Clinicopathologic Study of The Acute Cutaneous Graft-Versus-Host Disease after Bone Marrow Transplantation in Hematologic Disorders.
- Author:
Ji Sun LEE
1
;
Hyun Jeong PARK
;
Jun Young LEE
;
Baik Kee CHO
;
Chang Suk KANG
;
Chun Choo KIM
Author Information
1. Department of Dermatology, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. hjpark@catholic.ac.kr
- Publication Type:Original Article
- Keywords:
Acute cutaneous GVHR;
Clinicopathologic study
- MeSH:
Biopsy;
Bone Marrow Transplantation*;
Bone Marrow*;
Graft vs Host Disease*;
Humans;
Immunocompromised Host;
Leukocytes;
Neutrophils;
Skin
- From:Korean Journal of Dermatology
2003;41(9):1163-1168
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Graft-versus-host disease(GVHD) refers to the spectrum of organ dysfunction that occurs when immunocompetent leukocytes attack specific tissue in a relatively immunocompromised host. The most common clinical setting for GVHD is after bone marrow transplantation(BMT). Acute GVHD occurs in about 40% to 50% of HLA-matched allogeneic transplants and skin is the most commonly involved. Despite intense interest in the GVHD, little is known regarding the histopathologic change in cutaneous graft-versus-host reaction(GVHR). OBJECTIVE: We investigated the clinical and histological features of acute cutaneous GVHR in recipients receiving allogenic BMT. METHODS: On the basis of the patients' charts, photographs and biopsy specimens, we investigated the clinical manifestations and histological characteristics of acute cutaneous GVHR in 70 patients from January 1, 1998 through December 31, 1999. RESULTS: The most common cutaneous involvement sites are the chest(48.6%) and other frequent site are the face(21.4%), palm(20.0%), and extremities(10.0%). The clinical grades of 70 patients of acute cutaneous GVHR were 31 patients(44%) for grade 1, 25 patients (36%) for grade 2, 14 patients(20%) for grade 3, and 0 patient(0%) for grade 4. Clinically, acute cutaneous GVHR mainly presented as pruritic erythematous maculopapules or patches. Histopathologic grades of 70 patients of acute cutaneous GVHR were 25 patients(36%) for grade 1, 38 patients(54%) for grade 2, 7 patients(10%) for grade 3 and 0 (0%)patinet for grade 4. Histologically, the most common epidermal change in acute cutaneous GVHR is vacuolar degeneration (95.6%). Other epidermal findings are epidermal dyskeratotic cell(76.5%), hyperkeratosis(61.8%), spongiosis(61.8%), exocytosis(61.8%), atrophy(52.9%), and parakeratosis(13.2%), acanthosis(11.8%) and subepidermal cleft(10.0%) are rarely seen. In addition, dermal changes include perivascular lymphohistiocytic infiltration(94.1%), telangiectasia(57.4%), pigmentary incontinence(44.1%), endothelial swelling(33.8%), band-like infiltration(30.8%), neutrophilic infitraion (20.6%), periappendageal infiltration(14.7%) and extravasation of erythrocytes(13.2%).
