ANSWER TO LAST WEEKS QUIZ: Answer: C The image reveals segmentally prominent intracapillary foam cells, focally admixed with infiltrating inflammatory cells, and epithelial cell hyperplasia. Given the patient’s presentation with nephrotic syndrome and the notable absence of hematuria, these findings are most characteristic of the cellular variant of FSGS. Cellular FSGS is the least common of the FSGS variants recognized in the Columbia classification. Cellular lesions are thought to represent an early stage in the development of sclerotic FSGS lesions. The cellular variant is typically seen in primary FSGS, presenting with full nephrotic syndrome, but can also be seen in a variety of secondary etiologies. Given the histologic features of endocapillary hypercellularity there is significant potential to confuse cellular FSGS with proliferative GN. Clinical-pathologic correlation as well as IF studies (which should be negative) and EM (which should show diffuse podocyte effacement) help with this differential.
Posted on: Wed, 15 Oct 2014 02:26:50 +0000
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