Colombat et al listed histologic criteria for grading alveolar lesions in a patient following lung transplantation. The authors are from Beaujon Hospital in Clichy Cedex, France.
Histologic parameters in alveolar wall:
(1) pneumocyte hyperplasia
(2) alveolar wall thickness
(3) neutrophilic infiltrates of the alveolar wall
Histologic parameters in the alveolar spaces:
(4) neutrophil aggregates
(5) accumulation of macrophages
(6) fibrin deposition within the alveoli
(7) organization of the loose connective tissue within the alveolus
Each parameter is scored based on the following scheme:
|
Degree of Change for Each Parameter |
Grade and Points |
|
none |
0 |
|
mild |
1 |
|
moderate |
2 |
|
severe |
3 |
total histologic score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum total score: 0
• maximum total score: 21
• The higher the score the more severe the histologic change.
• In addition, the presence of viral inclusions, fungi, bacteria and/or Pneumocystis was recorded.
|
Grade 0 Lesions |
Grade 1 Lesions |
Grade 2 Lesions |
Grade 3 Lesions |
Overall Grade |
|
7 |
0 |
0 |
0 |
0 |
|
6 |
1 |
0 |
0 |
0 |
|
NA |
>= 2 |
0 |
0 |
1 |
|
NA |
NA |
1 or 2 |
0 |
2 |
|
NA |
NA |
>= 3 |
0 |
3 |
|
NA |
NA |
NA |
>= 1 |
3 |
where:
• The overall Grade 3 could cover total scores of 3 to 21. Although sensitive for change at the low end, there is a lot of lumping at the upper.
• A person with 7 Grade 1 lesions is classified as the same as a person with 2.
Specialty: Pulmonology, Surgery, general
