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[Histopathological diagnosis by skin biopsy]
1Department of Dermatology, Jikei University School of Medicine.
Nihon Rinsho. Japanese Journal of Clinical Medicine
|September 25, 1997
Summary
Early diagnosis of graft-vs-host disease (GVHD) via skin biopsy is crucial due to its poor prognosis. Histopathology reveals a lichenoid tissue reaction, but final diagnosis requires clinical correlation.
Area of Science:
- Dermatopathology
- Transplantation Immunology
Background:
- Post-transfusion graft-vs-host disease (GVHD) carries a poor prognosis, necessitating early and accurate diagnosis.
- Skin biopsy is a key diagnostic tool for identifying GVHD.
Purpose of the Study:
- To outline the essential histopathological findings of skin lesions in post-transfusion GVHD.
- To differentiate GVHD-related skin changes from other conditions with similar histopathology.
Main Methods:
- Histopathological examination of skin biopsies from patients with suspected GVHD.
- Analysis of characteristic features including lymphocytic infiltration, basal cell vacuolization, and dyskeratotic/necrotic keratinocytes.
- Correlation of histopathological findings with clinical symptoms.
Main Results:
- Skin lesions in GVHD exhibit lymphocytic infiltration at the dermo-epidermal junction with basal layer vacuolization.
- Scattered dyskeratotic or necrotic epidermal cells, some with satellite cell necrosis, are observed.
- These findings constitute a lichenoid tissue reaction, which is not exclusive to GVHD.
Conclusions:
- The histopathology of skin lesions in GVHD is characterized by a lichenoid tissue reaction.
- This reaction can also be present in drug eruptions, such as toxic epidermal necrolysis and erythema multiforme.
- A definitive diagnosis of GVHD requires integration of histopathological findings with clinical manifestations like liver dysfunction, diarrhea, and pancytopenia.