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Mucosal Biopsy After Bone Marrow Transplantation.

Maria Westerhoff¹, Laura W Lamps²

¹Anatomic Pathology, University of Washington Medical Center, 1959 Northeast Pacific Street, BB 220, Seattle, WA 98195, USA.

Surgical Pathology Clinics

|November 7, 2017

Summary

Diagnosing graft-versus-host disease (GVHD) in stem cell transplant patients is complex. Histology can mimic infection or drug toxicity, requiring careful review of clinical data for accurate gastrointestinal biopsy interpretation.

Keywords:

Adenovirus Apoptosis Cytomegalovirus Diarrhea in immunocompromised patient Graft-versus-host disease Hematopoietic stem cell transplant Mycophenolate mofetil toxicity Neutropenic enterocolitis

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Area of Science:

Gastroenterology
Hematology
Transplantation Medicine
Pathology

Background:

Hematopoietic stem cell transplantation (HSCT) patients often require gastrointestinal biopsies.
Histologic features of graft-versus-host disease (GVHD) can overlap with other conditions like infection and drug toxicity.
Concurrent conditions are common in HSCT recipients.

Purpose of the Study:

To highlight the diagnostic challenges in interpreting gastrointestinal mucosal biopsies from HSCT patients.
To emphasize the importance of integrating histologic findings with clinical data for accurate diagnosis.
To advocate for standardized pathology reporting to guide clinical management.

Main Methods:

Review of histologic features of GVHD, infection, and drug toxicity in gastrointestinal biopsies.
Analysis of clinical factors including biopsy timing, medication history, and laboratory data.
Correlation of pathologic findings with patient outcomes.

Main Results:

Histologic overlap between GVHD, infection, and drug toxicity complicates diagnosis.
Accurate diagnosis requires comprehensive evaluation of clinical context.
Multiple pathologies can coexist, further increasing diagnostic complexity.

Conclusions:

Interpreting gastrointestinal biopsies in HSCT recipients necessitates a multidisciplinary approach.
Thorough clinical correlation is crucial for differentiating GVHD from other conditions.
Standardized pathology reporting is essential for effective patient management and treatment decisions.