Radio S J, McManus B M, Winters G L, Kendall T J, Wilson J E, Costanzo-Nordin M R, Ye Y L
Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha.
Mod Pathol. 1991 Sep;4(5):654-60.
Endocardial infiltrates (EI) are a common and often problematic observation in endomyocardial biopsy specimens (EMBs) from patients receiving cyclosporine immunosuppression following cardiac transplant. Histologic and immunohistologic findings in 23 EMBs from 19 patients and 15 autopsy or explanted allografts demonstrated EIs to be rich in B lymphocytes (871/mm2) compared to T-lymphocytes (803/mm2). Macrophages also demonstrated an endocardial preference over deeper myocardium. In contrast, T-lymphocytes outnumbered B-lymphocytes in deeper myocardium (mean 44/mm2 versus 22/mm2) especially when rejection was present. In allograft specimens, the overall number of typical nodular EIs or percent length of endocardial involvement by EI did not correlate with the presence or absence of myocardial rejection at autopsy or explant but were related to implant duration (r = +0.63, p less than 0.01) and number of previous rejection episodes. The number of thin, nondiscrete endocardial infiltrates was greater in hearts with any myocardial rejection or inflammation present. No relationship was observed between EIs present in either EMB or allografts and the cumulative or mean dose or mean serum level of cyclosporine. Thus, a distinct morphologic and immunohistologic profile distinguishes EIs from acute rejection.
心内膜浸润（EI）是心脏移植后接受环孢素免疫抑制治疗的患者心内膜心肌活检标本（EMB）中常见且往往存在问题的表现。对19例患者的23份EMB以及15份尸检或移植的同种异体移植物进行组织学和免疫组织学检查发现，与T淋巴细胞（803/mm²）相比，EI富含B淋巴细胞（871/mm²）。巨噬细胞也表现出心内膜比深层心肌更易受累。相比之下，在深层心肌中T淋巴细胞数量超过B淋巴细胞（平均44/mm²对22/mm²），尤其是在存在排斥反应时。在同种异体移植标本中，典型结节状EI的总数或EI累及心内膜的长度百分比与尸检或移植时心肌排斥反应的有无无关，但与植入时间（r = +0.63，p小于0.01）和既往排斥发作次数有关。在存在任何心肌排斥或炎症的心脏中，薄的、不连续的心内膜浸润数量更多。在EMB或同种异体移植物中存在的EI与环孢素的累积剂量或平均剂量或平均血清水平之间未观察到相关性。因此，一种独特的形态学和免疫组织学特征将EI与急性排斥反应区分开来。
