Talk:Lung transplant pathology

No rejection

Microscopic description

The specimen has four alveolated lung parenchymal fragments. This is borderline adequate for the assessment of acute cellular rejection. There is an occasional small septal or peri bronchiole aggregate of small lymphocytes. No perivascular infiltrates are seen. The alveolar septa are generally thin, normal. Some hemosiderin deposition is present. There is no acute pneumonia. 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 for Pneumocystis (GMS) are negative. Immunohistochemical stains for adenovirus and CMV and in situ hybridization stain for EB virus (EBER) are negative.

Final diagnosis

Lung allograft, right upper lobe, transbronchial biopsies - ISHLT A0,Bx,C0, no acute cellular rejection, with:
i) specimen adequacy: borderline, 4 alveolated lung fragments assessed.
ii) peribronchiole lymphocyte aggregates: occasional, small.
iii) micro-organism special stains: negative fungal, Pneumocystis, CMV, adenovirus and EB virus.
iv) other: hemosiderin deposition.

Minimal rejection

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.

Final diagnosis

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