Jaffe R, Trager J D, Zeevi A, Sonmez-Alpan E, Duquesnoy R, Todo S, Rowe M, Starzl T E
Department of Pathology, University of Pittsburgh School of Medicine, Pennsylvania.
Pediatr Pathol. 1989;9(6):633-54. doi: 10.3109/15513818909022372.
We report the diagnostic surgical pathology of two children who underwent multivisceral abdominal transplantation and survived for 1 month and 6 months. There is little relevant literature, and diagnostic criteria for the various clinical possibilities are not established; this is made more complicated by the simultaneous occurrence of more than one process. We based our interpretations on conventional histology, augmented with immunohistology, including HLA staining that distinguished graft from host cells in situ. In some instances functional analysis of T cells propagated from the same biopsies was available and was used to corroborate morphological interpretations. A wide spectrum of changes was encountered. Graft-versus-host disease, a prime concern before surgery, was not seen. Rejection was severe in 1 patient, not present in the other, and both had evidence of lymphoproliferative disease, which was related to Epstein-Barr virus. Bacterial translocation through the gut wall was also a feature in both children. This paper documents and illustrates the various diagnostic possibilities.
我们报告了两名接受多脏器腹部移植并分别存活1个月和6个月的儿童的诊断性手术病理学情况。相关文献很少，且尚未确立各种临床可能性的诊断标准；由于不止一个过程同时发生，情况变得更加复杂。我们的解读基于传统组织学，并辅以免疫组织学，包括能在原位区分移植物与宿主细胞的HLA染色。在某些情况下，还可对取自相同活检组织的T细胞进行功能分析，并用于证实形态学解读。我们遇到了广泛的变化。术前主要关注的移植物抗宿主病未见发生。1例患者出现严重排斥反应，另1例未出现，且两者均有与爱泼斯坦-巴尔病毒相关的淋巴增殖性疾病证据。肠道细菌移位也是两名儿童的一个特征。本文记录并展示了各种诊断可能性。
