Talk:Lung transplant pathology

From Libre Pathology
Jump to: navigation, search

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 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 may 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 the 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,B0,C0, minimal acute cellular rejection, with:
i) specimen adequacy: borderline, four alveolated lung fragments assessed.
ii) perivascular lymphocyte aggregates: one focus.
iii) micro-organism special stains: all negative (fungi (PAS, PAS-D, GMS), pneumocystis (GMS), CMV, adenovirus and EB virus).
iv) other: hemosiderin macrophages.