Talk:Lung transplant pathology - Revision history

Michael: /* Minimal rejection */

2011-02-15T19:40:10Z

Minimal rejection

← Older revision		Revision as of 19:40, 15 February 2011
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	==Minimal rejection==		==Minimal rejection==
	===Microscopic description===		===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 ~~appears to~~ 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 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.		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===		===Final diagnosis===
	Lung allograft, right lower lobe, transbronchial biopsies - ISHLT A1,B0,C0, minimal acute cellular rejection, with:		Lung allograft, right lower lobe, transbronchial biopsies - ISHLT A1,B0,C0, minimal acute cellular rejection, with:
	<br> i) specimen adequacy: borderline, four alveolated lung fragments assessed.		<br> i) specimen adequacy: borderline, four alveolated lung fragments assessed.
	<br> ii) perivascular lymphocyte aggregates: one focus.		<br> ii) perivascular lymphocyte aggregates: one focus.
	<br> iii) micro-organism special stains: negative ~~fungal~~, ~~Pneumocystis~~, CMV,		<br> iii) micro-organism special stains: all negative (fungi (PAS, PAS-D, GMS), pneumocystis (GMS), CMV, adenovirus and EB virus).
	adenovirus and EB virus.
	<br> iv) other: hemosiderin macrophages.		<br> iv) other: hemosiderin macrophages.

Michael: /* Minimal rejection */ updage

2011-02-10T21:54:47Z

Minimal rejection: updage

← Older revision		Revision as of 21:54, 10 February 2011
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	==Minimal rejection==		==Minimal rejection==
	===Microscopic description===		===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.		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 appears to 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 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===		===Final diagnosis===
	Lung allograft, right lower lobe, transbronchial biopsies - ISHLT A1~~-A2~~,B1,C0, minimal~~-to-mild~~ acute cellular rejection, with:		Lung allograft, right lower lobe, transbronchial biopsies - ISHLT A1,B0,C0, minimal acute cellular rejection, with:
	<br> i) specimen adequacy: ~~satisfactory~~, 9 alveolated lung fragments assessed.		<br> i) specimen adequacy: borderline, four alveolated lung fragments assessed.
	<br> ii) ~~peribronchiole~~ lymphocyte aggregates: ~~present~~.		<br> ii) perivascular lymphocyte aggregates: one focus.
	<br> iii) micro-organism special stains: negative fungal, Pneumocystis, CMV,		<br> iii) micro-organism special stains: negative fungal, Pneumocystis, CMV,
	adenovirus and EB virus.		adenovirus and EB virus.
	<br> iv) other: hemosiderin macrophages.		<br> iv) other: hemosiderin macrophages.

Michael: update

2011-02-10T21:45:33Z

update

← Older revision		Revision as of 21:45, 10 February 2011
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	==~~None~~==		==No rejection==
	~~Lung allograft, right lower lobe, transbronchial biopsies - ISHLT Grade A0, B0, C0, no acute cellular rejection with:<br>~~		===Microscopic description===
	i) specimen ~~adequacy: borderline (4~~ alveolated lung fragments ~~assessed)~~.~~<br>~~		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.
	~~ii) micro~~-~~organism special~~ stains: negative ~~GMS~~.~~<br>~~
	~~iii~~) ~~other: hemosiderin-laden macrophages~~.

	==Minimal==		===Final diagnosis===
	Lung allograft, right lower lobe, transbronchial biopsies - ISHLT ~~Grade~~ A1, B0, C0, minimal acute cellular rejection with:		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).		<br> i) specimen adequacy: borderline, 4 alveolated lung fragments assessed.
	ii) micro-organism special stains: negative ~~GMS~~.		<br> ii) peribronchiole lymphocyte aggregates: occasional, small.
	~~iii~~) other: hemosiderin~~-laden~~ macrophages.		<br> iii) micro-organism special stains: negative fungal, Pneumocystis, CMV,
			adenovirus and EB virus.
			<br> 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:
			<br> i) specimen adequacy: satisfactory, 9 alveolated lung fragments assessed.
			<br> ii) peribronchiole lymphocyte aggregates: present.
			<br> iii) micro-organism special stains: negative fungal, Pneumocystis, CMV,
			adenovirus and EB virus.
			<br> iv) other: hemosiderin macrophages.

Michael: more

2011-02-10T21:38:24Z

← Older revision		Revision as of 21:38, 10 February 2011
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			==None==
	Lung allograft, right lower lobe, transbronchial biopsies - ISHLT Grade A0, B0, C0, no acute cellular rejection with:<br>		Lung allograft, right lower lobe, transbronchial biopsies - ISHLT Grade A0, B0, C0, no acute cellular rejection with:<br>
	i) specimen adequacy: borderline (4 alveolated lung fragments assessed).<br>		i) specimen adequacy: borderline (4 alveolated lung fragments assessed).<br>
	ii) micro-organism special stains: negative GMS.<br>		ii) micro-organism special stains: negative GMS.<br>
			iii) other: hemosiderin-laden macrophages.

			==Minimal==
			Lung allograft, right lower lobe, transbronchial biopsies - ISHLT Grade A1, B0, C0, minimal acute cellular rejection with:
			i) specimen adequacy: borderline (4 alveolated lung fragments assessed).
			ii) micro-organism special stains: negative GMS.
	iii) other: hemosiderin-laden macrophages.		iii) other: hemosiderin-laden macrophages.

Michael: create

2011-02-10T19:48:55Z

create

New page

Lung allograft, right lower lobe, transbronchial biopsies - ISHLT Grade A0, B0, C0, no acute cellular rejection with:<br>
i) specimen adequacy: borderline (4 alveolated lung fragments assessed).<br>
ii) micro-organism special stains: negative GMS.<br>
iii) other: hemosiderin-laden macrophages.