title: Histopathologic diagnosis of chronic graft-versus-host disease of the oral mucosa according to the National Institutes of Health Consensus.
abstract: OBJECTIVE
  To validate the minimal criteria of the histopathologic diagnosis of oral chronic graft-versus-host disease, based on the histopathologic classification of the National Institutes of Health and correlate them with clinical features.
  
  
  METHODS
  Forty-one specimens containing both oral mucosa and salivary glands were analyzed in slides stained with hematoxylin-eosin. The histological specimens were blindly examined by two trained pathologists using criteria recommended for the histopathologic diagnosis of chronic graft-versus-host disease proposed by the National Institutes of Health Consensus. The clinical classification of chronic graft-versus-host disease was correlated with analysis of slides.
  
  
  RESULTS
  Our data showed that the epithelium was involved in 39/41 specimens, presenting acanthosis (29/70.7%), exocytosis of lymphocytes (29/70.7%), thickening of basal lamina (29/70.7%), and apoptosis (15/36.6%). Connective tissue presented interstitial inflammatory infiltrate (38/92.7%). Minor salivary glands showed periductal fibrosis (38/92.7%), mixed periductal inflammatory infiltrate (32/78%), ductal ectasia (30/73.2%), lymphocytes around and into acinar units (30/73.2%), and interstitial fibrosis (29/70.7%). The most common clinical manifestations were lichenoid aspect (40/97.6%), complaints of sensitivity to oral feeding (38/92.7%), and dry mouth sensation (36/87.8%).
  
  
  CONCLUSIONS
  This study validated the National Institutes of Health Consensus of minimal histologic criteria for diagnosis of oral chronic graft-versus-host disease and has not found an association between the severity of clinical manifestation and the histopathological stage.
authors.affiliation: Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, SP, Brazil.
authors.forename: Paulo Sérgio da Silva
authors.initials: PS
authors.lastname: Santos
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Fábio Luiz
authors.initials: FL
authors.lastname: Coracin
authors.affiliation: Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.
authors.forename: José Carlos de Almeida
authors.initials: JC
authors.lastname: Barros
authors.affiliation: Faculdade de Odontologia, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Marina Helena Cury
authors.initials: MH
authors.lastname: Gallottini
mesh_terms: D001706:Biopsy; D002908:Chronic Disease; D032921:Consensus; D006086:Graft vs Host Disease / Q000145:classification / Q000150:complications / Q000473:pathology*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D009061:Mouth Mucosa / Q000473:pathology; D009316:National Institutes of Health (U.S.); D012466:Salivary Gland Diseases / Q000473:pathology*; D014481:United States