Graft-vs.-Host Disease

 Immunosuppressed recipient cannot destroy donor cells






Clinical Issues




• Represents major hepatic complication after stem cell transplant

• Common presenting signs are jaundice and hepatomegaly

• Elevated serum alkaline phosphatase and bilirubin

• Variably elevated transaminases


Microscopic




• Bile duct epithelial cell damage is key distinguishing feature
image Epithelial cell vacuolization and attenuation

image Withering, sloughing, and necrosis of biliary epithelial cells

image Lymphocytic infiltration

image Ductopenia with progression to chronic disease

• Portal inflammation is typically mild

• Endotheliitis in some cases

• Other nonspecific changes include cholestasis, lobular inflammation and hepatocyte swelling

• Acute hepatitis pattern also described

• Chronic graft-vs.-host disease features ductopenia, fibrosis

• Histologic findings may be focal

image
Bile Duct Injury in GVHD
Mild portal inflammation image and bile duct damage are seen in this case of hepatic graft-vs.-host disease (GVHD). The biliary epithelial cells are irregular and unevenly spaced image and show cytoplasmic vacuolization image. The duct lumen is irregular as well. These are all features of biliary epithelial damage.


image
Bile Duct Epithelial Cell Injury
Bile duct epithelial cell nuclei are pleomorphic, varying in size and polarity, and unevenly spaced image in this case of GVHD. There is cytoplasmic vacuolization. The portal inflammation is mild.

image
Injured Bile Duct
This case of GVHD shows mild portal inflammation and biliary epithelial cell injury image. The brown pigment indicates iron overload, which is often seen image in stem cell transplant recipients. The portal inflammation is mild.

image
Mild Cholestasis
H&E-stained slide shows nonspecific lobular changes seen in GVHD, including cholestasis image, mild inflammation, and hepatocyte swelling.


TERMINOLOGY


Abbreviations




• Graft-vs.-host disease (GVHD)


Synonyms




• “Vanishing bile duct syndrome” has been used as synonym, but is not specific term
image Refers to loss of bile ducts in chronic GVHD, drug-related cholangitis, or allograft rejection


Definitions




• Attack of immunocompetent, donor-derived cells against recipient tissues
image Usually occurs in bone marrow transplant or hematopoietic stem cell transplant recipients

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  4. Biliary Atresia

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Apr 20, 2017 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Graft-vs.-Host Disease

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