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Surgical Pathology Criteria
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Chronic Graft versus Host Disease of the Skin

Definition

  • Attack by engrafted hematopoietic cells and their progeny on host cutaneous tissues resulting in lichenoid or sclerodermatous changes

Alternate/Historical Names

  • Cutaneous GVHD

Diagnostic Criteria

  • Lichenoid type
    • Occurs any time post-transplant
    • Looks like lichen planus but with scant infiltrate
      • Epidermal atrophy or irregular acanthosis
      • Wedge shaped hypergranulosis
      • Squamatization of dermal-epidermal junction
      • Scant bandlike lymphocytic infiltrate
  • Sclerodermatous type
    • Occurs 6-12 month post-transplant
    • Looks like morphea
      • Square biopsy
      • Homogenized and thickened collagen bundles
      • Loss of hair follicles
      • Replacement of peri-eccrine fat
  • Chronic GVHD is not graded
    • Extent of disease (localized vs. generalized) is more important than histological severity

Sabine Kohler MD
Neeraja Kambham MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342

Original posting : June 30, 2007

Differential Diagnosis

Lichen Planus

  • Indistinguishable

Lichenoid Drug Eruption

  • Indistinguishable

Morphea

  • Indistinguishable

Radiation Dermatitis

  • Stellate fibroblasts
  • Swollen endothelial cells

Clinical

  • Acute vs. chronic GVHD
    • Poor correlation between pathologic features and clinical definition of acute vs. chronic
  • Chronic GVHD
    • Resembles autoimmune connective tissue disorders
    • Mortality is high due to infections promoted by GVHD associated immunodeficiency
    • Target organs more widespread but skin, liver and GI tract play a major role
  • Skin is most commonly affected organ in chronic GVHD
    • Can be localized or generalized
    • Clinical extent of lesions more important than histologic severity

Lists

Principal sites of graft versus host disease

Bibliography

  • Shulman HM, Kleiner D, Lee SJ, Morton T, Pavletic SZ, Farmer E, Moresi JM, Greenson J, Janin A, Martin PJ, McDonald G, Flowers ME, Turner M, Atkinson J, Lefkowitch J, Washington MK, Prieto VG, Kim SK, Argenyi Z, Diwan AH, Rashid A, Hiatt K, Couriel D, Schultz K, Hymes S, Vogelsang GB. Histopathologic diagnosis of chronic graft-versus-host disease: National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: II. Pathology Working Group Report. Biol Blood Marrow Transplant. 2006 Jan;12(1):31-47.
  • Heymer B. Clinical and diagnostic pathology of graft versus host disease. Springer Verlag, 2002.
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