What’s your diagnosis in this renal transplant?
The photomicrographs show an exuberant adenovirus infection of the renal allograft and positive adenovirus IHC stain. Dense lymphoplasmacytic and neutrophilic interstitial inflammation is seen surrounding enlarged tubules stuffed with epithelioid granulomatous inflammation. Of note, not all areas showed the dense interstitial inflammation and in areas with only the epithelioid granulomatous tubular inflammation, focal tubular rupture and extension of the histiocytes into the interstitium was seen with surrounding edema that mimicked carcinoma with a desmoplastic response.
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