Genital manifestation of graft-vs.-host disease: a series of case reports.
BACKGROUND
After hematopoietic stem cell transplantation (HSCT), many patients present genital graft-vs.-host disease (GVHD) that can culminate with sexual problems, which are poorly dimensioned.


OBJECTIVE
We hope to draw attention to the need to perform genital biopsy to diagnose genital GVHD, and thus to call attention to the need to incorporate careful attention to sexual health in the treatment of these patients.


METHODS
Five allogeneic stem cell transplant recipients complaining of coital pain after HSCT were clinically diagnosed for genital GVHD. Genital biopsies were given for histological analysis, and microphotographs of the corresponding marked field in the slide were taken. Specimens were evaluated by the site pathologist and then sent to a reference pathologist, each blinded to the histological findings. A literature search was performed in PubMed/MEDLINE (1966-2009) for cross-sectional and cohort studies or trials related to genital GVHD. Expert opinions peer reviews and case reports were also considered.


METHODS
HSCT, genital GVHD, genital biopsy.


RESULTS
The biopsy showed evidence of dilated apoptotic cells in the basal layer and detachment of the epithelial lining of the mucosa, hyalinization and thickening of collagen fibers, capillary ectasia, and mononuclear inflammatory infiltrate of the submucosa. Three patients presented vulval lesion such as leucoplasia and ulcer on the large lip. Histological analyses showed evidence of epithelial hyperplasia and influx of inflammatory cells to the epithelial surface, intercellular edema and spongiosis, apoptotic bodies on the basal layer of the epithelium, spongiosis, and nuclear vacuolization. A common treatment based on corticotherapy resulted in complete remission of coetaneous or mucous genital lesions in all five patients.


CONCLUSIONS
Genital biopsy is important to differentially diagnose GVHD and secondary symptoms due to hypoestrogenism. Prevention is the most important step in controlling the evolution GVHD in the vagina to prevent vaginal obstruction and sexual dysfunction.
Lara
Lúcia Alves da Silva
LA
Sexual Medicine Service of Human Reproduction Sector, Department of Gynaecology and Obstetrics, Faculty of Medicine of Ribeirão Preto, São Paulo University, Ribeirão Preto, SP, Brazil. luciaalvess@yahoo.com.br
De Andrade
Jurandyr Moreira
JM
Mauad
Lenira Maria Queiroz
LM
Ferrarese
Sany Rose
SR
Marana
Heitor Ricardo Cosiski
HR
Tiezzi
Daniel Guimarães
DG
De Sá Rosa e Silva
Ana Carolina Japur
AC
D000328:Adult; D017209:Apoptosis; D001706:Biopsy; D004414:Dyspareunia / Q000209:etiology; D004848:Epithelium / Q000473:pathology; D005260:Female; D006086:Graft vs Host Disease / Q000175:diagnosis*; D006801:Humans; D006965:Hyperplasia / Q000276:immunology; D033581:Stem Cell Transplantation; D014184:Transplantation, Homologous; D014617:Vacuoles / Q000473:pathology; D014623:Vaginal Diseases / Q000276:immunology* / Q000473:pathology; D014845:Vulvar Diseases / Q000276:immunology* / Q000473:pathology