Cutaneous Graft versus Host Reaction: Clinicopathologic Study / 대한피부과학회지

BACKGROUND: Graft-versus-host disease(GVHD) frequently produces cutaneous and systemic complications in patients receiving allogenic bone marrow transplantation. Familiarity with these reactions and their treatment is important to dermatologists involved in the care of bone marrow transplant recipients. OBJECTIVE: Our purpose was to find the clinical and histopathological features of cutaneous graft versus host reaction(GVHR). METHODS: We retrospectively reviewed patients who had undergone cutaneous GVHR after allogenic bone marrow transplantation in our institute over ten years. RESULTS AND CONCLUSION: 1.We found GVHD in 40% patients with allogenic bone marrow transplantation. 2.There was cutaneous GVHR in 86.5%, liver GVHR in 44.2% and gastrointestinal systems involvement in 34.6% of all GVHD patients. 3.Acute cutaneous GVHR presented as a generalized maculopapular exanthem and chronic cutaneous GVHR appeared as generalized maculopapular eruptions or lichenoid lesions. 4.Histopathologically, in 65.4%(17/26) of acute GVHR showed characteristic changes such as basal cell degeneration, dyskeratotic cells in epidermis, spongiosis, subepidermal cleft, and inflammatory cell infiltration and in 78.3% of chronic GVHR revealed acute GVHR-like or lichenoid change. 5.Treatment of moderate to severe GVHD consisted of high-dose corticosteroids and cyclosporine. There were 23.1% mortality due to sepsis in GVHD patients.

A Histopathological Comparative Study between Erythema Multiforme and Acute Cutaneous Graft - versus - Host Reactions / 대한피부과학회지

BACKGROUND: The histopathological findings of acute cutaneous graft-versus-host reaction are similar to that of erythema multiforme. OBJECTIVE: The objective of this study was to compare the histopathological findings of acute cutaneous graft-versus-host reactions with that of erythema multiforme. METHODS: Histopathological setions of 9 patients with grade 2 acute cutaneous graft-versus- host. reactions and of 13 patient,, with erythema multiforme were reviewed. RESULTS: Parakeratosis, the degree of the exocytosis and the endothelial cell swelling were not useful in the differential diagnosis between acute cutaneous graft-versus-host reactions and ery- thema multiforme. Rete ridge effacement and relative hyperkeratosis were characteristic in many cases of acute cutaneous graft-versus-host reactions but absent in erythema multiforme. Spongiosis, vacuolar degeneration of the basal cells, perivascular lymphocytic infiltration and erythrocyte extravasation were usually more prominent in erythema multiforme than in acute cutaneous graft-versus-host reactions. The number of dyskeratotic cells per epidermal linear mm was usually higher in erythema multiforme but not in acute cutaneous graft-versus-host reactions. An eosinophilic infiltrate was observed occasionally in erythema multiforme but not in acute cutaneous graft-versus-host reactions. CONCLUSION: The histopathological findings show the same pattern of interface dermatitis and are different only in degree beween acute cutaneous graft-versus-host reactions and eryt,hema multiforrne. Rete ridge effacement and relative hyperkeratosis speaks for a diagnosis of acute cutaneous graft-versus-host reactions, and an eosinophilic infiltrate for a diagnosis of erythema multiforme.