Dermatopathology Case 85
There is poor correlation between the
biopsy finding following transplantation and clinical severity of the
disease and biopsy is of limited value in predicting the progression
of the lesion to higher grade GVHD.
Grade 0 - normal ;
Grade 1 - basal vacuolar change ;
Grade 2 - dyskeratotic cell in epidermis and lymphocytic infiltrate ;
Grade 3 - formation of clefts & microvescicles;
Grade 4 - separation of epidermis from dermis ;
lymphocytic infiltrate in the upper dermis.
Scattered shrunken, degenerate keratinocytes throughout the epidermis.
Keratocytes have pyknotic nucleus , eosinophilic and hyalinized
cytoplasm and are accompanied by one or more lymphocytes known as
"satellite cell necrosis".
In severe cases the appearances are those of
Differential diagnosis: Subacute radiation dermatitis,
Early lichenoid phase
greatly resemble lichen planus -
- satellite cell necrosis in the epidermis,
- degeneration of basal cell layer,
- mononuclear cell infiltrate immediately below the epidermis,
- prominent pigment incontinence
- In case of follicular papules the
features resemble those of lichen planopilaris.
- Rarely 'columnar epidermal
necrosis' is noted.
Late sclerodermoid phase-
- Atrophy of epidermis.
- Basal layer vacuolar degeneration.
- Eosinophilic body formation rare or absent.
- Thickened or hyalinized collagen bundles which extends into
- Atrophy of adnexal structures due to dermal fibrosis.
IgM and C3 in colloid bodies. Granular or linear deposition of IgM in
the basement membrane zone is often present.