Talk:Heart transplant pathology

Biopsy - benign

Microscopic

The biopsy sample is adequate to pathologically evaluate acute cellular rejection activity. There is microcopic focal endomyocardial fibrosis which may represent the site of a previous biopsy. One small lymphocytic infiltrate is seen superficially (Quilty effect). Inflammation of the myocardium is not appreciated. Edema of the myocardium is not appreciated. Myocardial vessels are unremarkable.

Final diagnosis

Heart allograft, endomyocardial biopsies x 5 - ISHLT Grade 0, no evidence of acute cellular rejection, with:

i) AMR - 0 (by ordinary light microscopy)

ii) endomyocardial fibrosis, focal

iii) endocardial lymphocytic infiltrate (Quilty effect), small

Biopsy - mild cellular 1

Microscopic

The sections show endomyocardium that is of sufficient size to evaluate for acute cellular rejection activity and has multiple myocardial scars. There are focal, sparse lymphocytic infiltrates adjacent to the scar tissue, which is consistent with old biopsy sites. Most blood vessels appear histomorphologically normal; however, there is focal, mild vascular swelling with perivascular edema and lymphocyte margination. There is no evidence of post transplant lymphoproliferative disease.

Final diagnosis

Heart allograft, endomyocardial biopsies x 7 - ISHLT Grade 1R, acute cellular rejection, focal, mild.

Biopsy - mild cellular 2

Microscopic

The sections show endomyocardium that is of sufficient size to evaluate for acute cellular rejection activity. There are focal, lymphocytic infiltrates adjacent to blood vessels with reactive endothelium. No myocyte necrosis is identified. No perivascular edema is evident. The myocardium has multiple scars, shows reactive hypertrophy with nuclear enlargement, and has lipofuscin deposits. There is fatty replacement of the myocardium involving up to 15% of the biopsy. Focally, myocytes have clear cytoplasmic vacuoles (lipid accumulation). There is no evidence of a post transplant lymphoproliferative disease.

Final diagnosis

Heart allograft, endomyocardial biopsies x 5 - ISHLT Grade 1R, mild acute cellular rejection, focal, with:

i) AMR - 0 (by ordinary light microscopy)

ii) endomyocardial fibrosis, focal

iii) fatty replacement of myocardium and myocyte vacuolization

Biopsy - moderate

Microscopic description

Multiple serial sections show that there is one large, and two smaller regions of perivascular, deep myocardial, lymphocyte-predominant inflammation. The large lesion is associated with, reactive endothelium, edema of the myocardium, cytoplasmic myocyte eosinophilia and moderate reactive nuclear enlargement. The myocardial vessels distant from the lymphocytic infiltrates, focally, show lymphocyte-margination without endothelial changes and without significant edema.

The biopsy sample is adequate to pathologically evaluate acute cellular rejection activity. There is no significant endomyocardial fibrosis. Several lymphocytic infiltrates are seen superficially (Quilty effect).

Final diagnosis

Heart allograft, endomyocardial biopsies x 4 - ISHLT Grade 1-2, mild-to-moderate acute cellular rejection, with:
i) antibody-mediated rejection (AMR) - 0 (by ordinary light microscopy)
ii) no significant endomyocardial fibrosis
iii) Quilty effect (endocardial lymphocytic infiltrate), several