INTRODUCTION: 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. AIM: 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. MAIN OUTCOME MEASURES: 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. CONCLUSION: 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.
INTRODUCTION: 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. AIM: 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. MAIN OUTCOME MEASURES: 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. CONCLUSION: 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.
Authors: Rachel Phelan; Annie Im; Rebecca L Hunter; Yoshihiro Inamoto; Maria Teresa Lupo-Stanghellini; Alicia Rovo; Sherif M Badawy; Linda Burns; Hesham Eissa; Hemant S Murthy; Pinki Prasad; Akshay Sharma; Elizabeth Suelzer; Vaibhav Agrawal; Mahmoud Aljurf; Karen Baker; Grzegorz W Basak; David Buchbinder; Zachariah DeFilipp; Lana Desnica Grkovic; Ajoy Dias; Hermann Einsele; Michael L Eisenberg; Narendranath Epperla; Nosha Farhadfar; Arthur Flatau; Robert Peter Gale; Hildegard Greinix; Betty K Hamilton; Shahrukh Hashmi; Peiman Hematti; Kareem Jamani; Dipnarine Maharaj; John Murray; Seema Naik; Sunita Nathan; Steven Pavletic; Zinaida Peric; Drazen Pulanic; Richard Ross; Andrea Salonia; Isabel Sanchez-Ortega; Bipin N Savani; Tal Schechter; Ami J Shah; Stephanie M Smith; John A Snowden; Amir Steinberg; Douglas Tremblay; Sarah C Vij; Lauren Walker; Daniel Wolff; Jean A Yared; Hélène Schoemans; André Tichelli Journal: Transplant Cell Ther Date: 2021-10-29
Authors: Rachel Phelan; Annie Im; Hélène Schoemans; André Tichelli; Rebecca L Hunter; Yoshihiro Inamoto; Maria Teresa Lupo-Stanghellini; Alicia Rovo; Sherif M Badawy; Linda Burns; Hesham Eissa; Hemant S Murthy; Pinki Prasad; Akshay Sharma; Elizabeth Suelzer; Vaibhav Agrawal; Mahmoud Aljurf; Karen Baker; Grzegorz W Basak; David Buchbinder; Zachariah DeFilipp; Lana Desnica Grkovic; Ajoy Dias; Hermann Einsele; Michael L Eisenberg; Narendranath Epperla; Nosha Farhadfar; Arthur Flatau; Robert Peter Gale; Hildegard Greinix; Betty K Hamilton; Shahrukh Hashmi; Peiman Hematti; Kareem Jamani; Dipnarine Maharaj; John Murray; Seema Naik; Sunita Nathan; Steven Pavletic; Zinaida Peric; Drazen Pulanic; Richard Ross; Andrea Salonia; Isabel Sanchez-Ortega; Bipin N Savani; Tal Schechter; Ami J Shah; Stephanie M Smith; John A Snowden; Amir Steinberg; Douglas Tremblay; Sarah C Vij; Lauren Walker; Daniel Wolff; Jean A Yared Journal: Bone Marrow Transplant Date: 2022-05-06 Impact factor: 5.174
Authors: Karen L Syrjala; Hélène Schoemans; Jean C Yi; Shelby L Langer; Ahona Mukherjee; Lynn Onstad; Stephanie J Lee Journal: Transplant Cell Ther Date: 2020-09-29