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| Image | | Image | ||
|- | |- | ||
| acute vascular | | antibody-mediated rejection (acute vascular) | ||
| edema, dilated small vessels | | edema, dilated small vessels | ||
| scant inflammation | | scant inflammation | ||
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|- | |- | ||
| acute cellular (1R) | | acute cellular (1R) | ||
| 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) | ||
| 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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| Image | | Image | ||
|- | |- | ||
| Quilty | | Quilty effect | ||
| endocardial/subendocardial B-lymphocytes (in clusters) | | 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] | | [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] | ||
|- | |- | ||
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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)]. | ||
==Quilty== | ==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=== | ===General=== | ||
*Can be confused for rejection. | *Can be confused for rejection. | ||
*Benign behaviour. | *Benign behaviour. | ||
Trivia: | |||
*The name ''Quilty'' comes from the patient in which this was first recognized. | |||
===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 (B cells and T cells). | ||
* | **Associated with the endocardium ("endothelium of the heart"), i.e. on the surface - '''key feature'''. | ||
**Quilty A: Endocardial/subendocardial. | **Often have capillaries in centre; usu. not associated with large blood vessels. | ||
**Quilty B: Endocardial/subendocardial + myocardium. | **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> | ****+/-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> | ||
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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: | 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. | *Acute cellular rejection. | ||
*Chronic 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> | ||
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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: | ||
*[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)]. | ||
===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> | |||
*[[C4d]]. | |||
*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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Notes: | Notes: | ||
*Morphologically vaguely 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= |
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