Department of Pathology, University of Maryland Medical Center, Baltimore MD 21201, USA.
Hum Pathol. 2013 Jul;44(7):1233-40. doi: 10.1016/j.humpath.2012.11.012. Epub 2013 Jan 31.
The histopathologic features of pulmonary graft-versus-host disease (GVHD) status post-bone marrow transplant are not well described. Lung biopsies from patients with clinically suspected GVHD were studied. There were 17 biopsies from 9 men and 5 women. Alveolar changes were classified as acute lung injury with intra-alveolar fibrin, organizing pneumonia (OP), and chronic interstitial pneumonia (CIP). Intraepithelial bronchiolar T cells were increased in 16 of 17 biopsies within bronchiolar mucosa (56 ± 30 per 100 epithelial cells). Atypical pneumocytes were present in 10 biopsies, and atypia was marked in 2 biopsies. Reactive bronchiolar cells were also seen in all 3 groups and showed mild atypia in 5 and marked atypia in 1, mimicking viral cytopathic effect. Apoptosis of bronchiolar epithelium and interstitium was seen in all but 1 case and was most marked in the acute injury and OP patterns. Perivenular cuffing was present in 11 of 17 biopsies. All 3 patients with acute injury died of acute respiratory distress syndrome; 1 patient with OP died of systemic GVHD; and 1 patient with CIP pattern died of opportunistic infection. Obstructive lung disease with obliterative bronchiolitis developed in 3 patients, all of whom stabilized with treatment and were alive at last follow-up (mean, 25 months). All 3 histologic patterns of pulmonary GVHD are characterized by intrabronchiolar T cells, apoptosis, and perivenulitis, which help to distinguish GVHD from infections. The acute lung injury pattern has a poor prognosis, and bronchiolitis obliterans syndrome develops in a subset of patients with CIP histologic pattern.
肺移植物抗宿主病（GVHD）状态后的组织病理学特征描述不明确。对临床疑似 GVHD 的患者进行了肺活检。9 名男性和 5 名女性中有 17 例活检。肺泡变化分为肺泡内纤维蛋白性急性肺损伤、机化性肺炎（OP）和慢性间质性肺炎（CIP）。17 例活检中有 16 例在细支气管黏膜上皮内发现上皮细胞内的细支气管 T 细胞增多（每 100 个上皮细胞中 56 ± 30 个）。10 例活检中有不典型肺泡细胞，2 例活检中不典型明显。所有 3 组均可见反应性细支气管细胞，其中 5 例有轻度不典型，1 例有明显不典型，类似于病毒性细胞病变效应。除 1 例外，所有病例均可见细支气管上皮和间质细胞凋亡，在急性损伤和 OP 模式中最为明显。17 例活检中有 11 例存在血管周围套袖状浸润。所有 3 例急性损伤患者均死于急性呼吸窘迫综合征；1 例 OP 患者死于全身 GVHD；1 例 CIP 患者死于机会性感染。3 例患者出现阻塞性肺病伴闭塞性细支气管炎，经治疗稳定，在最后一次随访时（平均 25 个月）均存活。所有 3 种肺 GVHD 组织学类型均表现为细支气管内 T 细胞、凋亡和血管周围炎，有助于将 GVHD 与感染区分开来。急性肺损伤模式预后较差，CIP 组织学模式的一部分患者会出现闭塞性细支气管炎综合征。
