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器官移植病理学临床技术操作规范(2019版)——肺移植

中华医学会器官移植学分会

中华医学会器官移植学分会. 器官移植病理学临床技术操作规范(2019版)——肺移植[J]. 器官移植, 2019, 10(4): 383-392. doi: 10.3969/j.issn.1674-7445.2019.04.007
引用本文: 中华医学会器官移植学分会. 器官移植病理学临床技术操作规范(2019版)——肺移植[J]. 器官移植, 2019, 10(4): 383-392. doi: 10.3969/j.issn.1674-7445.2019.04.007
Branch of Organ Transplantation of Chinese Medical Association. Clinical technical operation specification for pathology of organ transplantation (2019 edition): lung transplantation[J]. ORGAN TRANSPLANTATION, 2019, 10(4): 383-392. doi: 10.3969/j.issn.1674-7445.2019.04.007
Citation: Branch of Organ Transplantation of Chinese Medical Association. Clinical technical operation specification for pathology of organ transplantation (2019 edition): lung transplantation[J]. ORGAN TRANSPLANTATION, 2019, 10(4): 383-392. doi: 10.3969/j.issn.1674-7445.2019.04.007

器官移植病理学临床技术操作规范(2019版)——肺移植

doi: 10.3969/j.issn.1674-7445.2019.04.007
基金项目: 

江苏省第四期“ 333工程” BRA2013026

无锡市科技发展指令性计划 CSEY1N1102

无锡市科技发展指令性计划 WX18IVJN015

无锡市医院管理中心科研重大项目 YGZXZ1405

江苏省科教强卫项目 JCRCB2016003

国家卫生和计划生育委员会行业科研专项基金 201302009

中国医学科学院中央级公益性科研院所基本科研业务费专项基金 2018PT32018

华中科技大学自主创新基金项目 01- 08-540149

详细信息
    通讯作者:

    郭晖,Email: zcguo@tjh.tjmu.edu.cn;吴波,Email: 15852759830@126.com;陈静瑜,Email: chenjingyu333@sina.com

  • 中图分类号: R617, R36

Clinical technical operation specification for pathology of organ transplantation (2019 edition): lung transplantation

  • 摘要: 为了进一步规范器官移植病理学临床技术操作,中华医学会器官移植学分会组织器官移植专家和移植病理学专家,从移植肺活组织检查病理学临床操作规范、移植肺并发症的病理学诊断临床技术操作规范、诊断性介入肺脏病学快速现场评价技术在移植肺病理诊断中的初步应用等方面,制定器官移植病理学临床技术操作规范(2019版)之肺移植病理学临床技术操作规范。

     

  • 图  1  移植肺活检组织中的人为假象(苏木素-伊红,×200)

    图示活检肺组织内因夹捏所致的组织夹痕(↑)

    Figure  1.  Artificial false appearance in lung allograft biopsy tissue

    图  2  移植肺急性排斥反应的病理学特征

    A图示轻微急性排斥反应(A1级),在移植肺活检组织中的特征性表现为血管周围少数单个核细胞浸润,通常涉及小静脉,浸润的炎性细胞少而松散,未见血管周围密集的单个核细胞浸润(HE,×200);B图示轻度急性排斥反应(A2级),移植肺活检组织中的特征性表现为小血管周围间质有明显的单核炎症细胞浸润,可见嗜酸细胞及内皮炎(HE,×200);C图示中度急性排斥反应(A3级),移植肺活检组织内的血管周围单个核炎性细胞浸润,且炎性浸润从小血管的周围间质扩展浸润进入肺泡间隔,并伴有肺泡间隔增宽和肺泡间隔内浸润的细胞数量增多(HE,×200);D图示重度急性排斥反应(A4级,重度的小动脉分支血管内皮炎),小动脉内皮淋巴细胞浸润及局部内膜轻微水肿(HE,×400)

    Figure  2.  Pathological characteristics of acute rejection of lung allograft

    图  3  移植肺急性排斥反应的小气道炎症的病理学特征(HE,×200)

    A图示移植肺急性排斥反应的低级别淋巴细胞性细支气管炎(B1R级),细支气管黏膜外周轻度的、局灶片状的单个核细胞浸润,其远离呼吸上皮,无支气管黏膜上皮损伤;B图示高级别淋巴细胞性细支气管炎(B2R级),在高级别淋巴细胞性细支气管炎中,与低级别相比,单个核细胞在黏膜下明显增多,并与上皮基底膜相连,且通过基底膜渗透进入被覆的呼吸上皮,可见上皮细胞坏死、脱落和凋亡

    Figure  3.  Pathological characteristics of small airway inflammation in acute rejection of lung allograft

    图  4  移植肺慢性排斥反应的闭塞性细支气管炎的病理学特征

    A图示移植肺活检组织内的终末细支气管黏膜被覆上皮部分破坏缺失,管壁平滑肌层破坏,局部黏膜下偏心性的纤维组织增生及增生的纤维组织压迫细支气管管腔致气道管腔扭曲和狭窄(HE,×200);B图示呼吸性细支气管内增生的纤维组织填塞致管腔明显闭锁(↑)(HE,×400)

    Figure  4.  Pathological characteristics of bronchiolitis obliterans with chronic rejection of lung allograft

    图  5  移植肺慢性血管性排斥反应的病理学特征(HE,×200)

    图示移植肺内小静脉管壁局部增生增厚及管腔部分狭窄

    Figure  5.  Pathological characteristics of chronic vascular rejection of lung allograft

    图  6  移植肺微血管炎或中性粒细胞性毛细血管炎的病理学特征(HE,×1 000)

    A图示移植肺活检组织内肺泡间隔毛细血管管腔内淋巴细胞和中性粒细胞淤积浸润(↑);B图示微动脉管腔内中性粒细胞淤积(↑)

    Figure  6.  Pathological characteristics of microvasculitis or neutrophilic capillaritis in lung allograft

    图  7  移植肺的限制性移植肺综合征的病理学特征(HE,×200)

    图示部分移植肺的肺泡腔内可见肺泡上皮细胞显著增生,同时可见局部肺泡间隔纤维组织明显增生及部分肺泡被增生的纤维组织填塞

    Figure  7.  Pathological characteristics of restrictive allograft syndrome in lung allograft

    图  8  移植肺曲霉感染的病理学特征(HE,×200)

    图示移植肺活检组织内曲霉菌丝

    Figure  8.  Pathological characteristics of aspergillus infection in lung allograft

    图  9  移植肺毛霉感染的病理学特征

    A图示移植肺活检组织内毛霉菌丝(↑)(HE,×100);B图(HE,×1 000)

    Figure  9.  Pathological characteristics of mucor infection in lung allograft

    图  10  移植肺巨细胞病毒感染的病理学特征

    A图示移植肺肺泡上皮细胞核内病毒包涵体(HE,×400);B图示感染细胞免疫组化CMV染色见阳性表达,肺泡上皮细胞核呈阳性深褐色(免疫组化,×400)

    Figure  10.  Pathological characteristics of cytomegalovirus infection in lung allograft

    图  11  移植肺缺血-再灌注损伤的病理学特征

    A图示移植肺活检组织内的肺泡内可见较多脱落的肺泡上皮细胞(↑)(HE,×100);B图示移植肺活检组织内严重的缺血-再灌注损伤,肺泡表面明显的透明膜形成(↑)(HE,×200)

    Figure  11.  Pathological characteristics of ischemiareperfusion injury in lung allograft

    图  12  移植肺误吸的病理学特征(HE,×200)

    图示移植肺活检组织内可见外源性物质,为吸入的食物残渣

    Figure  12.  Pathological characteristics of aspiration of lung allograft

    图  13  移植肺大气道炎症的病理学特征(HE,×200)

    图示含软骨的大气道,气道管壁大量中性粒细胞和淋巴细胞浸润,提示感染,同时可见局部黏膜坏死脱落呈糜烂,部分呼吸道黏膜鳞状上皮化生

    Figure  13.  Pathological characteristics of airborne tract inflammation in lung allograft

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出版历程
  • 收稿日期:  2019-03-28
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2019-07-15

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