Fig. 7.1
(a–d) Examples of Grade 0—no rejection. Note the normal epidermis and minimal, superficial perivascular, lymphocyte-predominant inflammatory infiltrate
7.1.2 Grade I Rejection: Mild
The presence of mild inflammation characterizes mild, acute cellular rejection (ACR). There should be no involvement of the overlying epidermis (Figs. 7.2).
![A329070_1_En_7_Fig2_HTML.gif](/wp-content/uploads/2016/10/A329070_1_En_7_Fig2_HTML.gif)
![A329070_1_En_7_Fig2_HTML.gif](/wp-content/uploads/2016/10/A329070_1_En_7_Fig2_HTML.gif)
Fig. 7.2
(a–c) Examples of Grade I—mild rejection. Mild, superficial perivascular, lymphocyte-predominant inflammatory infiltrate. No epidermal involvement
7.1.2.1 Differential Diagnosis
Viral exanthem
Drug eruption
7.1.3 Grade II Rejection: Moderate
The presence of a moderate to severe degree of perivascular inflammation, with or without mild epidermal and/or adnexal involvement (limited to spongiosis and exocytosis) without epidermal dyskeratosis/apoptosis characterizes moderate ACR (Fig. 7.3).
![A329070_1_En_7_Fig3_HTML.gif](/wp-content/uploads/2016/10/A329070_1_En_7_Fig3_HTML.gif)
![A329070_1_En_7_Fig3_HTML.gif](/wp-content/uploads/2016/10/A329070_1_En_7_Fig3_HTML.gif)
Fig. 7.3
(a–d) Examples of Grade II—moderate rejection. Moderate to severe perivascular inflammation with or without mild epidermal and/or adnexal involvement. Note the lymphocyte exocytosis into the epidermis without epidermal dyskeratosis/apoptosis (c). Note the epidermal spongiosis and lymphocyte exocytosis without epidermal dyskeratosis/apoptosis (d)
7.1.3.1 Differential Diagnosis
Drug eruption
Eczematous process (allergic/irritant contact dermatitis)
Id reaction
Infectious process (fungal, bacterial, viral)
7.1.4 Grade III Rejection: Severe
The presence of dense inflammation and epidermal involvement with epithelial apoptosis, dyskeratosis, and/or keratinolysis characterizes severe ACR (Fig. 7.4).
![A329070_1_En_7_Fig4_HTML.gif](/wp-content/uploads/2016/10/A329070_1_En_7_Fig4_HTML.gif)
![A329070_1_En_7_Fig4_HTML.gif](/wp-content/uploads/2016/10/A329070_1_En_7_Fig4_HTML.gif)
Fig. 7.4
(a–f) Examples of Grade III—severe rejection. Dense inflammation and epidermal involvement with epithelial apoptosis and dyskeratosis. Note the epithelial dyskeratosis/apoptosis involving the epidermis and the follicular epithelium (c–f)
7.1.4.1 Differential Diagnosis
Drug eruption
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