MICROSCOPIC DESCRIPTION:
Part I:
Part 1 shows lymphoid tissue with an effaced architecture. The cellular composition is polymorphic with frequent large cells containing vesicular nuclei, coarse heterochromatin, and prominent nucleoli. Many of the cells appear multilobated or binucleate. Apoptotic forms are noted, and mitotic activity within large cells is also noted. Such cells comprise approximately 10% of the population. Of greater frequency are numerous small lymphoid cells scattered diffusely throughout the interstices. There is a mildly epithelioid appearance in some areas due to the accumulation of cells resembling histiocytes. However, granuloma formation is not appreciated. In some areas, there appears to be residual lymphoid architecture characterized by small cells and occasional preserved sinusoids. These tend to be at the periphery of the specimen. Immunocytochemical stains show the large cells to be positive for CD30 and negative for LeuM1. The majority of large atypical cells stain positively with the B-cell marker, L26. Although the large cells are negative for the T-cell marker, CD3 , this stains the majority of small cells which appear histologically normal. Both Kappa and Lambda are negative in the large aberrant cells. Frequent S-100 positive cells are seen scattered throughout the specimen. These often contain phagocytic debris. Immunocytochemical stain for Epstein-Barr virus-latent membrane protein is seen virtually uniformly in the larger cells and occasionally in smaller cells as well. Similarly, the EBER stain is uniformly distributed within the larger cells.
Part II:
Part 2 is labeled allograft kidney, and is scored according the Banff system as follows:
| 1. Glomerulosclerosis | ||||
|---|---|---|---|---|
| 1.1 Number of glomeruli | ( ) | |||
| 1.2 Number globally sclerotic | (30-50%) | |||
| 1.3 Segmental sclerosis | ( )YES | (X)NO | 2. Glomerulitis | ( )0 | (X)1 | ( )2 | ( )3 |
| 3. Interstitial inflammation | ( )0 | ( )1 | (X)2 | ( )3 |
| 4. Intimal arteritis | (X)0 | ( )1 | ( )2 | ( )3 |
| 5. Tubulitis | ( )0 | ( )1 | (X)2 | ( )3 |
| 6. Arteriolar hyalin | ( )0 | ( )1 | ( )2 | (X)3 |
| 7. Chronic glomerular change | ( )0 | (X)1 | ( )2 | ( )3 |
| 8. Interstitial fibrosis | ( )0 | ( )1 | ( )2 | (X)3 |
| 9. Tubular atrophy | ( )0 | ( )1 | (X)2 | ( )3 |
| 10. Vascular intimal sclerosis | ( )0 | ( )1 | ( )2 | (X)3 |
| 11. Diagnostic categories | ||||
| 11.1 Acute rejection: | (X) Grade I (mild)(i2, t2, v0) | |||
| 11.2 Chronic allograft nephropathy: | (X) Grade III (severe) | |||
| 11.3 Other: | (X) Miscellaneous (focal infarction) | |||
Flow Cytometry