ANSWER TO LAST WEEKS QUESTION: Answer E. The large tubular - TopicsExpress

ANSWER TO LAST WEEKS QUESTION: Answer E. The large tubular epithelial nuclei shown in the center raise the possibility of viral cytopathic change, especially BK polyoma virus. Before diagnosing rejection or virus, the biopsy material should next be assayed for polyoma virus. Many SV40 antibodies cross-react with polyoma BK and JC; some labs prefer in situ hybridization. Correlation with other viral assays (esp. trends over time) is also important, including viral urine or serum PCR, or the urine haufen assay. This was a case of refractory rejection with negative tissue and serum viral studies, with reactive epithelial change.

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