title: Histologic findings in lung biopsies in patients with suspected graft-versus-host disease.
abstract: The histopathologic features of pulmonary graft-versus-host disease (GVHD) status post-bone marrow transplant are not well described. Lung biopsies from patients with clinically suspected GVHD were studied. There were 17 biopsies from 9 men and 5 women. Alveolar changes were classified as acute lung injury with intra-alveolar fibrin, organizing pneumonia (OP), and chronic interstitial pneumonia (CIP). Intraepithelial bronchiolar T cells were increased in 16 of 17 biopsies within bronchiolar mucosa (56 ± 30 per 100 epithelial cells). Atypical pneumocytes were present in 10 biopsies, and atypia was marked in 2 biopsies. Reactive bronchiolar cells were also seen in all 3 groups and showed mild atypia in 5 and marked atypia in 1, mimicking viral cytopathic effect. Apoptosis of bronchiolar epithelium and interstitium was seen in all but 1 case and was most marked in the acute injury and OP patterns. Perivenular cuffing was present in 11 of 17 biopsies. All 3 patients with acute injury died of acute respiratory distress syndrome; 1 patient with OP died of systemic GVHD; and 1 patient with CIP pattern died of opportunistic infection. Obstructive lung disease with obliterative bronchiolitis developed in 3 patients, all of whom stabilized with treatment and were alive at last follow-up (mean, 25 months). All 3 histologic patterns of pulmonary GVHD are characterized by intrabronchiolar T cells, apoptosis, and perivenulitis, which help to distinguish GVHD from infections. The acute lung injury pattern has a poor prognosis, and bronchiolitis obliterans syndrome develops in a subset of patients with CIP histologic pattern.
authors: Department of Pathology, University of Maryland Medical Center, Baltimore MD 21201, USA.
authors: Lauren
authors: L
authors: Xu
authors: Cinthia
authors: C
authors: Drachenberg
authors: Fabio
authors: F
authors: Tavora
authors: Allen
authors: A
authors: Burke
mesh_terms: D055371:Acute Lung Injury / Q000209:etiology / Q000473:pathology*; D000328:Adult; D000368:Aged; D017209:Apoptosis; D001706:Biopsy; D055745:Bronchioles / Q000473:pathology; D002908:Chronic Disease; D005260:Female; D006086:Graft vs Host Disease / Q000150:complications / Q000473:pathology*; D006801:Humans; D008168:Lung / Q000473:pathology*; D017563:Lung Diseases, Interstitial / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000473:pathology*; D020545:Respiratory Mucosa / Q000473:pathology; D012189:Retrospective Studies