Oral Manifestations of Chronic Graft-versus-host Disease: A clinicopathological study

Fourteen patients with oral chronic graft-versus-host disease (GVHD) who received allogenic bone marrow transplantation were clinically and histopathologically studied. Most patients had lichenoid lesions on the oral mucosa and xerostomia. Two patients displayed multiple superficial mucoceles of the buccal mucosa as vesicular lesions. These clinical features resembled those of autoimmune diseases, such as lichen planus and Sjogren's syndrome. Histopathologically, all cases showed oral mucosal and minor salivary gland involvement characteristic of chronic GVHD, irrespective of the presence or absence of systemic lesions. The oral mucosa showed subepithelial lymphocytic infiltration with epithelial recessive changes, and the minor salivary glands displayed inflammatory changes or fibrosis with destructive alteration of epithelial cells. Immunohistochemically, CD3-positive cells were more numerous than CD79α-positive cells in the oral mucosa, while CD3- and CD79α-positive cells were equally observed in the minor salivary glands. CD4- and CD8-positive cells were detected equally in both the oral mucosa and the minor salivary glands. CD1a- and CD68-positive cells were scattered throughout the oral mucosa and the minor salivary glands. Cellular and humoral immune systems may differ between the oral mucosa and salivary glands in patients with chronic GVHD. CD1a- and CD68-positive cells may play a role in antigen presentation in oral lesions involved in chronic GVHD.