Difference between revisions of "Talk:Lung transplant pathology"

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==Minimal rejection==
==Minimal rejection==
===Microscopic description===
===Microscopic description===
The specimen has nine pieces of alveolated lung tissue. Some large airways are included. There are several small alveolar septal aggregates of small lymphocytes. These minimally expand the alveolar septa. A few cuff small vessels. Some larger aggregates are present, most airway-associated, but a few not clearly next to bronchioles. Except for in a larger peribronchiole aggregate, no activated lymphocytes are present. There are no eosinophils or neutrophils. Focal, mild submucosal and mural lymphocytic infiltrates are present in larger airways. There is no associated epithelial damage. A patchy fibrinous alveolar exudate is seen in some areas. There are scattered hemosiderophages. Some acute alveolar hemorrhage is present, likely procedural. Larger airways have mild anthracotic pigment. No suggestion of bronchiolitis obliterans or organizing pneumonia is seen with elastic trichrome stain. Special stains for fungus (PAS with and without diastase, GMS) and Pneumocystis (GMS) are negative. Immunohistochemical stains for adenovirus and CMV and in situ hybridization stain for EB virus (EBER) are negative.
The specimen has four pieces of alveolated lung tissue. This is borderline adequate for the assessment of acute cellular rejection. Some medium-sized airways and bronchial wall is included. There are several small alveolar septal aggregates of small lymphocytes. These minimally expand the alveolar septa. One large lymphocyte aggregate, adjacent to anthrocotic pigment, is present and appears to be associated with a blood vessel. There are no eosinophils or neutrophils. There is no epithelial damage. There are scattered hemosidern-laden macrophages. There is no suggestion of bronchiolitis obliterans or organizing pneumonia is seen with elastic trichrome stain. Special stains for fungus (PAS with and without diastase, GMS) and Pneumocystis (GMS) are negative. Immunohistochemical stains for adenovirus and CMV and in situ hybridization stain for EB virus (EBER) are negative.  


===Final diagnosis===
===Final diagnosis===
Lung allograft, right lower lobe, transbronchial biopsies - ISHLT A1-A2,B1,C0, minimal-to-mild acute cellular rejection, with:
Lung allograft, right lower lobe, transbronchial biopsies - ISHLT A1,B0,C0, minimal acute cellular rejection, with:
<br>    i) specimen adequacy: satisfactory, 9 alveolated lung fragments assessed.
<br>    i) specimen adequacy: borderline, four alveolated lung fragments assessed.
<br>    ii) peribronchiole lymphocyte aggregates: present.
<br>    ii) perivascular lymphocyte aggregates: one focus.
<br>    iii) micro-organism special stains: negative fungal, Pneumocystis, CMV,
<br>    iii) micro-organism special stains: negative fungal, Pneumocystis, CMV,
adenovirus and EB virus.
adenovirus and EB virus.
<br>    iv) other: hemosiderin macrophages.
<br>    iv) other: hemosiderin macrophages.
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