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Graft-versus-host disease (view source)
Revision as of 19:03, 11 February 2021
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'''Graft-versus-host disease''', abbreviated as '''GVHD''', is a rare thingy seen mostly in tertiary care centres. It is a complication of hematopoietic stem cell transplantation. | '''Graft-versus-host disease''', abbreviated as '''GVHD''', is a rare thingy seen mostly in tertiary care centres. It is a complication of [[hematopoietic stem cell transplantation]]. | ||
==General== | |||
*Complication of hematopoietic stem cell transplantation, i.e. bone marrow transplantation (BMT). | *Complication of hematopoietic stem cell transplantation, i.e. bone marrow transplantation (BMT). | ||
**Affects skin, liver (bile ducts), gastrointestinal tract.<ref name=pmid15792120>{{cite journal |author=Niino D, Nakashima M, Kondo H, ''et al.'' |title=Correlation of donor-derived keratinocytes and severity of graft-versus-host disease (GVHD) in epidermis |journal=Pathol. Res. Pract. |volume=200 |issue=11-12 |pages=775–81 |year=2005 |pmid=15792120 |doi= |url=}</ref><ref>{{cite journal |author=van Dijk AM, Kessler FL, Verdonck LF, ''et al.'' |title=Primary human keratinocytes as targets in predicting acute graft-versus-host disease following HLA-identical bone marrow transplantation |journal=Br. J. Haematol. |volume=111 |issue=3 |pages=791–6 |year=2000 |month=December |pmid=11122139 |doi= |url=}}</ref> | **Affects skin, liver (bile ducts), gastrointestinal tract.<ref name=pmid15792120>{{cite journal |author=Niino D, Nakashima M, Kondo H, ''et al.'' |title=Correlation of donor-derived keratinocytes and severity of graft-versus-host disease (GVHD) in epidermis |journal=Pathol. Res. Pract. |volume=200 |issue=11-12 |pages=775–81 |year=2005 |pmid=15792120 |doi= |url=}}</ref><ref>{{cite journal |author=van Dijk AM, Kessler FL, Verdonck LF, ''et al.'' |title=Primary human keratinocytes as targets in predicting acute graft-versus-host disease following HLA-identical bone marrow transplantation |journal=Br. J. Haematol. |volume=111 |issue=3 |pages=791–6 |year=2000 |month=December |pmid=11122139 |doi= |url=}}</ref> | ||
*The histology of GVHD in the intestine is the same as rejection in bowel transplantation.<ref>GT. 14 January 2011.</ref> | *The histology of GVHD in the intestine is the same as rejection in bowel transplantation.<ref>GT. 14 January 2011.</ref> | ||
Clinical: | Clinical: | ||
*May present as diarrhea. | *May present as diarrhea. | ||
*Main DDx (clinical): infection | *Main DDx (clinical): infection and certain drugs, especially mycophenolate | ||
==Microscopic== | |||
===Microscopic (skin)=== | ===Microscopic (skin)=== | ||
Features:<ref name=stanford>{{cite web |url=http://surgpathcriteria.stanford.edu/transplant/skinacutegvhd/printable.html |title=Acute Graft versus Host Disease of the Skin |last1= |first1= |last2= |first2= |date= |work= |publisher= |accessdate=January 17, 2011}}</ref> | Features:<ref name=stanford>{{cite web |url=http://surgpathcriteria.stanford.edu/transplant/skinacutegvhd/printable.html |title=Acute Graft versus Host Disease of the Skin |last1= |first1= |last2= |first2= |date= |work= |publisher= |accessdate=January 17, 2011}}</ref> | ||
#Keratinocyte apoptosis. | #Keratinocyte [[apoptosis]]. | ||
#*Intensely eosinophilic on [[H&E]]. | #*Intensely eosinophilic on [[H&E]]. | ||
#Epidermotropic lymphocytic infiltrate = lymphocytes in the epidermis. | #Epidermotropic lymphocytic infiltrate = lymphocytes in the epidermis. | ||
#Vacuolar degeneration of basal and suprabasal cells in the epidermis. | #Vacuolar degeneration of basal and suprabasal cells in the epidermis. | ||
Note: | |||
*Apoptotic cells should not be confused with dyskeratotic cells.<ref>{{cite web |url=http://dermatology.acvsc.org.au/dermatology_assets/documents/proc2007/acvs%20dermatology%20chapter%20proceedings%202007%20-%20nimmo%20-%20dyskeratotic,%20apoptotic%20or%20acantholytic%20keratinocytes.pdf |title=Dyskeratotic, apoptotic or acantholytic keratinocytes? How to differentiate these on histology and what meaning does this have to the disease in question |author=Judith S. Nimmo |date= |work= |publisher= |accessdate=17 January 2011}}</ref> | |||
====Grading<ref name=stanford/>==== | ====Grading<ref name=stanford/>==== | ||
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Notes: | Notes: | ||
*Neutrophils | *Neutrophils may be present. | ||
DDx: | |||
* | *Drug effect (mycophenolate mofetil) - cannot be distinguished from GVHD. | ||
====Grading<ref name=pmid20953169/>==== | ====Grading<ref name=pmid20953169/>==== | ||
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Notes: | Notes: | ||
*Low-grade rejection is a diagnosis that requires a careful examination, i.e. it is subtle. | *Low-grade rejection is a diagnosis that requires a careful examination, i.e. it is subtle. | ||
===Microscopic (liver)=== | |||
:See: ''[[Vanishing bile duct syndrome]]''. | |||
===Images=== | |||
<gallery> | |||
Image: apoptotic gastropathy intermed mag.jpg | Consistent with gastric GvHD (need to exclude mycophenolate as an alternative cause) - intermed mag. (WC) | |||
Image: apoptotic gastropathy high mag.jpg | Consistent with gastric GvHD - high mag. (WC) | |||
Image: Colonic graft-versus-host disease (high magnification).jpg | Colonic GvHD - high mag. (WC) | |||
Image: Skin graft versus host disease high mag 1.jpg | Skin GvHD - high mag. (WC) | |||
Image: Skin graft versus host disease high mag 1.jpg | Skin GvHD - high mag. (WC) | |||
</gallery> | |||
*[https://www.nature.com/articles/modpathol2010163/figures/1 GVHD grade 1-4 (nature.com)].<ref name=pmid20953169/> | |||
==See also== | ==See also== | ||
*[[Hematopoietic stem cell transplantation]]. | |||
*[[Small bowel]]. | *[[Small bowel]]. | ||
*[[Colon]]. | *[[Colon]]. | ||