title: [Skin biopsy in diagnosis of chronic graft-versus-host disease in patients after allogeneic haematopoietic stem cell transplantation: pathologist's point of view on quantitative scoring system].
abstract: BACKGROUND
  Pathology diagnosis of chronic graft-versus-host-disease (GVHD) after allogeneic haematopoietic stem cell transplantation (allo-HSCT) is an important issue in clinical follow-up, in spite of frequent difficulties in interpretation., related to dynamic changes occurring in the skin during the disease, as well as to sequelae of basic disease and immunosuppressive therapy. Recently presented Consensus NIH (National Health Institute, Bethesda, USA) of histopathologic (HP) analysis is still complex and intrinsically divergent, thus clinically difficult to implement.
  
  
  OBJECTIVE
  Analysis of clinical value of histological evaluation results of skin biopsy in children after allo-HSCT and its correlation with clinical status.
  
  
  METHODS
  Ten skin biopsies were taken from 7 patients (4 boys, 3 girls, age 3-15 years) after allo-HSCT (6 MFD, 1 MMUD) and analyzed after hematoxylin/eosine and immunohistochemical (CD3, CD45T, CD20) staining. Pathology analysis was based on commonly accepted criteria enabling simple and unambiguous interpretation. Results were compared with clinical data and indications for immunosuppressive therapy.
  
  
  RESULTS
  It was found that reliable and coherent interpretation can be made when following parameters were taken into account: 1. in epithelium: the presence of apoptosis, archetypical changes and vacuolar degeneration in the basilar layer, presence of CD3/CD45 in the epidermis; 2. in the dermis: the extent of collagenization, presence of melanophages and lymphocyte infiltrations; 3. in the eccrine glands epithelium: eccrine glands atrophy and presence of lymphocytes.
  
  
  CONCLUSIONS
  A new scoring system of skin biopsy analysis in patients with chronic GVHD based on the modified NIH Consensus was proposed. The preliminary clinical value of histological results was assessed. Skin biopsy evaluation based on limited qualitative and quantitative analysis of lymphocyte infiltrates together with studies on intensity of apoptosis, collagenization and archetypical changes is a valuable diagnostic method complementary to clinical records, enabling easier undertaking of therapeutic decisions.
authors.affiliation: Katedra i Klinika Pediatrii, Hematologii i Onkologii, Collegium Medicum im. Ludwika Rydygiera w Bydgoszczy, Uniwersytet im. Mikołaja Kopernika, ul. Curie-Skłodowskiej 9, 85-094 Bydgoszcz, Poland.
authors.forename: Dariusz
authors.initials: D
authors.lastname: Grzanka
authors.forename: Jan
authors.initials: J
authors.lastname: Styczyński
authors.forename: Robert
authors.initials: R
authors.lastname: Debski
authors.forename: Anna
authors.initials: A
authors.lastname: Krenska
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Pacholska
authors.forename: Andrzej I
authors.initials: AI
authors.lastname: Prokurat
authors.forename: Mariusz
authors.initials: M
authors.lastname: Wysocki
authors.forename: Andrzej
authors.initials: A
authors.lastname: Marszałek
mesh_terms: D000293:Adolescent; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology* / Q000473:pathology*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D012867:Skin / Q000473:pathology*; D014184:Transplantation, Homologous / Q000009:adverse effects