Au W-Y, Yeung C-K, Cheung M-C, Trendell-Smith N J
Department of Medicine, Queen Mary Hospital, Pokfulam Road, Hong Kong.
Br J Dermatol. 2008 Aug;159(2):470-2. doi: 10.1111/j.1365-2133.2008.08645.x. Epub 2008 May 22.
Graft-versus-host disease (GVHD) often complicates allogeneic stem cell transplantation (SCT) and affects mainly the gut, liver, lung and skin. The microscopic morphological features of late-phase sclerodermatous chronic GVHD in the skin, namely epidermal atrophy, lymphoplasmacytic infiltration, dense dermal fibrosis and adnexal atrophy, are histologically indistinguishable from those in sporadic systemic sclerosis, morphoea and the related condition of lichen sclerosus. Mucosal orifices including those of the genitourinary system may be severely affected. We present three SCT recipients with chronic GVHD and severe posthitis leading to phimosis requiring surgery. The excised prepuces showed features of lichen sclerosus including epidermal atrophy and a subepidermal zone of eosinophilic, homogeneous and hyalinized collagen above a band-like lymphoplasmacytic infiltrate. These cases add further evidence to support the notion that penile lichen sclerosus should be included within the expanding sclerodermoid spectrum of late-stage cutaneous chronic GVHD.
移植物抗宿主病（GVHD）常使异基因干细胞移植（SCT）变得复杂，主要影响肠道、肝脏、肺和皮肤。皮肤晚期硬皮病样慢性移植物抗宿主病的微观形态特征，即表皮萎缩、淋巴细胞浆细胞浸润、真皮致密纤维化和附属器萎缩，在组织学上与散发性系统性硬化症、硬斑病及相关的硬化性苔藓状况无法区分。包括泌尿生殖系统在内的黏膜开口可能会受到严重影响。我们报告了3例患有慢性移植物抗宿主病和严重阴茎头炎并导致包茎需要手术的干细胞移植受者。切除的包皮显示出硬化性苔藓的特征，包括表皮萎缩以及在带状淋巴细胞浆细胞浸润上方有嗜酸性、均匀且透明化的胶原组成的表皮下区域。这些病例进一步证明了阴茎硬化性苔藓应被纳入晚期皮肤慢性移植物抗宿主病不断扩大的硬皮病样谱系这一观点。
