Luthringer D J, Yamashita J T, Czer L S, Trento A, Fishbein M C
Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif. 90048-1869, USA.
J Heart Lung Transplant. 1995 May-Jun;14(3):537-43.
Myocardial lymphocytic infiltration after transplantation is usually a manifestation of acute cellular rejection. However, purely endocardial infiltrates are generally not regarded as rejection (so-called "Quilty lesions"). The nature of epicardial lymphoid infiltration in cardiac allografts and its significance when observed in endomyocardial biopsies or autopsies are uncertain.
Twenty-seven cases of transplant-associated epicardial lymphoid infiltration were identified; 16 cases were identified from 1602 consecutive transplant biopsy specimens from 125 patients, and 11 from 14 autopsies, ranging from 1 to 35 months (mean 7.8 months) after transplantation.
The infiltrates were composed of aggregates of lymphocytes and histiocytes distributed throughout the epicardium. Plasma cells were found in 52% of cases, with occasional eosinophils and rare neutrophils. Most were vascular, and four autopsy cases had follicle formation. Twenty-four cases (93%) showed a mixed population of cells in a random distribution consisting of T cells in association with fewer B cells and histiocytes. Fifteen cases (nine autopsies, six biopsies) had acute rejection, and nine autopsies had chronic vascular rejection. Fourteen of twenty-four cases (58%) showed concurrent Quilty lesion (nine autopsies, five biopsies), and the remainder showed at least one Quilty lesion in an earlier biopsy.
Epicardial lymphoid infiltrates occur with significant frequency after heart transplantation and can be associated with, and mimic, acute cellular rejection. However, they exhibit morphologic and immunophenotypic features which are distinguishable from rejection-associated infiltrates.
移植后心肌淋巴细胞浸润通常是急性细胞排斥反应的表现。然而，单纯的心内膜浸润一般不被视为排斥反应（所谓的“奎尔蒂病变”）。心脏同种异体移植中心外膜淋巴样浸润的性质及其在心内膜活检或尸检中观察到的意义尚不确定。
确定了27例与移植相关的心外膜淋巴样浸润病例；16例来自125例患者的1602份连续移植活检标本，11例来自14例尸检，时间为移植后1至35个月（平均7.8个月）。
浸润由淋巴细胞和组织细胞聚集体组成，分布于心外膜各处。52%的病例中发现浆细胞，偶尔有嗜酸性粒细胞，罕见中性粒细胞。大多数为血管性，4例尸检病例有滤泡形成。24例（93%）显示细胞混合群体随机分布，由T细胞与较少的B细胞和组织细胞组成。15例（9例尸检，6例活检）有急性排斥反应，9例尸检有慢性血管排斥反应。24例中的14例（58%）显示并发奎尔蒂病变（9例尸检，5例活检），其余病例在早期活检中显示至少有一处奎尔蒂病变。
心外膜淋巴样浸润在心脏移植后发生率较高，可与急性细胞排斥反应相关并与之相似。然而，它们表现出与排斥反应相关浸润不同的形态学和免疫表型特征。
