A pathologist examining a cardiac biopsy from a patient with suspected cardiac allograft rejection identifies Quilty lesions. These represent:
- A Focal areas of ischemic coagulative necrosis in the graft
- B Antibody-mediated microvascular injury with C4d deposition
- C Lymphocytic endocardial infiltrates that may mimic acute cellular rejection ✓
- D Myocyte vacuolization from calcineurin inhibitor toxicity
Explanation
Quilty lesions (Quilty effect) are focal endocardial infiltrates of B and T lymphocytes seen in cardiac transplant biopsies. They are a known pitfall in grading acute cellular rejection because they can overlap with the endocardium (Quilty B), mimicking rejection grade ≥1R. Their significance is debated — they are not graded as rejection per ISHLT 2004 grading guidelines but may indicate ongoing immune activation. Antibody-mediated rejection shows C4d deposition in capillaries, microvascular injury, and DSA (donor-specific antibodies). Calcineurin inhibitor toxicity causes myocyte vacuolization.
Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.