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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

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