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Graft versus host-disease Grade II - Grade III of the stomach
Haematoxylin & Eosin (H&E)
61 years
The 61 year old male patient suffering from myeloma (IgA-kappa) was hospitalized after a second allogeneic hematopoietic stem-cell transplantation. In the course of the hospitalization he developed nausea, vomiting and obstipation. The patient had a history of intestinal graft versus host disease, cytomegalo-virus (CMV)-colitis as well as sepsis due to infection with enterococcus faecium and alternaria infectoria. The patient's condition did not improve after steroid treatment, thus a treatment-refractory graft versus host disease was diagnosed. Palliative care was initiated.
Mucosa of the gastric corpus and antrum showing a massive increase of the rate of apoptosis in glandular epithelial cells. Focal depiction of glands with numerous apoptotic figures resembling 'exploding crypts'. Apoptotic bodies are more numerous in the neck area of the glands. Dilated glands are present, some of them with accumulation of granular eosinophilic debris representing cytoplasm of sloughed gastric epithelial cells intermixed with nuclear debris. Glands are lined by attenuated, regenerative-appearing epithelial cells.
The histomorphologic findings correspond to the diagnosis of a graft versus host disease grade II – focally grade III acccording to Sale and Shulman.
Philipp Granacher, University of Basel
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