Tollemar V, Arvidsson H, Häbel H, Tudzarovski N, Legert K Garming, Le Blanc K, Warfvinge G, Sugars R V
Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
Medical Statistics Unit, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
Heliyon. 2023 Apr 15;9(4):e15517. doi: 10.1016/j.heliyon.2023.e15517. eCollection 2023 Apr.
The oral cavity commonly displays mucosal lichenoid lesions and salivary gland dysfunction, which are considered different chronic Graft-versus-Host Disease (cGVHD) pathophysiology's. However, diagnostics of salivary gland (sg-)cGVHD are limited. The objectives of the current study are to evaluate the minor salivary gland (MSG) histo-immunopathological profiles post allogenic hematopoietic cell transplantation based on sg-cGVHD criteria. : Histopathology was characterized according to two published grading strategies. Firstly, the National Institute of Health (NIH) assessed peri-ductal/acinar infiltration, exocytosis, damage, and fibrosis, and a points-based grading scheme was established (0-16 points, Grade (G) 0 to IV). Second, a modified Sjögren's Syndrome focus-score with parenchymal damage was also adapted, (0-10 points, Score 0 to 2). 146 MSG biopsies from 79 patients were compared, using the histopathological specific criteria for sg-cGVHD pathology. Quantitative immunohistochemistry for T-cells (CD4, CD8), B-cells (CD19, CD20), monocytic cells (CD68) and dendritic cells (CD1a) were also assessed. The large-scale cohort validated the use of both grading schemes. GIII-GIV and score 2 signified a histopathological diagnosis of "likely" sg-cGVHD. Immunopathological severity was associated with increased T-cells (CD4 and CD8) and monocytic (CD68) infiltrate, with minimal involvement of B-cells (CD19 and CD20), and Langerhans cells (CD1a). Both schemes were verified as being suitable for histological grading to improve assessment and diagnosis of sg-cGVHD. The NIH cGVHD grading appears to be more beneficial for research purposes, including final diagnostics of "no/inactive", "possible" or "likely" cGVHD. The study highlights the intricacies of sg-cGVHD pathology; and the need for standardized assessment to improve patient management associated to sg-cGVHD.
口腔常见黏膜苔藓样病变和唾液腺功能障碍，它们被认为是不同的慢性移植物抗宿主病（cGVHD）病理生理学表现。然而，唾液腺（sg-）cGVHD的诊断方法有限。本研究的目的是根据sg-cGVHD标准评估异基因造血细胞移植后小唾液腺（MSG）的组织免疫病理学特征。组织病理学根据两种已发表的分级策略进行特征描述。首先，美国国立卫生研究院（NIH）评估导管周围/腺泡浸润、胞吐作用、损伤和纤维化情况，并建立了基于积分的分级方案（0 - 16分，0至IV级）。其次，还采用了一种改良的伴有实质损伤的干燥综合征焦点评分法（0 - 10分，0至2分）。使用sg-cGVHD病理学的组织病理学特定标准，对79例患者的146份MSG活检样本进行了比较。还评估了T细胞（CD4、CD8）、B细胞（CD19、CD20）、单核细胞（CD68）和树突状细胞（CD1a）的定量免疫组织化学。大规模队列研究验证了两种分级方案的应用。III - IV级和2分表示组织病理学诊断为“可能”的sg-cGVHD。免疫病理学严重程度与T细胞（CD4和CD8）和单核细胞（CD68）浸润增加相关，B细胞（CD19和CD20）及朗格汉斯细胞（CD1a）受累最少。两种方案均被证实适用于组织学分级，以改善sg-cGVHD的评估和诊断。NIH的cGVHD分级似乎对研究目的更有益，包括“无/非活动性”、“可能”或“很可能”cGVHD的最终诊断。该研究突出了sg-cGVHD病理学的复杂性，以及进行标准化评估以改善sg-cGVHD相关患者管理的必要性。
