PAS x40 - RCPA

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3. Borderline changes:• suspicious for acute TCMR• may coincide with categories 2, 5 & 6• this category is used• when no intimal arteritis is present• but there are foci of tubulitis (t1, t2 or t3)with minor interstitial infiltration (i0 or i1)• or interstitial infiltration (i2, i3) with mild(t1) tubulitis
4. T-cell-mediated rejection (TCMR):may coincide with categories 2, 5 & 6• acute T-cell-mediated rejection (Type/Grade:)IA. Cases with significant interstitial infiltration (>25% of parenchymaaffected, i2 or i3) and foci of moderate tubulitis (t2)IB. Cases with significant interstitial infiltration (>25% of parenchymaaffected, i2 or i3) and foci of severe tubulitis (t3)IIA.Cases with mild-to-moderate intimal arteritis (v1)IIB. Cases with severe intimal arteritis comprising >25% of the luminalarea (v2)III. Cases with ‘transmural’ arteritis and/or arterial fibrinoid change andnecrosis of medial smooth muscle cells with accompanyinglymphocytic inflammation (v3)• chronic active T-cell-mediated rejection‘chronic allograft arteriopathy’ (arterial intimal fibrosis withmononuclear cell infiltration in fibrosis, formation of neo-intima)
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Laboratory handling of renal Bx:•
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Our Medical Laboratory Scientist re
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Tissue for light microscopy:• des
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A paraffin embedded renal biopsy co
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Immunohistochemical stains:Native
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Examination of H&E stains:• on lo
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Medium power examination of H&E sta
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High power examination of H&E stain
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H&E x2This is an H&E stain of a ren
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H&E x10This is a higher power view.
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H&E x10This is renal medulla. Most
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marksglomerulimarks arteriolesmarks
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H&E x40marksglomeruli/Bowman’s ca
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H&E x40marks arteriolesoutlines par
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tubular polevascular pole
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peritubular capllariesarteriolessma
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H&E x2H&E x10This is a biopsy from
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atrophic tubules in anarea of inter
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segmental sclerosisfocal mild incre
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the mesangium is expandedby amorpho
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PAS x10
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Bowman’s capsulemesangiumtubular
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PAS x40Glomerulus sectioned through
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segmental sclerosisfocal hyalinosis
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OVG x40 - interlobulararteryOVG x40
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Masson x40 -normal glomerulusMasson
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Masson x40Masson x40variations in s
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Masson x40: glomerulus with mesangi
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AgMT x40 - small arteryAgMT x40 - g
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AgMT x100Can you identify mesangial
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This biopsy is from someonewith the
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AgMT x100 -variations in staining f
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mesangial cell nucleismallsubepithe
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AgMT x100:there is fuzzy materialor
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Congo red stain showing theapple gr
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Examination of immunohistochemical
Page 77 and 78: IF IgG x40Normal kidney -immunofluo
Page 79 and 80: IF fibrin x40Normal kidney -immunof
Page 81 and 82: IF C1q x40Normal kidney -immunofluo
Page 83 and 84: IP IgA x40Normal kidney - immunoper
Page 85 and 86: IP IgG x40Normal kidney - immunoper
Page 87 and 88: IP IgM x40Normal kidney - immunoper
Page 89 and 90: IP C3 x10
Page 91 and 92: IP C1q x40IP C1q x10Normal kidney -
Page 93 and 94: IP kappa x40IP lambda x40Immunopero
Page 95 and 96: IP C4d x40Immunoperoxidase for C4d
Page 97 and 98: IP SV40 x40 biopsy BImmunoperoxidas
Page 99 and 100: Electron microscopy:• a piece of
Page 101 and 102: Toluidine blue x40Toluidine blue x2
Page 103 and 104: Assessment of the glomerulus in ele
Page 105 and 106: This is a low power electron microg
Page 107 and 108: This glomerulus is normocellular, w
Page 109 and 110: mesangial matrixepithelial cellfoot
Page 111 and 112: The Banff Classification of Renal A
Page 113 and 114: Specimen adequacy(a necessary prere
Page 115 and 116: Quantitative criteria for mononucle
Page 117 and 118: Quantitative criteria for arteriola
Page 119 and 120: Quantitative criteria for peritubul
Page 121 and 122: Quantitative criteria for interstit
Page 123 and 124: Quantitative criteria for fibrous i
Page 125 and 126: C4d scoring :% biopsy area(cortex a
Page 127: 2. Antibody-mediated changes:may co
Page 131 and 132: 6. Other:• changes not considered
Page 133 and 134: References:• Banff 07 Classificat
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PAS x40 - RCPA

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