Histologic Features of Intestinal Thrombotic Microangiopathy in Pediatric and Young Adult Patients after Hematopoietic Stem Cell Transplantation Javier.

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Presentation transcript:

Histologic Features of Intestinal Thrombotic Microangiopathy in Pediatric and Young Adult Patients after Hematopoietic Stem Cell Transplantation Javier El-Bietar, Mikako Warren, Christopher Dandoy, Kasiani C. Myers, Adam Lane, Gregory Wallace, Stella M. Davies, Sonata Jodele Biology of Blood and Marrow Transplantation Volume 21, Issue 11, Pages 1994-2001 (November 2015) DOI: 10.1016/j.bbmt.2015.06.016 Copyright © 2015 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 1 Histologic samples showing mucosal hemorrhage (H&E, biopsies from 4 iTMA patients, A-C: colon, original magnification ×100, ×400, ×600, respectively, D: stomach, ×400). (A) Patchy distribution of fragmented RBC extravasation located at and/or close to the disrupted capillaries in the lamina propria. (B-C) Capillaries demonstrate fragmented RBC extravasation with partial (B, black arrow) and total (C, clear arrow) disruption of the wall. (D) Hemosiderin deposits (stained brown) and hemosiderin-laden macrophages represent remote mucosal hemorrhage. Nikon Eclipse 80i, 10x/0.30, 40x/0.75, 60x/0.85, Diagnostic Instruments 14.2 Color Mosaic, Spot software. Biology of Blood and Marrow Transplantation 2015 21, 1994-2001DOI: (10.1016/j.bbmt.2015.06.016) Copyright © 2015 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 2 Histologic samples showing loss of glands and mucosal denudation (H&E, biopsies from 3 iTMA patients, A-B: colon, original magnification ×100, C: colon, original magnification ×200). (A-C) The surface epithelium is denuded. The lamina propria shows significant (> 50%) gland loss, appears fibrotic (B, asterisk), and is partially replaced by regenerated epithelium (C, black arrows). Nikon Eclipse 80i, 10x/0.30, 20/0.75, Diagnostic Instruments 14.2 Color Mosaic, Spot software. Biology of Blood and Marrow Transplantation 2015 21, 1994-2001DOI: (10.1016/j.bbmt.2015.06.016) Copyright © 2015 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 3 Histologic samples showing intraluminal schistocytes, fibrin and microthrombi as well as endothelial cell swelling and separation. (A-B) Intraluminal schistocytes (H&E, biopsies from 2 iTMA patients, colon, original magnification ×400). Fragmented and degenerated RBCs (asterisk) are present within the capillaries. (C-D) Intraluminal fibrin (H&E, biopsies from 2 iTMA patients, C: esophagus, original magnification ×400, D: colon, original magnification ×400). Capillaries demonstrate fibrin debris in the lumen. Note the fibrin is present in the space between separated endothelial cells (black arrows) and the basement membrane. (E-F) Intraluminal microthrombi (H&E, biopsies from 2 iTMA patients, colon, original magnification ×400). Capillaries are totally occluded by fibrin (clear arrow). (G) Endothelial cell swelling (H&E, biopsies from 2 iTMA patients, colon, original magnification ×400). Capillaries are lined by endothelial cells (asterisk) with enlarged nuclei > 3 times wider than the normal nuclei. (H) Endothelial cell separation (H&E, biopsies from 2 iTMA patients, colon, original magnification ×400). The endothelial cells are separated from the basement membrane (double arrow). Nikon Eclipse 80i, 40x/0.75, Diagnostic Instruments 14.2 Color Mosaic, Spot software. Biology of Blood and Marrow Transplantation 2015 21, 1994-2001DOI: (10.1016/j.bbmt.2015.06.016) Copyright © 2015 American Society for Blood and Marrow Transplantation Terms and Conditions