A 46-year-old woman presents for a routine endomyocardial biopsy after transplantation roughly 2 years after her transplant. By report the patient was feeling well. Four pieces of tissue were obtained.
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Quilty lesion and 1R rejection.
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Quilty lesions are benign collections of lymphocytes. They are known mimickers of rejection. By the H&E, the wide discrepancy in the amount of inflammation on the one piece versus the other pieces suggested it was not likely to be rejection. A CD21 is not very sensitive, but it is specific for a Quilty lesion. Reference: The presence of a CD21+ follicular dendritic cell network distinguishes invasive Quilty lesions from cardiac acute cellular rejection. There is a small focus of rejection on one piece of tissue earning the designation of 1R.
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