Acute Cellular Rejection -III

 

In Grade 2 R two or more foci of mononuclear cells lymphocytes/macrophages) with associated myocyte damage are present. Eosinophils may be present. The foci may be distributed in one or more than one biopsy fragment. Intervening areas of uninvolved myocardium are present between the foci of rejection (Figures 9 and 10). Low-grade (Grade 1R) rejection can be present in other biopsy pieces.
Grade 3 R (severe, high-grade, acute cellular rejection) A diffuse inflammatory process, either predominantly lymphocytes and macrophages or a polymorphous infiltrate , is present, involving multiple biopsy fragments (Figures 11 and 12). In most cases, the majority of biopsy fragments are involved, although the intensity of the infiltrate may vary between pieces. Multiple areas of associated myocyte damage are present. In the most severe forms of cellular (and humoral) rejection,edema, interstitial hemorrhage and vasculitis may be present.