Drachenberg C B, Abruzzo L V, Klassen D K, Bartlett S T, Johnson L B, Kuo P C, Kumar D, Papadimitriou J C
Department of Pathology, University of Maryland School of Medicine, Baltimore, USA.
Hum Pathol. 1998 Jun;29(6):569-77. doi: 10.1016/s0046-8177(98)80005-1.
The clinical and pathological features of acute pancreas allograft rejection and involvement of the graft by posttransplantation lymphoproliferative disorders (PTLD) overlap. Because the treatment is diametrically opposite in these two types of lesions, an accurate diagnosis is essential. The histological features in pancreas allograft needle biopsy specimens (n=7) and pancreatectomies (n=4) from four patients with Epstein-Barr virus (EBV)-related PTLD were compared with the material from 14 patients who did not develop PTLD after 12 to 58 months of follow-up and whose biopsy specimens (n=10) and pancreatectomies (n=10) showed rejection-related heavy or atypical inflammatory infiltrates. Features typical of rejection included most (>75%) being of mixed small and large, activated-appearing T lymphocytes, a smaller component of mature plasma cells, and variable numbers of eosinophils. Cytologically atypical cells were always a minority (< 10%). The inflammation involved the septal spaces with proportional involvement of the exocrine tissue, veins, ducts, and arteries. The inflammation was particularly targeted against the acini and was associated with acinar cell damage. Features characteristic of PTLD were nodular and expansile infiltrates, composed of a significant proportion of atypical, plasmacytoid B cells (40% to 70% of the infiltrate); Reed-Sternberg-like cells were noted in two patients. The infiltrates involved the parenchyma randomly with no apparent affinity for the acinar tissue. Extensive infiltration of the peripancreatic soft tissues was common. Arterial walls were not involved in PTLD unless there was concurrent acute vascular rejection. Features identified in both conditions were foci of necrosis and infiltration of venous walls with associated endotheliitis. Samples with concurrent PTLD and acute rejection showed combinations of these features. In situ hybridization for EBER (Epstein-Barr-encoded RNAs) was positive only in the samples from patients with PTLD. Based on the assessment of morphological differences and the selective use of relatively simple ancillary techniques, PTLD can be correctly diagnosed even in small tissue samples such as needle biopsy specimens. An early diagnosis will lead to the appropriate treatment.
急性胰腺移植排斥反应的临床和病理特征与移植后淋巴细胞增生性疾病（PTLD）累及移植物的情况存在重叠。由于这两种病变的治疗方法截然相反，准确诊断至关重要。对4例与爱泼斯坦-巴尔病毒（EBV）相关的PTLD患者的胰腺移植针吸活检标本（n = 7）和胰腺切除术标本（n = 4）的组织学特征，与14例在随访12至58个月后未发生PTLD且其活检标本（n = 10）和胰腺切除术标本（n = 10）显示有与排斥反应相关的重度或非典型炎性浸润的患者的标本进行了比较。排斥反应的典型特征包括大多数（>75%）为大小混合、呈现活化状态的T淋巴细胞，成熟浆细胞的成分较少，以及数量不等的嗜酸性粒细胞。细胞学上非典型细胞始终占少数（<10%）。炎症累及间隔间隙，外分泌组织、静脉、导管和动脉也按比例受累。炎症尤其靶向腺泡，并伴有腺泡细胞损伤。PTLD的特征性表现为结节状和扩展性浸润，由相当比例的非典型浆细胞样B细胞组成（占浸润细胞的40%至70%）；2例患者可见里德-斯特恩伯格样细胞。浸润随机累及实质，对腺泡组织无明显亲和力。胰腺周围软组织广泛浸润很常见。除非同时存在急性血管排斥反应，PTLD不累及动脉壁。两种情况均可见到的特征为坏死灶和静脉壁浸润伴相关的内皮炎。同时存在PTLD和急性排斥反应的样本表现出这些特征的组合。EBER（爱泼斯坦-巴尔病毒编码RNA）原位杂交仅在PTLD患者的样本中呈阳性。基于形态学差异的评估以及相对简单辅助技术的选择性应用，即使在针吸活检标本等小组织样本中也能正确诊断PTLD。早期诊断将带来恰当的治疗。
