosis
=========================================================================

Lichenoid chronic GVHD: resembles lichen planus, but LP lacks satellite cell necrosis, plasma cells or eosinophils
Late stage chronic GVHD: resembles scleroderma, but clinical history is different

Additional references
=========================================================================

eMedicine, Wikipedia

End of Skin-nontumor > Other dermatoses > Graft versus host disease


This information is intended for physicians and related personnel, who understand that medical information is often imperfect, and must be interpreted in the context of a patient's clinical data using reasonable medical judgment. This website should not be used as a substitute for the advice of a licensed physician.

All information on this website is protected by copyright of PathologyOutlines.com, Inc. Information from third parties may also be protected by copyright. Please contact us at copyrightPathOut@gmail.com with any questions (click here for other contact information).