Heart transplant pathology: Difference between revisions

Jump to navigation Jump to search
← Older edit
Michael (talk | contribs)
49,299 edits
+table - overview
Michael (talk | contribs)
49,299 edits
m →IHC: w
 
(29 intermediate revisions by the same user not shown)
Line 1: Line 1:
'''[[Heart]] transplant pathology''' is a niche in [[cardiac pathology]].
'''[[Heart]] transplant pathology''' is a niche in [[cardiac pathology]].
It comes in different flavours:
*Acute vascular rejection.
*Cellular rejection.
*Chronic rejection.


==Overview - table==
==Overview - table==
Grading scheme 2004/1990:<ref>{{Ref WMSP|136}}</ref>  
===Types of rejection<ref name=Ref_WMSP136-7>{{Ref WMSP|136-7}}</ref>===
{| class="wikitable"
{| class="wikitable"
| Type (grade)
| Type (grade)
Line 14: Line 9:
| Image
| Image
|-
|-
| acute
| antibody-mediated rejection (acute vascular)
| edema, dilated small vessels
| edema, dilated small vessels
| scant inflammation
| scant inflammation
| [http://www.pathconsultddx.com/pathCon/largeImage?pii=S1559-8675%2806%2970592-7&figureId=fig4]
| [http://www.pathconsultddx.com/pathCon/largeImage?pii=S1559-8675%2806%2970592-7&figureId=fig4 acute]
|-
|-
| cellular (0R)
| normal (0R)
| normal
| normal
| no extravascular monocytes
| no extravascular monocytes
|
|
|-
|-
| cellular (1R)
| acute cellular (1R)
| infiltrate, myocyte damage
| (perivascular) inflammatory infiltrate, myocyte damage
| scant interstitial infiltrate (lymphoplasmic), scant damage
| scant interstitial infiltrate (lymphoplasmacytic), scant damage
| [http://www.pathconsultddx.com/pathCon/largeImage?pii=S1559-8675%2806%2970592-7&figureId=fig1 mild]
| [http://www.pathconsultddx.com/pathCon/largeImage?pii=S1559-8675%2806%2970592-7&figureId=fig1 mild cellular]
|-
|-
| cellular (2R)
| acute cellular (2R)
| space-occupying lesion
| (perivascular) inflammatory space-occupying lesion
| diffuse interstitial infiltrate displaces parenchyma (lymphoplasmic), obvious damage
| diffuse interstitial infiltrate displaces parenchyma (lymphoplasmacytic), obvious damage (myocyte eosinophilia or drop-out)
| [http://www.pathconsultddx.com/pathCon/largeImage?pii=S1559-8675%2806%2970592-7&figureId=fig2 mod.], [http://www.pathconsultddx.com/pathCon/largeImage?pii=S1559-8675%2806%2970592-7&figureId=fig3 mod. resolving]
| [http://www.pathconsultddx.com/pathCon/largeImage?pii=S1559-8675%2806%2970592-7&figureId=fig2 mod. cellular], [http://www.pathconsultddx.com/pathCon/largeImage?pii=S1559-8675%2806%2970592-7&figureId=fig3 mod. cellular resolving]
|-
|-
| cellular (3R)
| acute cellular (3R)
| disruption of normal arch.
| disruption of normal arch.
| diffuse interstitial infiltrate disrupts parenchyma (lymphoplasmic & PMNs), fibre loss/damage
| diffuse interstitial infiltrate disrupts parenchyma (lymphoplasmic & [[PMN]]s), fibre loss/damage
|  
|  
|-
|-
| chronic
| chronic
| concentric intimal thicking
| concentric intimal thicking
| internal elastic lamina preserved (unlike atherosclerosis)
| internal elastic lamina preserved (unlike [[atherosclerosis]])
| [http://newsroom.ucla.edu/portal/ucla/srp-view.aspx?id=118724], [http://www.pathconsultddx.com/pathCon/largeImage?pii=S1559-8675%2806%2970592-7&figureId=fig5]
| [http://newsroom.ucla.edu/portal/ucla/srp-view.aspx?id=118724 chronic], [http://www.pathconsultddx.com/pathCon/largeImage?pii=S1559-8675%2806%2970592-7&figureId=fig5 chronic]
|}
|}


===Pitfalls<ref name=Ref_WMSP136-7>{{Ref WMSP|136-7}}</ref>===
{| class="wikitable"
| Name
| Description
| Details
| Image
|-
| Quilty effect
| endocardial/subendocardial B-lymphocytes (in clusters)
| may extend into myocardium, not assoc. with blood vessels +/-myocyte damage; benign behaviour clinically
| [http://medeponyms.com/entry/7/ Quilty effect], [http://www.e-heart.org/Pages/08_Heart_Transplant/08_Heart_Transplant_ELI%20_001.htm Quilty effect]
|-
| Old biopsy site
| hemosiderin-laden macrophages
| fibrosis/myocyte replacement
| [http://www.pathconsultddx.com/pathCon/largeImage?pii=S1559-8675%2806%2970592-7&figureId=fig6 old Bx site]
|}


=Mimics=
==Biopsy site reaction==
==Biopsy site reaction==
===General===
===General===
Line 58: Line 71:
Image: [http://www.pathconsultddx.com/pathCon/largeImage?pii=S1559-8675%2806%2970592-7&figureId=fig6 Biopsy site (pathconsultddx.com)].
Image: [http://www.pathconsultddx.com/pathCon/largeImage?pii=S1559-8675%2806%2970592-7&figureId=fig6 Biopsy site (pathconsultddx.com)].


==Acute rejection==
==Quilty effect==
*[[AKA]] ''endocardial lymphocytic infiltrate''.<ref name=pmid17683180>{{cite journal |author=Tan CD, Baldwin WM, Rodriguez ER |title=Update on cardiac transplantation pathology |journal=Arch. Pathol. Lab. Med. |volume=131 |issue=8 |pages=1169–91 |year=2007 |month=August |pmid=17683180 |doi= |url=}}</ref>
===General===
*Can be confused for rejection.
*Benign behaviour.
 
Trivia:
*The name ''Quilty'' comes from the patient in which this was first recognized.
 
===Microscopic===
Features:<ref name=emed_htp>URL: [http://emedicine.medscape.com/article/1612493-overview http://emedicine.medscape.com/article/1612493-overview]. Accessed on: 8 March 2011.</ref>
*Lymphocytes in clusters (B cells and T cells).
**Associated with the endocardium ("endothelium of the heart"), i.e. on the surface - '''key feature'''.
**Often have capillaries in centre; usu. not associated with large blood vessels.
**Lymphocytes separated by collagen.
 
Notes:
*No longer subclassified.<ref name=pmid17683180/>
**Traditional classification (by location):
***Quilty A: Endocardial/subendocardial.
***Quilty B: Endocardial/subendocardial + myocardium.
****+/-Myocyte damage.<ref name=pmid9192483>{{cite journal |author=Winters GL |title=The challenge of endomyocardial biopsy interpretation in assessing cardiac allograft rejection |journal=Curr. Opin. Cardiol. |volume=12 |issue=2 |pages=146–52 |year=1997 |month=March |pmid=9192483 |doi= |url=}}</ref>
 
Images:
*[http://medeponyms.com/entry/7/ Quilty effect (medeponyms.com)].
*[http://www.e-heart.org/Pages/08_Heart_Transplant/08_Heart_Transplant_ELI%20_001.htm Quilty effect (e-heart.org)].
 
===IHC===
Mix of T cell and B cells:<ref name=emed_htp>URL: [http://emedicine.medscape.com/article/1612493-overview http://emedicine.medscape.com/article/1612493-overview]. Accessed on: 8 March 2011.</ref>
*CD3 +ve.
*CD20 +ve.
 
Notes:
*ACR is T cells.<ref name=emed_htp>URL: [http://emedicine.medscape.com/article/1612493-overview http://emedicine.medscape.com/article/1612493-overview]. Accessed on: 8 March 2011.</ref>
 
==Coronary atherosclerosis (ischemic injury)==
===General===
*Usu. early - related to atherosclerosis in the donor heart.
*Not typically biopsied. (???)
 
===Microscopic===
Features:
*Findings seen in [[atherosclerosis]].
 
=Rejection=
It comes in different flavours:<ref>URL: [http://emedicine.medscape.com/article/1612493-overview http://emedicine.medscape.com/article/1612493-overview]. Accessed on: 9 Febraury 2011.</ref>
*Antibody-mediated rejection (acute vascular rejection).
*Acute cellular rejection.
*Chronic rejection.
 
==Antibody-mediated rejection==
*Abbreviated as ''AMR''.
 
===General===
*[[AKA]] ''acute vascular rejection'', ''hyperacute rejection'', ''humoral rejection''.<ref name=pmid17683180>{{cite journal |author=Tan CD, Baldwin WM, Rodriguez ER |title=Update on cardiac transplantation pathology |journal=Arch. Pathol. Lab. Med. |volume=131 |issue=8 |pages=1169–91 |year=2007 |month=August |pmid=17683180 |doi= |url=}}</ref><ref>{{cite journal |author=Olsen SL, Wagoner LE, Hammond EH, ''et al.'' |title=Vascular rejection in heart transplantation: clinical correlation, treatment options, and future considerations |journal=J. Heart Lung Transplant. |volume=12 |issue=2 |pages=S135–42 |year=1993 |pmid=8476883 |doi= |url=}}</ref>
 
===Microscopic===
===Microscopic===
Features:<ref>URL: [http://www.pathconsultddx.com/pathCon/largeImage?pii=S1559-8675%2806%2970592-7&figureId=fig4 http://www.pathconsultddx.com/pathCon/largeImage?pii=S1559-8675%2806%2970592-7&figureId=fig4]. Accessed on: 7 January 2011.</ref>
Features:<ref>URL: [http://www.pathconsultddx.com/pathCon/largeImage?pii=S1559-8675%2806%2970592-7&figureId=fig4 http://www.pathconsultddx.com/pathCon/largeImage?pii=S1559-8675%2806%2970592-7&figureId=fig4]. Accessed on: 7 January 2011.</ref>
Line 64: Line 132:
*Dilated small vessels.
*Dilated small vessels.
*Scant inflammatory infiltrate.
*Scant inflammatory infiltrate.
**Macrophage margination.<ref>{{cite journal |author=Lee CY, Lotfi-Emran S, Erdinc M, ''et al.'' |title=The involvement of FcR mechanisms in antibody-mediated rejection |journal=Transplantation |volume=84 |issue=10 |pages=1324–34 |year=2007 |month=November |pmid=18049118 |doi=10.1097/01.tp.0000287457.54761.53 |url=}}</ref> (???)


Image:  
Image:  
*[http://www.pathconsultddx.com/pathCon/largeImage?pii=S1559-8675%2806%2970592-7&figureId=fig4 Acute rejection (pathconsultddx.com)].
*[http://www.pathconsultddx.com/pathCon/largeImage?pii=S1559-8675%2806%2970592-7&figureId=fig4 Acute rejection (pathconsultddx.com)].


==Cellular rejection==
===IHC===
Grading scheme 2004/1990:<ref>{{Ref WMSP|136}}</ref>  
Features:<ref name=pmid17683180>{{cite journal |author=Tan CD, Baldwin WM, Rodriguez ER |title=Update on cardiac transplantation pathology |journal=Arch. Pathol. Lab. Med. |volume=131 |issue=8 |pages=1169–91 |year=2007 |month=August |pmid=17683180 |doi= |url=}}</ref>
*[[C4d]].
*C3d.
 
==Acute cellular rejection==
===General===
*Common form of rejection.
 
===Microscopic===
Features:
*Perivascular lymphocytic infiltrate, usu. deep.
*Reactive endothelium.
*+/-Myocardial eosinophilia.
*+/-Expansion of perivascular space.
 
Notes:
*The main DDx is a Quilty lesion - these are attached to the surface and are typically not associated with a blood vessel.
 
===Grading - comparison===
Grading scheme 2004/1990:<ref name=Ref_WMSP136>{{Ref WMSP|136}}</ref>  
{| class="wikitable"
{| class="wikitable"
| Grade 2004
| Grade 2004
Line 121: Line 209:


==Chronic rejection==
==Chronic rejection==
===General===
*[[AKA]] ''transplant arteriopathy'' or ''cardiac allograft vasculopathy''.
*Thought to be a form of accelerated atherosclerosis.<ref name=Ref_WMSP137>{{Ref WMSP|137}}</ref>


===Microscopic===
===Microscopic===
Line 132: Line 223:


Notes:
Notes:
*Vague similar to atherosclerosis.
*Morphologically vaguely similar to atherosclerosis.
 
=Other=
==Post-transplant lymphoproliferative disorder==
{{Main|Post-transplant lymphoproliferative disorder}}
*Abbreviated ''PTLD''.
===General===
*Rare.
*Associated with [[EBV]].<ref>URL: [http://emedicine.medscape.com/article/431364-overview http://emedicine.medscape.com/article/431364-overview]. Accessed on: 10 February 2011.</ref>
 
===Microscopic===
Features:
*Large cell lymphoma - see [[DLBCL]].


==See also==
=See also=
*[[Heart]].
*[[Heart]].
*[[Lung transplant pathology]].
*[[Lung transplant pathology]].


==References==
=References=
{{Reflist|1}}
{{Reflist|2}}


==External links==
=External links=
*[http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970592-7 Heart transplant rejection (pathconsultddx.com)].
*[http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970592-7 Heart transplant rejection (pathconsultddx.com)].
*[http://emedicine.medscape.com/article/1612493-overview Heart transplant rejection (emedicine.medscape.com)].


[[Category: Cardiovascular pathology]]
[[Category: Cardiovascular pathology]]
Retrieved from "https://librepathology.org/wiki/Heart_transplant_pathology"