PATHIST
WEB
The
Home of High Resolution Light Microscopy (HRLM)
La
Cuna de Microscopía Optica de Alta Resolución
(MOAR)
La Cuna de Microscopía Optica de Alta Resolución (MOAR)
DEPARTMENT
OF PATHOLOGY
LOUISIANA STATE
UNIVERSITY
HEALTH SCIENCES CENTER
VETERANS AFFAIRS MEDICAL CENTER
NEW ORLEANS, LOUISIANA
LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER
VETERANS AFFAIRS MEDICAL CENTER
NEW ORLEANS, LOUISIANA
DIFFERENT
APPROACH FOR THE MORPHOLOGIC STUDY OF THE
GLOMERULOPATHIES.
SLE
Active Complications (AC)
(WHO Active Lesions)
Page SLE 3
(WHO Active Lesions)
Page SLE 3
LES
Complicaciones Activas (CA)
(OMS Lesiones Activas)
Página LES 3
(OMS Lesiones Activas)
Página LES 3
Local Navigational Box
Complications:
The glomerulonephritis
(basic, primary lesions:
(PPGN, MBGN,
MXGN), with any grade
(I-III) may be superimposed by additional lesions or
complications . These complications are more frequently
present in the higher grades and advanced stages. There are
active complications (AC) (WHO active lesions) and chronic
complicatios (CC) (WHO sclerosing lesions). These should be
graded independently from the basic lesions. The Pathologist
must be aware that a thrombotic microangiopathy may produce
glomerular necrosis, thrombosis and cell proliferation in
any grade of SLE nephritis.
Active complications
(AC) (WHO active lesions):
Necrosis, thrombosis,
active crescents, GBM rupture, fibrin deposition, endothelio
mesangial cell proliferation, inflammatory cell
infiltration, karyorrhexis, hematoxylin bodies (rare),
hyaline thrombi (these are different from the wire loops),
tubular or vascular deposits, vasculitis, thombotic
microangiopathy, tubular necrosis and degeneration, accute
lymphoid interstitial nephritis with tubulitis.
See pictures below.
Complicaciones:
La glomerulonefritis del LES (lesiones básicas,
primarias: GNPP, GNMB,
GNMX), con cualquier
grado (I-III) pueden revelar lesiones superpuestas o
complicaciones. Estas complicaciones son mas frecuentes en
los grados altos y estadios avanzados. Hay complicaciones
activas (CA) (OMS lesiones activas) y complicaciones
cronicas (CC) (OMS lesiones esclerosantes). Estas
complicaciones deben graduarse independientemente de las
lesiones básicas. El Patólogo debe estar
conciente que la microangiopatía trombótica
puede producir lesiones de necrosis, trombosis y
preoliferación celular en cualquier tipo de nefritis
del LES.
Complicaciones activas
(CA) (OMS lesiones activas):
Necrosis, Trombosis,
semilunas activas, ruptura de la MBG, deposición de
fibrina, proliferación celular endotelio mesangial,
infiltración inflamatoria, cariorrexis, cuerpos
hematoxilinicos (raro), trombos hialinos (son diferentes de
las asas de alambre), depósitos inmunes vasculares o
tubulares, vasculitis, microangiopatía
trombótica, necrosis y degeneración tubular,
nefritis intersticial linfoide con tubulitis. Ver las
ilustraciones más abajo.
Grading Active Complications (AC). See: SLE 6. Checklist a
Graduando las Complicaciones Activas (CA). Ver: LES 6. Lista comprobación a
Fig# 13.
PPGN basic grade III
with focal thrombotic microangiopathy (red arrows) and GNMP
(PPGN III, AC3 >50%, CC1 >50%).
GNPP grado básico
III con microangiopatía trombótica (flechas
rojas) y GNMP (GNPP III, AC3 >50%, CC1
>50%).
Fig#
14.
MXGN basic grade II with
focal segmental necrosis. Fibrin (1) and segmental fibrosis
(2) (MXGN II, AC3 <25%, CC1 <25%).
GNMX grado básico
II con necrosis focal y segmentaria. Fibrina (1) y fibrosis
segmentaria (2) (GNMX II AC3 <25%, CC1
<25%).
Fig# 15. PPGN grade II with global necrosis (1) and capillary thrombosis (2) (PPGN II, AC3 <25%, CC1 26-50%.
Fig# 16. PPGN grade I (Mesangial SLE) with cellular crescent (red arrows). (PPGN I, AC3 <25%, CC0.
Fig# 17. PPGN grade III with cellular crescent (1) and segmental fibrosis (2) (PPGN III, AC3 >26-50%, CC1 <25%.
Fig# 18. SLE MBGN grade I with cellular crescent (red arrows) and mild patchy interstitial fibrosis. (MBGN I, AC3 <25%, CC1 >50%).
Fig# 19. MXGN grade III , no acute complications, with diffuse superimposed MCGN and mild uniform interstitial fibrosis (MXGN III, AC0, CC2 >50%).
Fig# 20. PPGN grade III, no acute complications, with superimposed MCGN and mild uniform interstitial fibrosis (PPGN III, AC0, CC2 >50%)
Fig# 21. PPGN grade II, with diffuse mesangial cell proliferation and patchy interstitial fibrosis (PPGN II, AC1 >50%, CC2 >50%).
Fig# 22. MBGN (SLE) grade I, with mesangial cell proliferation and crescents (MBGN I, AC3 <25%, CC0)
Fig# 23. PPGN grade III with hyaline thrombi (red arrows) and MCGN (PPGN II, AC0, CC2 >50%).
Fig# 24. PPGN grade III with patchy interstitial nephritis and tubular deposits (red arrows) and diffuse but mild interstitial fibrosis (PPGN III, AC1 26-50%, CC2 >25%).
Fig# 24A. PPGN grade III with patchy interstitial nephritis and deposits in veins(short arrows) and tubules (long arrows). (PPGN III, AC1 26-50%, CC2 >25%).
Fig# 25. PPGN grade III with interstitial nephritis (1). Tubulitis (2) and fibrotic glomeruli (3) (PPGN III, AC2 > 50%, CC1 26-50%).
Fig# 26. PPGN grade III with immune deposits (1). Lamina elastica (2), Muscularis (3) and Intraluminal fibrin (4) (PPGN III, AC3 <25%, CC2 >25%).
Fig# 27. SLE MBGN and Interstitial nephritis.
Fig# 28. SLE MBGN and Thrombotic microangiopathy.
%20IH.jpg)
Fig# 29. PPGN grade II. IgG antinuclear Ab. Grade unknown.
Fig# 30. PPGN grade III microtubular particles (red arrows). Grade unknown.