|
Clinical History:
56 year old male status post heart allograft secondary
to congestive heart failure. His previous biopsy showed
mild acute cellular rejection with focal myocyte damage,
ISHLT 2004 grade R1.
Another biopsy which was
done 15 days later, showed no evidence of mild acute
cellular rejection, ISHLT 2004 grade R0 but one fragment
showed a large Quilty B lesion.
Histology: Figure A
shows endocardium with a large focus of mononuclear
inflammatory infiltrate spreading deeper between the
myocardial fibers: this infiltrate shows focal myocyte
encroachment and includes some plasma cells and a
central capillary vessel. CD4, CD8 and CD20 are all
positive (Figure E, F and B). CD21 is also positive
which is a strong indicator of quilty effect. (Figures C
and D). Trichrome staining shows no significant fibrosis
(Figure G) |
