Contributed by Anthony J. Demetris, M.D.
PATIENT HISTORY:
Per referral report, the patient is a 47-year-old female. S/P intestinal transplant eight days ago. Minimal granularity on endoscopy. On OKT3. Review of outside material.

Final Diagnosis (Case 2)


SMALL BOWEL ALLOGRAFT, ILEUM, ENDOSCOPIC BIOPSY -
  1. NO EVIDENCE OF ACUTE REJECTION (LESS THAN ONE APOPTOTIC BODY PER TEN CRYPTS; see microscopic description).
  2. INTACT MUCOSAL ARCHITECTURE WITH MILD FOCAL NEUTROPHIL CONGESTION.

Previous Biopsies on this Patient:
[See Case 1]

TPIS Related Resources:
Small Bowel Transplant Topics

Gross Description (Case 2)


The specimen consists of two (2) consult slides with an accompanying surgical pathology report.

Microscopic Description (Case 2)


(2 HE) The normal small intestinal architecture is largely intact. Long and delicate villi are recognized. Some of the surface epithelium is focally denuded, which appears to be artefactual. In most regions, there is no underlying neutrophil congestion, nor necrosis, which otherwise might be expected. However, very slight and focal neutrophil sludging and red cell congestion are seen in one area. There is no significant mononuclear inflammatory cell infiltrate and no evidence of crypt infiltration or damage is seen. There is less than one apoptotic body per ten crypts. Lymphocytes and plasma cells normally present in the lamina propria appear small and inactive. No viral inclusions are seen.

Overall, the histopathologic findings are relatively mild and non-specific. There is no definite evidence of acute rejection, nor significant immune activation. The focal neutrophil sludging and congestion may be related to the biopsy procedure.

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