Figure 99

Immunohistochemical staining with anti-monocyte-macrophage antibody (CD68). This reaction confirms that the intracapillary hypercellularity is due mainly to accumulation of these mononuclear leukocytes. Their average number in acute stages of cryoglob-ulinemic glomerulonephritis is four times greater than in severe proliferative lupus nephritis [15]. (Immunoperoxidase X 250.)

FIGURE 9-10 (see Color Plate)

Monocyte in close contact with a massive endocapillary deposit showing phagocytic activity. (Uranyl acetate-lead citrate X 8000.) (Courtesy of Department of Pathology, San Carlo Borromeo Hospital, Milan, Italy.)

FIGURE 9-11 (see Color Plate)

Presence of huge intracapillary deposits typical of cryoglobulinemic glomerulonephritis. These huge intracapillary deposits are called intraluminal thrombi. The only possible differential diagnosis is with glomerulonephritis secondary to Waldenstrom macroglobu-linemia. The glomerulus shows morphologic lesions similar to those seen in Figure 9-8, characterized by marked endocapillary hypercellularity mainly a result of mononuclear leukocyte accumulation. Two large intraluminal deposits, stained in green and red, are evident in the part of the glomerular tuft opposite the vascular pole. It is now well known that these deposits are expressions of acute and massive intracapillary precipitation of circulating cryo-globulins. (Trichrome stain X 250.)

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