The Pathology of Pulmonary Disease After Pediatric Hematopoietic Stem Cell Transplantation.

Autor:	Cortes-Santiago N; Department of Pediatrics, Section of Hematology, Baylor College of Medicine; Texas Children's Hospital, Houston, TX., Deutsch G; Department of Laboratory Medicine and Pathology, University of Washington School of Medicine; Department of Laboratories, Seattle Children's Hospital, Seattle, WA., Patel KR; Department of Pediatrics, Section of Hematology, Baylor College of Medicine; Texas Children's Hospital, Houston, TX., Silva-Carmona M; Department of Pediatrics, Division of Pulmonary Medicine, Baylor College of Medicine; Texas Children's Hospital, Houston, TX., Henderson C; Department of Pediatric Pulmonology, Emory University, Children's Healthcare of Atlanta, Atlanta, GA., Sartain SE; Department of Pediatrics, Section of Hematology, Baylor College of Medicine; Texas Children's Hospital, Houston, TX., Bhar S; Department of Pediatrics, Divisions of Hematology-Oncology and Critical Care Medicine, Pediatric Bone Marrow Transplantation and Cellular Therapy, Baylor College of Medicine; Texas Children's Hospital, Houston, TX., Pogoriler J; Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.
Jazyk:	angličtina
Zdroj:	The American journal of surgical pathology [Am J Surg Pathol] 2024 Oct 01; Vol. 48 (10), pp. 1201-1214. Date of Electronic Publication: 2024 Jul 29.
DOI:	10.1097/PAS.0000000000002267
Abstrakt:	Pulmonary complications continue to cause significant morbidity and mortality in posthematopoietic stem cell transplantation (HSCT) settings. The histopathology of pulmonary diseases in the post-HSCT context is poorly characterized, especially in the pediatric population. We sought to characterize the pathologic spectrum of pulmonary disease post-HSCT in a pediatric cohort. Fifty-six specimens, including 53 biopsy specimens, corresponding to 53 patients, were identified. Biopsy slides were reviewed and assigned to diagnostic categories (infectious, graft-versus-host disease, vasculopathy, indeterminate, and others) by consensus among 3 pediatric pulmonary pathologists, taking into consideration pathologic, clinical, radiologic, and laboratory findings. The most common diagnostic category was infection (n=20). Vasculopathy, mostly in the form of fibromyxoid intimal expansion, was very common in the entire cohort (n=26) and was the sole finding in a small subset of patients (n=5), with particularly poor outcomes. A subset of biopsies remained indeterminate (n=10), and the findings in this cohort were dominated by acute lung injury. The latter group had a poor prognosis, with a short biopsy-to-death interval. The overall clinicopathologic concordance was 40%, most commonly agreeing in the infectious category. Finally, wedge biopsies led to a change in management in 69% of cases versus 23% of limited procedures (i.e., core needle biopsies). Our results suggest that while infectious complications continue to be common post-HSCT, other findings such as vasculopathy and acute lung injury portend a particularly poor prognosis and should be actively sought and reported. Competing Interests: Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies in this article. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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