Heart transplant pathology: Difference between revisions
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| acute cellular (1R) | | acute cellular (1R) | ||
| perivascular infiltrate, myocyte damage | | (perivascular) inflammatory infiltrate, myocyte damage | ||
| scant interstitial infiltrate ( | | 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) | ||
| (perivascular) space-occupying lesion | | (perivascular) inflammatory space-occupying lesion | ||
| diffuse interstitial infiltrate displaces parenchyma ( | | 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> | ||
* | *Lymphocytes in clusters (B cells and T cells). | ||
**Associated with the endocardium ("endothelium of the heart"), i.e. on the surface - '''key feature'''. | **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: | Notes: | ||
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*[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- | *Antibody-mediated rejection (acute vascular rejection). | ||
*Acute cellular rejection. | *Acute cellular rejection. | ||
*Chronic rejection. | *Chronic rejection. | ||
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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" | ||
| Line 208: | Line 231: | ||
===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=== | ||