View source for CRP-35

'''CRP-35'''
==Clinical History==
The patient is a 25 year old female who is status post renal transplant two years ago. She presents for explant nephrectomy due to rejection.

==Gross Description==
The specimen is received in a container labeled with the patient's name, medical record number and “transplant nephrectomy”.  Received in saline solution is a fragmented and distorted nephrectomy specimen that weighs in aggregate 250 grams and measures 15 x 8 x 4 cm in greatest dimension. The kidney is externally covered by a tan-pink shiny capsule with areas of petechial hemorrhages. This capsule strips with ease, revealing a red-brown granular external surface. The cut surface is pale tan with congestion. The cortico-medullary junction cannot be grossly identified and the portion of pelvico-calyceal system that can be grossly identified, is lined by a tan-white smooth glistening and congested mucosa.  No gross lesions are present. The specimen is submitted in four cassettes.

==Pathology==
===Case CRP-035 H&E===
<peir-vm>specialcrp/CRP-035_HE</peir-vm>
===Case CRP-035 PASH===
<peir-vm>specialcrp/CRP-035_PASH</peir-vm>
===Case CRP-035 IHC===
<peir-vm>specialcrp/CRP-035_IHC</peir-vm>
===Case CRP-035 IHC_control===
<peir-vm>specialcrp/CRP-035_IHC_control</peir-vm>


<div class="usermessage mw-customtoggle-diagnosis" style="cursor:pointer"> Microscopic Description, Immunofluorescence, and Electron Microscopy</div>
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==Microscopic Description==
===Light Microscopy===
A1-A4 – Sections through transplant kidney. A microscopic examination has been performed.

===Immunofluorescence===
IHC-CD68

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<spoiler text="Diagnosis and Comments">
Kidney, transplant nephrectomy – Malakoplakia
-	Moderately severe chronic vascular rejection and acute vascular rejection
-	Acute tubulitis.
-	Tubular atrophy and interstitial fibrosis

Much of the renal parenchyma is replaced by sheets of large eosinophilic macrophages with occasional small round structures in their cytoplasm, consistent with Michaelis-Guttman bodies. These macrophages stain strongly with CD68 and are negative for cytokeratin. The stains for fungal organisms, acid fast bacilli and Whipples bacteria are negative.

</spoiler>