Heart transplant pathology: Difference between revisions

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|-
|-
| acute 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 cellular]
| [http://www.pathconsultddx.com/pathCon/largeImage?pii=S1559-8675%2806%2970592-7&figureId=fig1 mild cellular]
|-
|-
| acute 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. cellular], [http://www.pathconsultddx.com/pathCon/largeImage?pii=S1559-8675%2806%2970592-7&figureId=fig3 mod. cellular 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]
|-
|-
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===Microscopic===
===Microscopic===
Features:
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>
*B-lymphocytes (in clusters).
*Lymphocytes in clusters (B cells and T cells).
**'''Not''' associated with blood vessels.
**Associated with the endocardium ("endothelium of the heart"), i.e. on the surface - '''key feature'''.
*Usually endocardial, i.e. associated with the endocardium ("endothelium of the heart").
**Often have capillaries in centre; usu. not associated with large blood vessels.
**Lymphocytes separated by collagen.


Notes:
Notes:
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***Quilty A: Endocardial/subendocardial.
***Quilty A: Endocardial/subendocardial.
***Quilty B: Endocardial/subendocardial + myocardium.
***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>
****+/-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:
Images:
*[http://medeponyms.com/entry/7/ Quilty effect (medeponyms.com)].
*[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)].
*[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)==
==Coronary atherosclerosis (ischemic injury)==
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=Rejection=
=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>
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-mediate rejection (acute vascular rejection).
*Antibody-mediated rejection (acute vascular rejection).
*Acute cellular rejection.
*Acute cellular rejection.
*Chronic rejection.
*Chronic rejection.
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*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:  
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===IHC===
===IHC===
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>
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.
*[[C4d]].
*C3d.
*C3d.


==Acute cellular rejection==
==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>  
Grading scheme 2004/1990:<ref name=Ref_WMSP136>{{Ref WMSP|136}}</ref>  
{| class="wikitable"
{| class="wikitable"
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===General===
===General===
*Rare.
*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>
*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===
===Microscopic===
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