The changes in acute graft-versus-host disease may be seen in many organs, but often are best seen in the skin, liver, and gastrointestinal tract. Biopsy of these organs can may show a spectrum of histopathologic changes which correlate with the clinical severity of the disease.
Skin Biopsy |
Grade |
normal histology, or changes due to other conditions |
0 |
vacuolar degeneration and/or necrosis of basal layer |
1 |
spongiosis, dyskeratosis, eosinophilic necrosis of epithelial cells |
2 |
focal microscopic epidermal-dermal separation |
3 |
frank epidermal loss |
4 |
Confirmation of diagnosis: The presence of a mononuclear cell infiltrate involving the epidermis or hair follicle epithelium. There is usually a superficial perivascular infiltrate of lymphocytes with exocytosis into the lower half of the epidermis.
(1) A few patients may show no inflammatory reaction, and in others the infiltrate is very light.
(2) Vacuolar alteration and dyskeratosis without an inflammatory infiltrate may occur due to the chemotherapy itself, but this effect tend to disappear 1-2 weeks after therapy.
(3) Radiation therapy may causes mild edema, a mononuclear infiltration of the papillary dermis, spongioisis, mild vacuolization of the basal layer of the skin and occasional dyskeratotic epidermal cells. These changes tend to disappear 1-2 weeks after the radiation exposure.
(4) Drug reactions may cause changes similar to mild GVHD.
(5) If the diagnosis is in doubt, rebiopsy of several sites over time may be needed to make or exclude the diagnosis.
Liver Biopsy |
Grade |
normal histology or changes due to other conditions |
0 |
< 25% abnormal small interlobular bile ducts (atypical degeneration and/or necrosis) |
1 |
25 - 50% |
2 |
50 - 75% |
3 |
> 75% |
4 |
Differential diagnosis of changes in the liver biopsy:
(1) Viral hepatitis with cholangiolytic change may be very difficult to distinguish from GVHD. In viral hepatitis there ballooning degeneration of hepatocytes, while in GVHD there is eosinophilic degeneration of single cells and/or dropout of single or small groups of hepatocytes.
(2) Drug reactions may be confused with mild GVHD.
Gastrointestinal Tract Mucosal Biopsy |
Grade |
normal histology o changes due to other conditions |
0 |
dilatation of glands; single cell necrosis of epithelial cells |
1 |
necrosis and dropout of entire glands |
2 |
focal microscopic mucosal denudation/ulceration |
3 |
diffuse microscopic mucosal denudation/ulceration |
4 |
Differential diagnosis of changes in the gastrointestinal tract:
(1) High dose chemotherapy or radiation therapy may cause changes in the intestinal tract similar to mild GVHD, but this effect tends to disappear after 7-10 days.
(2) Severe viral infections may mimic GVHD reactions.
Purpose: To identify the histologic changes in skin, liver and intestinal biopsies seen with acute graft-versus-host disease (GVHD).
Specialty: Immunology/Rheumatology
Objective: laboratory tests, disease progression, complication detection
ICD-10: T86,