Skin-nontumor - Graft versus host disease

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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
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● 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
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● 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
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Contributed by Dr. Amy Lynn, Toledo, Ohio

Acute GVHD - various images

Chronic GVHD - various images

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

Differential diagnosis
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● 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
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● eMedicine, Wikipedia

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

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