| MICROSCOPIC
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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.
Grading:
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 ;
Acute Phase:
Sparse, diffuse
lymphocytic infiltrate in the upper dermis.
Extensive exocytosis
Basal vacuolation
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
toxic epidermal
necrolysis.
Differential diagnosis: Subacute radiation dermatitis,
drug eruption.
Chronic phase:
Early lichenoid phase
greatly resemble lichen planus -
- acanthosis,
- 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.
Pubmed
Late sclerodermoid phase-
- Atrophy of epidermis.
- Basal layer vacuolar degeneration.
- Eosinophilic body formation rare or absent.
- Thickened or hyalinized collagen bundles which extends into
the subcutis.
- Atrophy of adnexal structures due to dermal fibrosis.
Immunofluorescence:
IgM and C3 in colloid bodies. Granular or linear deposition of IgM in
the basement membrane zone is often present.
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