Abstract
ABSTRACTObjectiveTo validate the minimal criteria of the histopathologic diagnosis of oral chronic graft-versus-host disease, based on the histopathologic classification of the National Institutes of Health and correlate them with clinical features.MethodsForty-one specimens containing both oral mucosa and salivary glands were analyzed in slides stained with hematoxylin-eosin. The histological specimens were blindly examined by two trained pathologists using criteria recommended for the histopathologic diagnosis of chronic graft-versus-host disease proposed by the National Institutes of Health Consensus. The clinical classification of chronic graft-versus-host disease was correlated with analysis of slides.ResultsOur data showed that the epithelium was involved in 39/41 specimens, presenting acanthosis (29/70.7%), exocytosis of lymphocytes (29/70.7%), thickening of basal lamina (29/70.7%), and apoptosis (15/36.6%). Connective tissue presented interstitial inflammatory infiltrate (38/92.7%). Minor salivary glands showed periductal fibrosis (38/92.7%), mixed periductal inflammatory infiltrate (32/78%), ductal ectasia (30/73.2%), lymphocytes around and into acinar units (30/73.2%), and interstitial fibrosis (29/70.7%). The most common clinical manifestations were lichenoid aspect (40/97.6%), complaints of sensitivity to oral feeding (38/92.7%), and dry mouth sensation (36/87.8%).ConclusionThis study validated the National Institutes of Health Consensus of minimal histologic criteria for diagnosis of oral chronic graft-versus-host disease and has not found an association between the severity of clinical manifestation and the histopathological stage.
Highlights
IntroductionMain clinical features of oral Chronic graft-versus-host disease (cGVHD) include lichenoid changes, ulcerations and mucosal atrophy, salivary gland dysfunction, superficial mucoceles, reduced mouth opening due to sclerodermatous changes; and, perioral fibrosis.(4) Buccal mucosa and the lateral and ventral aspects of the tongue are commonly affected
Chronic graft-versus-host disease is the major cause of morbidity and mortality in patients undergoing allogenic hematopoietic stem cell transplantation (HSCT), affecting 30 to 50% of transplants(1) and 60 to 80% of long-term survivors(2) involving oral mucosa, skin, liver, gastrointestinal tract, and lymphoid system.(3) Oral mucosa can be the first site affected and its involvement may be seen in up to 80% of patients affected by cGVHD.(1)
In 2006, Shulman et al discussed the histopathological changes of cGVHD in several organs and suggested a new histopathological classification for this disease named according to the National Institutes of Health (NIH) Consensus’ classification(8) (Chart 2)
Summary
Main clinical features of oral cGVHD include lichenoid changes, ulcerations and mucosal atrophy, salivary gland dysfunction, superficial mucoceles, reduced mouth opening due to sclerodermatous changes; and, perioral fibrosis.(4) Buccal mucosa and the lateral and ventral aspects of the tongue are commonly affected. In 1995, suggested a histological grading of oral cGVHD ranging from grades I to IV according to the alterations in the oral mucosa and salivary glands(7) (Chart 1). In 2006, Shulman et al discussed the histopathological changes of cGVHD in several organs and suggested a new histopathological classification for this disease named according to the National Institutes of Health (NIH) Consensus’ classification(8) (Chart 2). Whereas Horn’s classification is a histological grading based on the degree of lymphocytic infiltration and destruction of glandular acini,(7) the NIH Consensus’ classification reflects the concept about the presence or absence of cGVHD by highlighting other histological features
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