Figure 3
Figure 3. Resolution of dermal fibrosis after HDIT and autologous HCT. Full-thickness skin biopsies from patient no. 11, collected at baseline and then at 1 and 5 years after HDIT, were histologically evaluated (H&E). The skin biopsies performed after HDIT were performed at a site adjacent to the baseline skin biopsy. The biopsies in the left-hand column were taken at original magnification × 5, and those in the right-hand column were taken at original magnification × 20. All sections were stained with H&E. (A) Skin biopsy was obtained before HDIT and autologous HCT. Pandermal sclerosis from the dermal-epidermal border to the hypodermis (subcutaneous fat) was observed. The epidermis is mildly acanthotic (thickened) with loss of rete ridges. The reticular dermis is replaced by dense compact collagen without normal fascicular bundles or dermal appendages. This pretransplantation skin biopsy was determined as grade 5 dermal fibrosis. The thickness of the dermis was measured at more than 2 mm. (B) In the higher-power magnification, the straightened dermal-subcutaneous border demonstrates the abnormal, densely packed, homogenized collagen. (C) The skin biopsy at 1 year after HDIT was determined to be a grade 2 dermal fibrosis and has less fibrosis than at baseline. The low-power magnification view shows crowded collagen fascicles with focal areas of residual thickened bundles. (D) A higher-power view of the 1-year skin biopsy from panel C shows thin and collagen bundles admixed with residual thick straightened hypereosinophilic collagen bundles without dense homogenization at baseline. The residual eccrine unit lacks any surrounding adipose tissue. (E) The skin biopsy at 5 years shows complete resolution of the dermal fibrosis (grade 0) with a reduction in the thickness of the dermis from baseline to 1 mm. The collagen bands in the dermis are thin with a relative increase in the intervening extracellular matrix (space between the collagen bands). The dermal-epidermal border remains straightened with loss of rete ridges. (F) A higher-power view of collagen in the lower reticular dermis demonstrates the change to thin wavy bundles separated by increased ground substance. See “Patients and methods; Assessment of skin biopsies” for more information on images.

Resolution of dermal fibrosis after HDIT and autologous HCT. Full-thickness skin biopsies from patient no. 11, collected at baseline and then at 1 and 5 years after HDIT, were histologically evaluated (H&E). The skin biopsies performed after HDIT were performed at a site adjacent to the baseline skin biopsy. The biopsies in the left-hand column were taken at original magnification × 5, and those in the right-hand column were taken at original magnification × 20. All sections were stained with H&E. (A) Skin biopsy was obtained before HDIT and autologous HCT. Pandermal sclerosis from the dermal-epidermal border to the hypodermis (subcutaneous fat) was observed. The epidermis is mildly acanthotic (thickened) with loss of rete ridges. The reticular dermis is replaced by dense compact collagen without normal fascicular bundles or dermal appendages. This pretransplantation skin biopsy was determined as grade 5 dermal fibrosis. The thickness of the dermis was measured at more than 2 mm. (B) In the higher-power magnification, the straightened dermal-subcutaneous border demonstrates the abnormal, densely packed, homogenized collagen. (C) The skin biopsy at 1 year after HDIT was determined to be a grade 2 dermal fibrosis and has less fibrosis than at baseline. The low-power magnification view shows crowded collagen fascicles with focal areas of residual thickened bundles. (D) A higher-power view of the 1-year skin biopsy from panel C shows thin and collagen bundles admixed with residual thick straightened hypereosinophilic collagen bundles without dense homogenization at baseline. The residual eccrine unit lacks any surrounding adipose tissue. (E) The skin biopsy at 5 years shows complete resolution of the dermal fibrosis (grade 0) with a reduction in the thickness of the dermis from baseline to 1 mm. The collagen bands in the dermis are thin with a relative increase in the intervening extracellular matrix (space between the collagen bands). The dermal-epidermal border remains straightened with loss of rete ridges. (F) A higher-power view of collagen in the lower reticular dermis demonstrates the change to thin wavy bundles separated by increased ground substance. See “Patients and methods; Assessment of skin biopsies” for more information on images.

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