Azad Shweta, Malhotra Veena, Kirtani Pawan, Choudhary Dharma
1Department of Histopathology, BLK Superspeciality Hospital, Pusa Road, New Delhi, India.
2Department of Bone Marrow Transplant and Hemato Oncology, BLK Superspeciality Hospital, Pusa Road, New Delhi, India.
Indian J Hematol Blood Transfus. 2019 Jan;35(1):83-88. doi: 10.1007/s12288-018-0969-2. Epub 2018 Jun 9.
Graft-versus-host disease (GVHD) is the major complication post hematopoeitic stem cell transplantation (HSCT) causing significant morbidity and mortality. Colonic biopsies were performed in 25 post HSCT patients presenting the diarrhea for diagnosis of acute graft versus host disease (A-GVHD). The present study was undertaken to evaluate and illustrate histomorphological features of A-GVHD in GI biopsies and to grade them. Histopathological features of gastrointestinal biopsies from 25 allogeneic HSCT patients having clinical suspicion of A-GVHD were evaluated and compared with colonic biopsies from negative controls. A-GVHD was observed in 17 cases, CMV colitis was present in 3 cases and one case had herpes simplex infection diagnosed in conjunction with serological findings. A-GVHD was graded as grade 1 and 2 in 10 cases and grade 3 and 4 in 7 cases. Apoptosis of crypt epithelial cells was the cardinal feature for diagnosis. Grade 1 and grade 2 A-GVHD cases showed crypt apoptosis in all cases as well as pericryptal apoptosis in lamina propria in many cases. Occasional crypt loss was seen in grade 2 GVHD. Inflammatory infiltrate was composed of lymphocytes and plasma cells. Neutrophils were inconspicuous. Grade 3 and grade 4 A-GVHD cases showed contiguous areas of multiple crypt loss and ulceration with inflammatory infiltrate predominantly composed of lymphocytes and plasma cells, but neutrophils were more prominent than in grade 1 and 2 A-GVHD. Apoptosis of crypt epithelial cells was present in all grade 3 &4 cases except one case. CMV cases were diagnosed by CMV inclusions and IHC stain. Several factors including drug-induced side effects and infections can cause difficulty in histologic interpretation of gastrointestinal biopsies for GVHD. Proper histomorphological interpretation of intestinal A-GVHD is critical for clinical management. A-GVHD is treated with immunosuppression which may worsen infective condition, if present.
移植物抗宿主病（GVHD）是造血干细胞移植（HSCT）后的主要并发症，可导致显著的发病率和死亡率。对25例造血干细胞移植后出现腹泻的患者进行了结肠活检，以诊断急性移植物抗宿主病（A-GVHD）。本研究旨在评估和阐述胃肠道活检中A-GVHD的组织形态学特征并进行分级。对25例临床怀疑为A-GVHD的异基因造血干细胞移植患者的胃肠道活检组织病理学特征进行评估，并与阴性对照的结肠活检进行比较。观察到17例A-GVHD，3例为巨细胞病毒结肠炎，1例结合血清学检查诊断为单纯疱疹感染。10例A-GVHD分级为1级和2级，7例为3级和4级。隐窝上皮细胞凋亡是诊断的主要特征。1级和2级A-GVHD病例在所有病例中均显示隐窝凋亡，许多病例在固有层中也显示隐窝周围凋亡。2级GVHD中偶尔可见隐窝缺失。炎症浸润由淋巴细胞和浆细胞组成。中性粒细胞不明显。3级和4级A-GVHD病例显示多个隐窝连续缺失和溃疡区域，炎症浸润主要由淋巴细胞和浆细胞组成，但中性粒细胞比1级和2级A-GVHD更突出。除1例病例外，所有3级和4级病例均存在隐窝上皮细胞凋亡。巨细胞病毒病例通过巨细胞病毒包涵体和免疫组化染色诊断。包括药物引起的副作用和感染在内的几个因素可能会导致胃肠道活检对GVHD的组织学解释困难。对肠道A-GVHD进行正确的组织形态学解释对临床管理至关重要。A-GVHD采用免疫抑制治疗，如果存在感染，可能会使感染状况恶化。
