Department of Dermatology, University of Pennsylvania, Philadelphia, PA.
Department of Dermatology, University of Virginia Medical Center, Charlottesville, VA.
Am J Dermatopathol. 2024 Nov 1;46(11):755-760. doi: 10.1097/DAD.0000000000002841. Epub 2024 Sep 17.
Chronic graft-versus-host disease (cGVHD) is the leading cause of morbidity and nonrelapse mortality after allogeneic hematopoietic cell transplantation. Skin biopsy of cGVHD is recommended when clinical features are not diagnostic, yet the histopathologic features of skin cGVHD are not well described. The objective of this study is to describe the histopathologic features of skin cGVHD in epidermal, sclerotic, and combination cGVHD. Of 49 patients with skin cGVHD, 30 of 49 (61.2%) were male, and mean age was 55 years (SD 11.1). Clinically, 33 of 49 (67.3%) had epidermal cGVHD (E-cGVHD), 1 of 49 (2.1%) had sclerotic cGVHD (S-cGVHD), and 15 of 49 (30.6%) had combination disease. The 49 patients corresponded to 83 unique pathologic specimens with 67 of 83 (80.7%) taken from E-cGVHD, and 16 of 83 (19.3%) from S-cGVHD lesions. Nearly all biopsy specimens from E-cGVHD showed minimal features of active GVHD, including apoptosis in the epidermal basal layer (n = 63, 94.0%), vacuolar change (n = 62, 92.5%), and lymphocyte satellitosis (n = 57, 85.1%). The predominant histologic pattern of E-cGVHD was lichen planus/interface dermatitis (n = 31, 47.0%). S-cGVHD specimens also showed minimal features of active GVHD with apoptosis of the epidermal basal layer (n = 11, 68.8%) and vacuolar change (n = 8, 50.0%). In addition, S-cGVHD showed sclerosis of the papillary and reticular dermis and subcutaneous septae (n = 8, 50.0%; n = 11, 68.8%; n = 5, 31.2%, respectively). The predominant histologic pattern of S-cGVHD was lichen sclerosus/morphea-like pattern (n = 10, 62.5%). Although minimal pathologic features of active GVHD are common, the majority of cGVHD biopsies share features with the inflammatory skin diseases that they clinically resemble. Complete histologic reporting is recommended with implications for disease endotyping and personalized therapy.
慢性移植物抗宿主病（cGVHD）是异基因造血细胞移植后发病率和非复发死亡率的主要原因。当临床特征无诊断意义时，建议对 cGVHD 进行皮肤活检，但皮肤 cGVHD 的组织病理学特征尚未得到很好描述。本研究的目的是描述表皮、硬化和联合 cGVHD 中皮肤 cGVHD 的组织病理学特征。在 49 例皮肤 cGVHD 患者中，30 例（61.2%）为男性，平均年龄为 55 岁（标准差 11.1）。临床上，33 例（67.3%）为表皮 cGVHD（E-cGVHD），1 例（2.1%）为硬化性 cGVHD（S-cGVHD），15 例（30.6%）为联合疾病。这 49 例患者对应 83 例独特的病理标本，其中 67 例（80.7%）来自 E-cGVHD，16 例（19.3%）来自 S-cGVHD 病变。几乎所有来自 E-cGVHD 的活检标本均显示出最小的急性移植物抗宿主病特征，包括表皮基底层的细胞凋亡（n=63，94.0%）、空泡化（n=62，92.5%）和淋巴细胞卫星现象（n=57，85.1%）。E-cGVHD 的主要组织学模式是扁平苔藓/界面性皮炎（n=31，47.0%）。S-cGVHD 标本也显示出最小的急性移植物抗宿主病特征，包括表皮基底层的细胞凋亡（n=11，68.8%）和空泡化（n=8，50.0%）。此外，S-cGVHD 显示出乳头层和网状真皮以及皮下隔的硬化（n=8，50.0%；n=11，68.8%；n=5，31.2%）。S-cGVHD 的主要组织学模式是硬皮病样瘢痕性苔藓/硬斑病样模式（n=10，62.5%）。尽管急性移植物抗宿主病的最小病理特征很常见，但大多数 cGVHD 活检与它们临床上相似的炎症性皮肤病具有共同特征。建议进行完整的组织学报告，以提示疾病的终末分型和个体化治疗。
