CRP-35: Difference between revisions - Pathology Education Instructional Resource

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'''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:==

==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==

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<div class="usermessage mw-customtoggle-diagnosis" style="cursor:pointer"> Microscopic Description, Immunofluorescence, and Electron Microscopy.</div>

<div class="usermessage mw-customtoggle-diagnosis" style="cursor:pointer"> Microscopic Description, Immunofluorescence, and Electron Microscopy</div>

==Microscopic Description:==

==Microscopic Description==

===Light Microscopy:===

===Light Microscopy===

A1-A4 – Sections through transplant kidney. A microscopic examination has been performed.

~~===Immunofluorescence:===~~

~~===Electron Microscopy:===~~

===Immunofluorescence===

IHC-CD68

</div></div>

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>

@@ Line 1: / Line 1: @@
 '''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:==
+==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==
@@ Line 15: / Line 17: @@
-<div class="usermessage mw-customtoggle-diagnosis" style="cursor:pointer"> Microscopic Description, Immunofluorescence, and Electron Microscopy.</div>
+<div class="usermessage mw-customtoggle-diagnosis" style="cursor:pointer"> Microscopic Description, Immunofluorescence, and Electron Microscopy</div>
 <div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-diagnosis">
 <div class="mw-collapsible-content">
-==Microscopic Description:==
+==Microscopic Description==
-===Light Microscopy:===
+===Light Microscopy===
+A1-A4 – Sections through transplant kidney. A microscopic examination has been performed.
-===Immunofluorescence:===
-===Electron Microscopy:===
+===Immunofluorescence===
+IHC-CD68
 </div></div>
 <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>