Difference between revisions of "Heart transplant pathology"

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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>
*Acute vascular rejection.
*Antibody-mediate rejection (acute vascular rejection).
*Acute cellular rejection.
*Acute cellular rejection.
*Chronic rejection.
*Chronic rejection.

Revision as of 20:36, 9 February 2011

Heart transplant pathology is a niche in cardiac pathology.

Overview - table

Types of rejection[1]

Type (grade) Description Details Image
antibody-mediated rejection (acute vascular) edema, dilated small vessels scant inflammation acute
normal (0R) normal no extravascular monocytes
acute cellular (1R) infiltrate, myocyte damage scant interstitial infiltrate (lymphoplasmic), scant damage mild cellular
acute cellular (2R) space-occupying lesion diffuse interstitial infiltrate displaces parenchyma (lymphoplasmic), obvious damage mod. cellular, mod. cellular resolving
acute cellular (3R) disruption of normal arch. diffuse interstitial infiltrate disrupts parenchyma (lymphoplasmic & PMNs), fibre loss/damage
chronic concentric intimal thicking internal elastic lamina preserved (unlike atherosclerosis) chronic, chronic

Pitfalls[1]

Name Description Details Image
Quilty A endocardial/subendocardial B-lymphocytes (in clusters) benign behaviour clinically Quilty effect, Quilty effect
Quilty B B-lymphocytes (in clusters) +/-myocyte damage; benign behaviour clinically Quilty effect, Quilty effect
Old biopsy site hemosiderin-laden macrophages fibrosis/myocyte replacement old Bx site

Mimics

Biopsy site reaction

General

  • Can be confused for rejection.

Microscopic

Features:

  • Hemosiderin-laden macrophages.
  • +/-Fibrosis/myofibre loss-replacement.
  • +/-Scant inflammatory infiltration.

Image: Biopsy site (pathconsultddx.com).

Quilty

General

  • Can be confused for rejection.
  • Benign behaviour.

Microscopic

Features:

  • B-lymphocytes (in clusters).
  • Location:
    • Quilty A: Endocardial/subendocardial.
    • Quilty B: Endocardial/subendocardial + myocardium.
        • +/-Myocyte damage.[2]

Images:

Coronary atherosclerosis (ischemic injury)

General

  • Usu. early - related to atherosclerosis in the donor heart.
  • Not typically biopsied. (???)

Microscopic

Features:

Rejection

It comes in different flavours:[3]

  • Antibody-mediate rejection (acute vascular rejection).
  • Acute cellular rejection.
  • Chronic rejection.

Antibody-mediated rejection

  • Abbreviated as AMR.

General

  • Used to be called acute vascular rejection.[4]

Microscopic

Features:[5]

  • Edema.
  • Dilated small vessels.
  • Scant inflammatory infiltrate.

Image:

IHC

Features:[6]

  • C4d.
  • C3d.

Acute cellular rejection

Grading scheme 2004/1990:[7]

Grade 2004 Grade 1990 Description Details Image
0R 0 normal no extravascular monocytes
1R 1A infiltrate, myocyte damage scant interstitial infiltrate (lymphoplasmic), scant damage mild
1R 1B infiltrate, myocyte damage diffuse interstitial infiltrate (lymphoplasmic), focal damage
1R 2 infiltrate, myocyte damage diffuse interstitial infiltrate (lymphoplasmic), obvious damage
2R 3A space-occupying lesion diffuse interstitial infiltrate displaces parenchyma (lymphoplasmic), obvious damage mod., mod. resolving
3R 3B disruption of normal arch. diffuse interstitial infiltrate disrupts parenchyma (lymphoplasmic & PMNs), obvious damage
3R 4 disruption of normal arch. diffuse interstitial infiltrate disrupts parenchyma (lymphoplasmic & PMNs), fibre loss

Chronic rejection

General

  • AKA transplant arteriopathy or cardiac allograft vasculopathy.
  • Thought to be a form of accelerated atherosclerosis.[8]

Microscopic

Features:[9]

  • Concentric intimal thickening.
  • Preservation of internal elastic lamina.

Images:

Notes:

  • Morphologically vaguely similar to atherosclerosis.

See also

References

  1. ↑ 1.0 1.1 Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 136-7. ISBN 978-0781765275.
  2. ↑ Winters GL (March 1997). "The challenge of endomyocardial biopsy interpretation in assessing cardiac allograft rejection". Curr. Opin. Cardiol. 12 (2): 146–52. PMID 9192483.
  3. ↑ URL: http://emedicine.medscape.com/article/1612493-overview. Accessed on: 9 Febraury 2011.
  4. ↑ Olsen SL, Wagoner LE, Hammond EH, et al. (1993). "Vascular rejection in heart transplantation: clinical correlation, treatment options, and future considerations". J. Heart Lung Transplant. 12 (2): S135–42. PMID 8476883.
  5. ↑ URL: http://www.pathconsultddx.com/pathCon/largeImage?pii=S1559-8675%2806%2970592-7&figureId=fig4. Accessed on: 7 January 2011.
  6. ↑ Tan CD, Baldwin WM, Rodriguez ER (August 2007). "Update on cardiac transplantation pathology". Arch. Pathol. Lab. Med. 131 (8): 1169–91. PMID 17683180.
  7. ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 136. ISBN 978-0781765275.
  8. ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 137. ISBN 978-0781765275.
  9. ↑ URL: http://www.pathconsultddx.com/pathCon/largeImage?pii=S1559-8675%2806%2970592-7&figureId=fig5. Accessed on: 7 January 2011.
  10. ↑ URL: http://newsroom.ucla.edu/portal/ucla/ucla-team-uncovers-mechanism-behind-179330.aspx. Accessed on: 7 January 2011.

External links

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