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- 移植穿刺病例
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The above biopsy shows severe tubulitis (t3). The background scattered mononuclear cell infiltration is present (but not dense). The photo 5 demonstrates a small artery with probable 1 or 3 mononuclear cells in intima. By definition, one mononuclear cell or lymphocyte in intima is enough for diagnosis of endoarteritis or intimal arteritis (v1). Usually I am not so aggressive. I feel more comfortable to call intimal arteritis when I see 4 or 5 lymphocytes in intima. Overall, this is a kidney with acute T-cell-mediated rejection, at least Banff type 1B, Banff type 2A cannot be ruled out.
Before signing out this case, SV40 stain is needed. Some of the tubular epithelial cells appear enlarged. But I cannot recognize any inclusions. I routinely stain every transplant biopsy with SV40. Sometime SV40 could highlight the tubular cells without inclusions. If we only rely on morphology (viral inclusion), we are going to miss some cases of BK virus infection.
Hum Pathol. 2006 Jun;37(6):684-8.
Expression of p53 in virally infected tubular cells in renal transplant patients with polyomavirus nephropathy.
Weinreb DB, Desman GT, Burstein DE, Kim DU, Dikman SH, Johnson EM.
Department of Pathology, Mount Sinai School of Medicine, New York, NY 10029, USA. david.weinreb@mssm.edu
Abstract
Polyomavirus (PV) infection is associated with ureteral stenosis, hemorrhagic cystitis, and interstitial nephritis in renal transplant patients. The 3 PVs detected in human beings-BK virus, JC virus, and simian virus 40-each encode highly homologous forms of a large T antigen, a transcriptional and replicational regulatory protein. We describe immunohistochemical findings in 5 renal transplant patients who developed PV nephropathy (PVN) and a sixth patient with both PVN and PV infection of the bladder mucosa. Polyomavirus infection was confirmed by immunohistochemical detection of T antigen in kidney and bladder biopsies. We report on the expression of p53 specific to virally infected cells in all biopsies positive for T antigen. Examination of posttransplant biopsies obtained from these 6 patients before they were diagnosed with PVN revealed no expression of T antigen or p53. Accumulation of p53 in PV-infected cells may occur in response to binding of p53 by T antigen, resulting in stabilization of p53. These results provide the first evidence for intracellular actions of PV T antigen in the context of nonneoplastic diseases.
