Rejection of Transplanted Small Intestine
Differential Diagnosis
- Nonspecific infectious enteritis
- Cytomegalovirus
- Adenovirus
- Herpes simplex virus
- Post-transplant lymphoproliferative disorder
- Features favoring rejection
- Crypt apoptosis
- Activated lymphocytes
- Increased number of eosinophils reported in patients pretreated with thymoglobulin or alemtuzumab
- Lymphocytic cryptitis is not specific for rejection
- Acute neutrophilic cryptitis suggests infection
- Specific viral infections must be ruled out
- Inclusions may be too small to be diagnostic on H&E stain
- Immunohistologic stain may demonstrate specific inclusions
- Background may range from lack of infiltrate to typical features of infectious enteritis
- More common in pediatric patients
- Features may overlap with rejection
- Inflammation, crypt apoptosis and regenerative epitihelia changes may be seen
- Viral inclusions in surface enterocytes (smudge cells)
- Immunohistologic stain may specifically identify the inclusions
- Histologic findings may overlap
- Identification of inclusions useful
- Ground glass nuclei
- Margination of chromatin
- Immunohistologic staining is useful
Post-transplant lymphoproliferative disorder
- Infiltrate of atypical large lymphocytes
- CD20+
- May form a mass lesion
