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Master Thesis

Apport de l'étude anatomopathologique au diagnostic de maladie du greffon contre l'hôte digestive : résultats d'une série unicentrique rétrospective de 112 patients allogreffés

Abstract : Background: Gastrointestinal (GI) graft versus host disease (GVHD) is a common and severe complication of allogeneic hematopoietic stem cell transplantation. Its symptoms and histological features are not specific; therefore the diagnosis may be difficult for pathologists and clinicians. Material and methods: In a retrospective study of 112 transplanted patients with clinically suspected GI GVHD, colonic biopsies were independently reviewed by three pathologists and classified in 4 grades according to the NIH Consensus Project recommendations: no GVHD, possible GVHD, probable GVHD and unequivocal evidence of GVHD. Results have then been compared with definitive clinical diagnosis. The goal of this study was to evaluate the contribution of pathological assessment for positive and differential diagnosis of GVHD. Results: Clinical diagnosis of GI GVHD was established for 70 patients (62.5%). The histological grades correlated well with the clinical diagnosis (p<0.001) and particularly with the prognosis, differentiating good and poor prognosis (p<0.05). Overall survival dropped sharply when severe lesions were observed. Apoptotic bodies were 20 times more numerous in GVHD group (p<0,0001). None of the suggested features to support GVHD diagnosis, such as eosinophils count, endocrine cells aggregates and immunohistochemical analysis (Cytomegalovirus, CD123, Chromogranin), was confirmed. Interobserver disagreement was observed only for 12 cases (4 of them had concurrent infection, and 2 were poor quality samples). Conclusion: Rigorous pathologic analysis of H&E slides without immunohistochemistry remains a strong and reproducible tool to diagnose GI GVHD, always in consideration of clinical and biological information. Histological grading proved to be a powerful prognostic factor, and could be divided in 2 or 3 groups instead of 4. Finally, we suggest a simple tool (decision tree) to support the interpretation of these biopsies.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01347085
Contributor : Bu Carreire Université de Bordeaux <>
Submitted on : Wednesday, July 20, 2016 - 12:09:18 PM
Last modification on : Wednesday, August 23, 2017 - 4:32:41 PM

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Fanny Sauvestre. Apport de l'étude anatomopathologique au diagnostic de maladie du greffon contre l'hôte digestive : résultats d'une série unicentrique rétrospective de 112 patients allogreffés . Médecine humaine et pathologie. 2016. ⟨dumas-01347085⟩

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