1 / 23

Case 6

Case 6. Helmut Hopfer , University Hospital Basel, Switzerland. morphological features. increased number of endocapillary leukocytes endothelial swelling dilatation of capillary loops occlusion or near occlusion of capillary lumina with cells u sually a focal and segmental lesion !.

shira
Télécharger la présentation

Case 6

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Case 6 Helmut Hopfer, University Hospital Basel, Switzerland

  2. morphologicalfeatures • increasednumberofendocapillaryleukocytes • endothelialswelling • dilatationofcapillaryloops • occlusionornearocclusionofcapillaryluminawithcells usually a focaland segmental lesion!

  3. EM differential diagnosis • transplant glomerulitis • endocapillaryglomerulonephritis • (intravascularlymphoma)

  4. transplant glomerulitis: definition • recognizing a pattern: • increasednumberofendocapillaryleukocytes • endothelialswelling • dilatationofcapillaryloops • occlusionornearocclusionofcapillaryluminawithcells • countingmononuclearcells (arbitrarycut-off) → nocleardistinctionbetweencelltypesby light microscopy! → immunohistochemistry, definitionofcut-off by ROC Example: endocapillary immune-complex GN CD20 CD68 CD5 ERG

  5. countingcells will not tellyouanythingaboutthepathogenesis

  6. glomerularrejection: pathogenesis

  7. 2. 1. 3.

  8. 1.

  9. 2.

  10. 3.

  11. discussion & conclusions • Whyaretheleukocytesthere? • Whatarethemonocytes / macrophagesdoingthere? • Whatarethelymphocytesdoingthere? → monocytesexert an earlyendocapillaryreparativefunction on theendothelialcells

  12. casepresentation Clinical history: 39 yearold male. Renal transplantation (TR) in 2005 due tohypertension. Malcompliancewithimmunosuppresion → twoepisodesofinterstitialcellularrejection. Diagnosticbiopsy (BX) 40 months after TR, rise in creatinineandnewlydiagnosedproteinuria. Diagnosis: Transplant glomerulitis (by EM), severe diffuse interstitialcellularrejection, C4d negative. Focal IFTA (10-20%). Follow up: Dialysisdependence 7 monthslater. BX withmixed T cell- and antibody-mediatedrejection, C4d positive.

More Related