Quilty lesionJoe Segen2017-04-11T11:24:47+00:00
Scanning (low) power H&E stained section with Quilty lesion
Definition A sub-endomyocardial infiltrate of lymphocytes seen in up to 30% of transplanted hearts, which consists of mostly T cells, with a CD4:CD8 ratio of 2-3:1, accompanied by B cells and plasma cells, background fibrosis and prominent vascularity.
The importance of Quilty lesions is to recognise that they are not a sign of acute rejection requiring stepped up immunosuppression.
Differential diagnosis Acute rejection
Histological variants (this subdivision was abandoned, as the two types are clinically indistinguishable)
• Quilty A Dense lymphocytic confined to the endocardium
• Quilty B Infiltrates extend or “spill-over” into the adjacent underlying myocardium and show extensive proliferation of small capillaries
Synonyms Post-transplantation endocardial infiltrate, Quilty effect