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