Heart transplant pathology - Revision history

Michael: /* IHC */ w

2011-11-22T18:28:19Z

IHC: w

← Older revision		Revision as of 18:28, 22 November 2011
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	===IHC===		===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>		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.		*[[C4d]].
	*C3d.		*C3d.

Michael: /* Rejection */ tweak

2011-11-04T18:04:51Z

Rejection: tweak

← Older revision		Revision as of 18:04, 4 November 2011
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	=Rejection=		=Rejection=
	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>		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-~~mediate~~ rejection (acute vascular rejection).		*Antibody-mediated rejection (acute vascular rejection).
	*Acute cellular rejection.		*Acute cellular rejection.
	*Chronic rejection.		*Chronic rejection.

Michael: /* Post-transplant lymphoproliferative disorder */ wikify

2011-04-14T15:03:25Z

Post-transplant lymphoproliferative disorder: wikify

← Older revision		Revision as of 15:03, 14 April 2011
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	===General===		===General===
	*Rare.		*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>		*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===		===Microscopic===

Michael: /* Microscopic */ more

2011-03-09T22:03:10Z

Microscopic: more

← Older revision		Revision as of 22:03, 9 March 2011
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	*Lymphocytes in clusters (B cells and T cells).		*Lymphocytes in clusters (B cells and T cells).
	**Associated with the endocardium ("endothelium of the heart"), i.e. on the surface - '''key feature'''.		**Associated with the endocardium ("endothelium of the heart"), i.e. on the surface - '''key feature'''.
	**~~Not~~ associated with large blood vessels~~; have capillaries in centre~~.		**Often have capillaries in centre; usu. not associated with large blood vessels.
			**Lymphocytes separated by collagen.

	Notes:		Notes:

Michael: /* Quilty effect */ more

2011-03-09T22:02:13Z

Quilty effect: more

← Older revision		Revision as of 22:02, 9 March 2011
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	===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).		*Lymphocytes in clusters (B cells and T cells).
	**Associated with the endocardium ("endothelium of the heart"), i.e. on the surface - '''key feature'''.		**Associated with the endocardium ("endothelium of the heart"), i.e. on the surface - '''key feature'''.
	**Not associated with blood vessels.		**Not associated with large blood vessels; have capillaries in centre.

	Notes:		Notes:
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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)==

Michael: /* Types of rejection{{Ref WMSP|136-7}} */ tweak

2011-03-09T21:22:30Z

Types of rejection{{Ref WMSP|136-7}}: tweak

← Older revision		Revision as of 21:22, 9 March 2011
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	\|-		\|-
	\| acute cellular (1R)		\| acute cellular (1R)
	\| perivascular infiltrate, myocyte damage		\| (perivascular) inflammatory infiltrate, myocyte damage
	\| scant interstitial infiltrate (~~lymphoplasmic~~), scant damage		\| 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)
	\| (perivascular) space-occupying lesion		\| (perivascular) inflammatory space-occupying lesion
	\| diffuse interstitial infiltrate displaces parenchyma (~~lymphoplasmic~~), obvious damage		\| 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]
	\|-		\|-

Michael: /* Acute cellular rejection */ more

2011-03-09T21:19:48Z

Acute cellular rejection: more

← Older revision		Revision as of 21:19, 9 March 2011
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	==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"

Michael: /* Antibody-mediated rejection */

2011-03-09T21:15:45Z

Antibody-mediated rejection

← Older revision		Revision as of 21:15, 9 March 2011
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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:

Michael: /* Quilty effect */ tweak

2011-03-09T21:07:46Z

Quilty effect: tweak

← Older revision		Revision as of 21:07, 9 March 2011
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	Features:		Features:
	*B-lymphocytes (in clusters).		*B-lymphocytes (in clusters).
	**'''~~Not~~''' ~~associated with blood vessels~~.		**Associated with the endocardium ("endothelium of the heart"), i.e. on the surface - '''key feature'''.
	*~~Usually endocardial, i.e.~~ associated with ~~the endocardium ("endothelium of the heart")~~.		**Not associated with blood vessels.

	Notes:		Notes:
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	***Quilty A: Endocardial/subendocardial.		***Quilty A: Endocardial/subendocardial.
	***Quilty B: Endocardial/subendocardial + myocardium.		***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>

	Images:		Images:

Michael: /* Types of rejection{{Ref WMSP|136-7}} */ tweak

2011-03-08T16:39:29Z

Types of rejection{{Ref WMSP|136-7}}: tweak

← Older revision		Revision as of 16:39, 8 March 2011
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	\|-		\|-
	\| acute cellular (1R)		\| acute cellular (1R)
	\| infiltrate, myocyte damage		\| perivascular infiltrate, myocyte damage
	\| scant interstitial infiltrate (lymphoplasmic), scant damage		\| scant interstitial infiltrate (lymphoplasmic), 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) space-occupying lesion
	\| diffuse interstitial infiltrate displaces parenchyma (lymphoplasmic), obvious damage		\| diffuse interstitial infiltrate displaces parenchyma (lymphoplasmic), obvious damage
	\| [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]