Bauer D J, Hood A F, Horn T D
Department of Dermatology, Johns Hopkins Medical Institutions, Baltimore, Md.
Arch Dermatol. 1993 Jul;129(7):855-8.
The cutaneous eruptions due to allogeneic graft-vs-host disease, autologous graft-vs-host disease, and lymphocyte recovery occur in the setting of peripheral leukocyte reconstitution after marrow aplasia. Since the eruptions of lymphocyte recovery (ELR) and autologous graft-vs-host disease develop in the presence of histocompatibility, we question whether reliable histologic differentiation is possible. To this end, we performed a retrospective, blind analysis of 38 skin biopsy specimens obtained from patients who received autologous marrow transplants or intensive chemotherapy alone for various malignant neoplasms.
In 31% of the cases, we were unable to distinguish between an ELR and a grade 2 graft-vs-host reaction. In 40% of the ELR specimens, a significant number of dyskeratotic keratinocytes were present, leading to the false interpretation of a grade 2 graft-vs-host reaction. Satellite cell necrosis was observed in both groups. The patterns of dyskeratotic keratinocytes were similar; one ELR specimen displayed prominent follicular involvement. Most ELR specimens were consistent with grade 1 graft-vs-host reaction changes.
These findings indicate that the presence of dyskeratotic keratinocytes is not specific for a graft-vs-host reaction and that cutaneous eruptions after autologous marrow transplantation are best considered an ELR.
同种异体移植物抗宿主病、自体移植物抗宿主病以及淋巴细胞恢复所导致的皮肤疹，发生于骨髓再生障碍后的外周白细胞重建过程中。鉴于淋巴细胞恢复性皮疹（ELR）和自体移植物抗宿主病是在组织相容性存在的情况下发生的，我们质疑是否能够进行可靠的组织学鉴别。为此，我们对38例皮肤活检标本进行了回顾性盲法分析，这些标本取自接受自体骨髓移植或仅接受强化化疗以治疗各种恶性肿瘤的患者。
在31%的病例中，我们无法区分ELR和2级移植物抗宿主反应。在40%的ELR标本中，存在大量角化不良的角质形成细胞，导致对2级移植物抗宿主反应的错误解读。两组均观察到卫星细胞坏死。角化不良角质形成细胞的模式相似；一份ELR标本显示出明显的毛囊受累。大多数ELR标本与1级移植物抗宿主反应变化一致。
这些发现表明，角化不良角质形成细胞的存在并非移植物抗宿主反应所特有，自体骨髓移植后的皮肤疹最好被视为ELR。
