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Diagnose This! (October 30, 2017)

L. Nich Cossey, MD
By L. Nich Cossey, MD

Oct 30, 2017

intimal arteritis
Camera information: Calibration= 1.000 Pixels per pixel; Capture format= 1392 x 1040, Full Frame HQ; Gamma= 0.99; Gain= 1.0 x; Exposure= 5.92 ms; Auto exposure= On; Image type= Colour; Shading= LM; Sharpening= Low; Black clip= 0; White clip= 189; Microscope information:

What is your diagnosis?​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​     ​

intimal arteritis

The photomicrographs show high power images of an artery which can be discerned by the presence of a visible internal elastic lamina. This artery shows endothelial lifting and numerous subendothelial lymphocytes. The included immunoperoxidase stain is of CD8 which stains for cytotoxic T-cells (mostly) and nicely highlights the subendothelial lymphocytes. In short, these findings are consistent with intimal arteritis. As the background tissue showed findings of T-cell mediated rejection (not shown) and the patient’s donor-specific antibodies were negative, this likely represents T-cell mediated vascular rejection.

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