Abstract
Bronchiolitis obliterans (BO) is one of the serious, noninfectious pulmonary complications after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Early diagnosis of BO is usually difficult because patients are often asymptomatic at an initial stage of the disease and pathologic findings are available mostly at the late stages. Therefore, the diagnosis of the disease is based on the pulmonary function test using the National Institute of Health consensus criteria. Here, we report a case of slowly progressive BO. A biopsy specimen at an early stage demonstrated alveolar destruction with lymphocyte infiltration in bronchial walls and mild narrowing of bronchioles without fibrosis, those were strongly indicative of initial pathologic changes of BO. Definitive BO followed, which was proven by both clinical course and autopsy. While alloreactive lymphocytes associated with chronic graft-versus-host disease are believed to initiate BO, we present a rare case that directly implies such a scenario.
Highlights
The pathogenesis of bronchiolitis obliterans (BO), a serious complication of allogeneic hematopoietic stem cell transplantation, is still unclear, whereas association with the presence of chronic graft-versus-host disease (GVHD) has been repeatedly documented [1]
We report a case of slowly progressive BO that reached the end stage 10 years after allo-HSCT
Several reports have suggested that the pathogenesis of BO is strongly associated with the presence of chronic GVHD and graft-versus-leukemia effect (GVL) [3]
Summary
Pathologic Findings of Bronchiolitis Obliterans after Allogeneic Hematopoietic Stem Cell Transplantation: A Proposal from a Case. Bronchiolitis obliterans (BO) is one of the serious, noninfectious pulmonary complications after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Diagnosis of BO is usually difficult because patients are often asymptomatic at an initial stage of the disease and pathologic findings are available mostly at the late stages. The diagnosis of the disease is based on the pulmonary function test using the National Institute of Health consensus criteria. A biopsy specimen at an early stage demonstrated alveolar destruction with lymphocyte infiltration in bronchial walls and mild narrowing of bronchioles without fibrosis, those were strongly indicative of initial pathologic changes of BO. While alloreactive lymphocytes associated with chronic graftversus-host disease are believed to initiate BO, we present a rare case that directly implies such a scenario
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