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Acute Cellular Rejection - Grade 3R

Grade 3R (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. An example of such type of infiltrate involving multiple pieces is shown here.
In most cases, the majority of biopsy fragments are involved, although the intensity of the infiltrate may vary between pieces. Grade 3R 3B 001 (H&E X25)

These biopsies show abundant infiltration by mononuclear inflammatory cells which clearly expand the interstitial space between the myocytes.( H&E, X100)Grade 3R 3B 002

The myocardium is diffusely and extensively infiltrated by dense mononuclear inflammatory cells.  These represent a grade 3B in the ISHLTWF1990 (H&E,  X400)Grade 3A 01

The extensive inflammation can progress to the stage in which neutrophils and even vascular necrosis can be seen. Grade 3a 02

The most severe episodes of cellular rejection show interstitial hemorrhage and an example is shown here.





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