Polyomavirus nephropathy survey: March 2011

 

From January to March of 2011, the Polyomavirus Working Group established at the 2009 Banff meeting on allograft pathology conducted a survey to test the reproducibility of their proposed staging system of polyomavirus nephropathy.  Ninety-three participants completed the survey, which included an introductory module and an evaluation of 20 test cases.  The survey is reproduced below with the answers bolded and italicized. 

 

The proposed staging system may be viewed and downloaded as a PDF here

 

Further explanation of the staging system along with the introductory module and questions may be viewed and downloaded as a PDF here

 

Each case includes links to virtual slides.  When you click on the links provided, the slides will open up in a new tab or window in your web browser. You will view them using Aperio's Web Scope Software. The slide file name will be visible at the top of the page and will include the case number and the type of stain. You may click and drag to view different areas of the slide, and you can zoom in and out by using the toolbar on the side of the screen.

 

Case 1:  The below questions refer to Case 1.  There are 3 slides for Case 1. To access the slides for Case 1, please click here for an H&E slide, here for a trichrome slide, and here for an SV40 slide.  

 

1.  This case is best classified as

  • PVN-stage A (Medulla)
  • PVN-stage A (Cortex) (correct answer)
  • PVN-stage B (Medulla)
  • PVN-stage B (Cortex)
  • PVN-stage C

 

2.  The polyomavirus load level is (see footnote 6 in the staging system)

  • PVL.1
  • PVL.2 (correct answer)
  • PVL.3

 

3.  The "Banff '97" interstitial fibrosis "ci-score" is

  • ci0 (< 5% interstitial cortical fibrosis) (correct answer)
  • ci1 (6% - 25% interstitial cortical fibrosis)
  • ci2 (26% -50% interstitial cortical fibrosis)
  • ci3 (> 50% interstitial cortical fibrosis)

 

4.  The specimen meets adequacy criteria for the evaluation of PVN (see footnote 2):

  • Yes
  • No (correct answer)

 

5.  Is there any concern of acute or chronic rejection? 

  • Yes
  • No (correct answer)

 

Case 2:  The below questions refer to Case 2. There are 3 slides for Case 2. To access the slides for Case 2, please click here for an H&E slide, here for a trichrome slide, and here for an SV40 slide.

 

1.  This case is best classified as

  • PVN-stage A (Medulla)
  • PVN-stage A (Cortex) (correct answer)
  • PVN-stage B (Medulla)
  • PVN-stage B (Cortex)
  • PVN-stage C

 

2.  The polyomavirus load level is (see footnote 6 in the staging system)

  • PVL.1
  • PVL.2 (correct answer)
  • PVL.3

 

3.  The "Banff '97" interstitial fibrosis "ci-score" is

  • ci0 (< 5% interstitial cortical fibrosis)
  • ci1 (6% - 25% interstitial cortical fibrosis)
  • ci2 (26% -50% interstitial cortical fibrosis) (correct answer)
  • ci3 (> 50% interstitial cortical fibrosis)

 

4.  The specimen meets adequacy criteria for the evaluation of PVN (see footnote 2):

  • Yes (correct answer)
  • No

 

5.  Is there any concern of acute or chronic rejection? 

  • Yes
  • No (correct answer)

 

Case 3:  The below questions refer to Case 3. There are 3 slides for Case 3. To access the slides for Case 3, please click here for an H&E slide, here for a trichrome slide, and here for an SV40 slide.

 

1.  This case is best classified as

  • PVN-stage A (Medulla)
  • PVN-stage A (Cortex)
  • PVN-stage B (Medulla)
  • PVN-stage B (Cortex)
  • PVN-stage C (correct answer)

 

2.  The polyomavirus load level is (see footnote 6 in the staging system)

  • PVL.1
  • PVL.2 (correct answer)
  • PVL.3

 

3.  The "Banff '97" interstitial fibrosis "ci-score" is

  • ci0 (< 5% interstitial cortical fibrosis)
  • ci1 (6% - 25% interstitial cortical fibrosis)
  • ci2 (26% -50% interstitial cortical fibrosis)
  • ci3 (> 50% interstitial cortical fibrosis) (correct answer)

 

4.  The specimen meets adequacy criteria for the evaluation of PVN (see footnote 2):

  • Yes (correct answer)
  • No

 

5.  Is there any concern of acute or chronic rejection? 

  • Yes
  • No (correct answer)

 

Case 4:  The below questions refer to Case 4. There are 3 slides for Case 4. To access the slides for Case 4, please click here for an H&E slide, here for a trichrome slide, and here for an SV40 slide.

 

1.  This case is best classified as

  • PVN-stage A (Medulla)
  • PVN-stage A (Cortex)
  • PVN-stage B (Medulla)
  • PVN-stage B (Cortex) (correct answer)
  • PVN-stage C

 

2.  The polyomavirus load level is (see footnote 6 in the staging system)

  • PVL.1
  • PVL.2
  • PVL.3 (correct answer)

 

3.  The "Banff '97" interstitial fibrosis "ci-score" is

  • ci0 (< 5% interstitial cortical fibrosis)
  • ci1 (6% - 25% interstitial cortical fibrosis) (correct answer)
  • ci2 (26% -50% interstitial cortical fibrosis)
  • ci3 (> 50% interstitial cortical fibrosis)

 

4.  The specimen meets adequacy criteria for the evaluation of PVN (see footnote 2):

  • Yes (correct answer)
  • No

 

5.  Is there any concern of acute or chronic rejection? 

  • Yes
  • No (correct answer)

 

Case 5:  The below questions refer to Case 5. There are 2 slides for Case 5. To access the slides for Case 5, please click here for a PAS slide and here for an SV40 slide.

 

1.  This case is best classified as

  • PVN-stage A (Medulla)
  • PVN-stage A (Cortex)
  • PVN-stage B (Medulla) (correct answer)
  • PVN-stage B (Cortex)
  • PVN-stage C

 

2.  The polyomavirus load level is (see footnote 6 in the staging system)

  • PVL.1 (correct answer)
  • PVL.2
  • PVL.3

 

3.  The "Banff '97" interstitial fibrosis "ci-score" is

  • ci0 (< 5% interstitial cortical fibrosis) (correct answer)
  • ci1 (6% - 25% interstitial cortical fibrosis)
  • ci2 (26% -50% interstitial cortical fibrosis)
  • ci3 (> 50% interstitial cortical fibrosis)

 

4.  The specimen meets adequacy criteria for the evaluation of PVN (see footnote 2):

  • Yes (correct answer)
  • No

 

5.  Is there any concern of acute or chronic rejection? 

  • Yes (correct answer)
  • No

 

Case 6:  The below questions refer to Case 6. There are 3 slides for Case 6. To access the slides for Case 6, please click here for a PAS slide, here for a trichrome slide, and here for an SV40 slide.

 

1.  This case is best classified as

  • PVN-stage A (Medulla)
  • PVN-stage A (Cortex)
  • PVN-stage B (Medulla)
  • PVN-stage B (Cortex) (correct answer)
  • PVN-stage C

 

2.  The polyomavirus load level is (see footnote 6 in the staging system)

  • PVL.1
  • PVL.2
  • PVL.3 (correct answer)

 

3.  The "Banff '97" interstitial fibrosis "ci-score" is

  • ci0 (< 5% interstitial cortical fibrosis) (correct answer)
  • ci1 (6% - 25% interstitial cortical fibrosis)
  • ci2 (26% -50% interstitial cortical fibrosis)
  • ci3 (> 50% interstitial cortical fibrosis)

 

4.  The specimen meets adequacy criteria for the evaluation of PVN (see footnote 2):

  • Yes
  • No (correct answer)

 

5.  Is there any concern of acute or chronic rejection? 

  • Yes
  • No (correct answer)

 

Case 7:  The below questions refer to Case 7. There are 3 slides for Case 7. To access the slides for Case 7, please click here for a PAS slide, here for a trichrome slide, and here for an SV40 slide.

 

1.  This case is best classified as

  • PVN-stage A (Medulla) (correct answer)
  • PVN-stage A (Cortex)
  • PVN-stage B (Medulla)
  • PVN-stage B (Cortex)
  • PVN-stage C

 

2.  The polyomavirus load level is (see footnote 6 in the staging system)

  • PVL.1 (correct answer)
  • PVL.2
  • PVL.3

 

3.  The "Banff '97" interstitial fibrosis "ci-score" is

  • ci0 (< 5% interstitial cortical fibrosis) (correct answer)
  • ci1 (6% - 25% interstitial cortical fibrosis)
  • ci2 (26% -50% interstitial cortical fibrosis)
  • ci3 (> 50% interstitial cortical fibrosis)

 

4.  The specimen meets adequacy criteria for the evaluation of PVN (see footnote 2):

  • Yes (correct answer)
  • No

 

5.  Is there any concern of acute or chronic rejection? 

  • Yes
  • No (correct answer)

 

Case 8:  The below questions refer to Case 8. There are 3 slides for Case 8. To access the slides for Case 8, please click here for an H&E slide, here for a PAS slide, and here for an SV40 slide.

 

1.  This case is best classified as

  • PVN-stage A (Medulla)
  • PVN-stage A (Cortex)
  • PVN-stage B (Medulla)
  • PVN-stage B (Cortex) (correct answer)
  • PVN-stage C

 

2.  The polyomavirus load level is (see footnote 6 in the staging system)

  • PVL.1
  • PVL.2
  • PVL.3 (correct answer)

 

3.  The "Banff '97" interstitial fibrosis "ci-score" is

  • ci0 (< 5% interstitial cortical fibrosis) (correct answer)
  • ci1 (6% - 25% interstitial cortical fibrosis)
  • ci2 (26% -50% interstitial cortical fibrosis)
  • ci3 (> 50% interstitial cortical fibrosis)

 

4.  The specimen meets adequacy criteria for the evaluation of PVN (see footnote 2):

  • Yes (correct answer)
  • No

 

5.  Is there any concern of acute or chronic rejection? 

  • Yes
  • No (correct answer)

 

Case 9:  The below questions refer to Case 9. There are 3 slides for Case 9. To access the slides for Case 9, please click here for an H&E slide, here for a trichrome slide, and here for an SV40 slide.

 

1.  This case is best classified as

  • PVN-stage A (Medulla)
  • PVN-stage A (Cortex)
  • PVN-stage B (Medulla)
  • PVN-stage B (Cortex)
  • PVN-stage C (correct answer)

 

2.  The polyomavirus load level is (see footnote 6 in the staging system)

  • PVL.1
  • PVL.2
  • PVL.3 (correct answer)

 

3.  The "Banff '97" interstitial fibrosis "ci-score" is

  • ci0 (< 5% interstitial cortical fibrosis)
  • ci1 (6% - 25% interstitial cortical fibrosis)
  • ci2 (26% -50% interstitial cortical fibrosis)
  • ci3 (> 50% interstitial cortical fibrosis) (correct answer)

 

4.  The specimen meets adequacy criteria for the evaluation of PVN (see footnote 2):

  • Yes (correct answer)
  • No

 

5.  Is there any concern of acute or chronic rejection? 

  • Yes
  • No (correct answer)

 

Case 10:  The below questions refer to Case 10. There are 3 slides for Case 10. To access the slides for Case 10, please click here for an H&E slide, here for a PAS slide, and here for an SV40 slide.

 

1.  This case is best classified as

  • PVN-stage A (Medulla) (correct answer)
  • PVN-stage A (Cortex)
  • PVN-stage B (Medulla)
  • PVN-stage B (Cortex)
  • PVN-stage C

 

2.  The polyomavirus load level is (see footnote 6 in the staging system)

  • PVL.1 (correct answer)
  • PVL.2
  • PVL.3

 

3.  The "Banff '97" interstitial fibrosis "ci-score" is

  • ci0 (< 5% interstitial cortical fibrosis) (correct answer)
  • ci1 (6% - 25% interstitial cortical fibrosis)
  • ci2 (26% -50% interstitial cortical fibrosis)
  • ci3 (> 50% interstitial cortical fibrosis)

 

4.  The specimen meets adequacy criteria for the evaluation of PVN (see footnote 2):

  • Yes (correct answer)
  • No

 

5.  Is there any concern of acute or chronic rejection? 

  • Yes
  • No (correct answer)

 

Case 11:  The below questions refer to Case 11. There are 3 slides for Case 11. To access the slides for Case 11, please click here for an H&E slide, here for a PAS slide, and here for an SV40 slide.

 

1.  This case is best classified as

  • PVN-stage A (Medulla)
  • PVN-stage A (Cortex) (correct answer)
  • PVN-stage B (Medulla)
  • PVN-stage B (Cortex)
  • PVN-stage C

 

2.  The polyomavirus load level is (see footnote 6 in the staging system)

  • PVL.1
  • PVL.2 (correct answer)
  • PVL.3

 

3.  The "Banff '97" interstitial fibrosis "ci-score" is

  • ci0 (< 5% interstitial cortical fibrosis)
  • ci1 (6% - 25% interstitial cortical fibrosis)
  • ci2 (26% -50% interstitial cortical fibrosis) (correct answer)
  • ci3 (> 50% interstitial cortical fibrosis)

 

4.  The specimen meets adequacy criteria for the evaluation of PVN (see footnote 2):

  • Yes (correct answer)
  • No

5.  Is there any concern of acute or chronic rejection? 

  • Yes (correct answer; one artery, medium-length core in H&E section with minimal evidence of sclerosing rejection)
  • No

 

Case 12:  The below questions refer to Case 12. There are 3 slides for Case 12. To access the slides for Case 12, please click here for an H&E slide, here for a PAS slide, and here for an SV40 slide.   Please note, the SV40 incubation included with this case is a "mismatched" slide.  It does not belong to this case and was erroneously included.  The reponses from this case have not been included in the statistical analysis.

 

1.  This case is best classified as

  • PVN-stage A (Medulla)
  • PVN-stage A (Cortex)
  • PVN-stage B (Medulla)
  • PVN-stage B (Cortex) (correct answer)
  • PVN-stage C

 

2.  The polyomavirus load level is (see footnote 6 in the staging system)

  • PVL.1
  • PVL.2 (correct answer)
  • PVL.3

 

3.  The "Banff '97" interstitial fibrosis "ci-score" is

  • ci0 (< 5% interstitial cortical fibrosis) (correct answer)
  • ci1 (6% - 25% interstitial cortical fibrosis)
  • ci2 (26% -50% interstitial cortical fibrosis)
  • ci3 (> 50% interstitial cortical fibrosis)

 

4.  The specimen meets adequacy criteria for the evaluation of PVN (see footnote 2):

  • Yes (correct answer)
  • No

 

5.  Is there any concern of acute or chronic rejection? 

  • Yes
  • No (correct answer)

 

Case 13:  The below questions refer to Case 13. There are 3 slides for Case 13. To access the slides for Case 13, please click here for an H&E slide, here for a trichrome slide, and here for an SV40 slide.

 

1.  This case is best classified as

  • PVN-stage A (Medulla)
  • PVN-stage A (Cortex)
  • PVN-stage B (Medulla)
  • PVN-stage B (Cortex) (correct answer)
  • PVN-stage C

 

2.  The polyomavirus load level is (see footnote 6 in the staging system)

  • PVL.1 (correct answer)
  • PVL.2
  • PVL.3

 

3.  The "Banff '97" interstitial fibrosis "ci-score" is

  • ci0 (< 5% interstitial cortical fibrosis)
  • ci1 (6% - 25% interstitial cortical fibrosis) (correct answer)
  • ci2 (26% -50% interstitial cortical fibrosis)
  • ci3 (> 50% interstitial cortical fibrosis)

 

4.  The specimen meets adequacy criteria for the evaluation of PVN (see footnote 2):

  • Yes (correct answer)
  • No

 

5.  Is there any concern of acute or chronic rejection? 

  • Yes
  • No (correct answer)

 

Case 14:  The below questions refer to Case 14. There are 2 slides for Case 14. To access the slides for Case 14, please click here for a trichrome slide and here for an SV40 slide.

 

1.  This case is best classified as

  • PVN-stage A (Medulla)
  • PVN-stage A (Cortex)
  • PVN-stage B (Medulla)
  • PVN-stage B (Cortex)
  • PVN-stage C (correct answer)

 

2.  The polyomavirus load level is (see footnote 6 in the staging system)

  • PVL.1
  • PVL.2 (correct answer)
  • PVL.3

 

3.  The "Banff '97" interstitial fibrosis "ci-score" is

  • ci0 (< 5% interstitial cortical fibrosis)
  • ci1 (6% - 25% interstitial cortical fibrosis)
  • ci2 (26% -50% interstitial cortical fibrosis)
  • ci3 (> 50% interstitial cortical fibrosis) (correct answer)

 

4.  The specimen meets adequacy criteria for the evaluation of PVN (see footnote 2):

  • Yes
  • No (correct answer)

 

5.  Is there any concern of acute or chronic rejection? 

  • Yes
  • No (correct answer)

 

Case 15:  The below questions refer to Case 15. There are 3 slides for Case 15. To access the slides for Case 15, please click here for an H&E slide, here for a PAS slide, and here for an SV40 slide.

 

1.  This case is best classified as

  • PVN-stage A (Medulla)
  • PVN-stage A (Cortex) (correct answer)
  • PVN-stage B (Medulla)
  • PVN-stage B (Cortex)
  • PVN-stage C

 

2.  The polyomavirus load level is (see footnote 6 in the staging system)

  • PVL.1 (correct answer)
  • PVL.2
  • PVL.3

 

3.  The "Banff '97" interstitial fibrosis "ci-score" is

  • ci0 (< 5% interstitial cortical fibrosis)
  • ci1 (6% - 25% interstitial cortical fibrosis)
  • ci2 (26% -50% interstitial cortical fibrosis) (correct answer)
  • ci3 (> 50% interstitial cortical fibrosis)

 

4.  The specimen meets adequacy criteria for the evaluation of PVN (see footnote 2):

  • Yes (correct answer)
  • No

 

5.  Is there any concern of acute or chronic rejection? 

  • Yes
  • No (correct answer)

 

Case 16:  The below questions refer to Case 16. There are 3 slides for Case 16. To access the slides for Case 16, please click here for a trichrome slide, here for a PAS slide, and here for an SV40 slide.

 

1.  This case is best classified as

  • PVN-stage A (Medulla)
  • PVN-stage A (Cortex)
  • PVN-stage B (Medulla)
  • PVN-stage B (Cortex) (correct answer)
  • PVN-stage C

 

2.  The polyomavirus load level is (see footnote 6 in the staging system)

  • PVL.1
  • PVL.2 (correct answer)
  • PVL.3

 

3.  The "Banff '97" interstitial fibrosis "ci-score" is

  • ci0 (< 5% interstitial cortical fibrosis)
  • ci1 (6% - 25% interstitial cortical fibrosis) (correct answer)
  • ci2 (26% -50% interstitial cortical fibrosis)
  • ci3 (> 50% interstitial cortical fibrosis)

 

4.  The specimen meets adequacy criteria for the evaluation of PVN (see footnote 2):

  • Yes (correct answer)
  • No

 

5.  Is there any concern of acute or chronic rejection? 

  • Yes
  • No (correct answer)

 

Case 17:  The below questions refer to Case 17. There are 3 slides for Case 17. To access the slides for Case 17, please click here for a PAS slide, here for a trichrome slide, and here for an SV40 slide.

 

1.  This case is best classified as

  • PVN-stage A (Medulla)
  • PVN-stage A (Cortex)
  • PVN-stage B (Medulla)
  • PVN-stage B (Cortex) (correct answer)
  • PVN-stage C

 

2.  The polyomavirus load level is (see footnote 6 in the staging system)

  • PVL.1
  • PVL.2
  • PVL.3 (correct answer)

 

3.  The "Banff '97" interstitial fibrosis "ci-score" is

  • ci0 (< 5% interstitial cortical fibrosis)
  • ci1 (6% - 25% interstitial cortical fibrosis)
  • ci2 (26% -50% interstitial cortical fibrosis)
  • ci3 (> 50% interstitial cortical fibrosis) (correct answer)

 

4.  The specimen meets adequacy criteria for the evaluation of PVN (see footnote 2):

  • Yes (correct answer)
  • No

 

5.  Is there any concern of acute or chronic rejection? 

  • Yes
  • No (correct answer)

 

Case 18:  The below questions refer to Case 18. There are 3 slides for Case 18. To access the slides for Case 18, please click here for an H&E slide, here for a trichrome slide, and here for an SV40 slide.

 

1.  This case is best classified as

  • PVN-stage A (Medulla)
  • PVN-stage A (Cortex)
  • PVN-stage B (Medulla)
  • PVN-stage B (Cortex)
  • PVN-stage C (correct answer)

 

2.  The polyomavirus load level is (see footnote 6 in the staging system)

  • PVL.1
  • PVL.2
  • PVL.3 (correct answer)

 

3.  The "Banff '97" interstitial fibrosis "ci-score" is

  • ci0 (< 5% interstitial cortical fibrosis)
  • ci1 (6% - 25% interstitial cortical fibrosis)
  • ci2 (26% -50% interstitial cortical fibrosis)
  • ci3 (> 50% interstitial cortical fibrosis) (correct answer)

 

4.  The specimen meets adequacy criteria for the evaluation of PVN (see footnote 2):

  • Yes (correct answer)
  • No

 

5.  Is there any concern of acute or chronic rejection? 

  • Yes
  • No (correct answer)

 

Case 19:  The below questions refer to Case 19. There are 3 slides for Case 19. To access the slides for Case 19, please click here for an H&E slide, here for a trichrome slide, and here for an SV40 slide.

 

1.  This case is best classified as

  • PVN-stage A (Medulla) (correct answer)
  • PVN-stage A (Cortex)
  • PVN-stage B (Medulla)
  • PVN-stage B (Cortex)
  • PVN-stage C

 

2.  The polyomavirus load level is (see footnote 6 in the staging system)

  • PVL.1 (correct answer)
  • PVL.2
  • PVL.3

 

3.  The "Banff '97" interstitial fibrosis "ci-score" is

  • ci0 (< 5% interstitial cortical fibrosis) (correct anwer)
  • ci1 (6% - 25% interstitial cortical fibrosis)
  • ci2 (26% -50% interstitial cortical fibrosis)
  • ci3 (> 50% interstitial cortical fibrosis)

 

4.  The specimen meets adequacy criteria for the evaluation of PVN (see footnote 2):

  • Yes (correct answer)
  • No

 

5.  Is there any concern of acute or chronic rejection? 

  • Yes
  • No (correct answer)

 

Case 20:  The below questions refer to Case 20. There are 3 slides for Case 20. To access the slides for Case 20, please click here for an H&E slide, here for a PAS slide, and here for an SV40 slide.

 

1.  This case is best classified as

  • PVN-stage A (Medulla)
  • PVN-stage A (Cortex) (correct answer)
  • PVN-stage B (Medulla)
  • PVN-stage B (Cortex)
  • PVN-stage C

 

2.  The polyomavirus load level is (see footnote 6 in the staging system)

  • PVL.1 (correct answer)
  • PVL.2
  • PVL.3

 

3.  The "Banff '97" interstitial fibrosis "ci-score" is

  • ci0 (< 5% interstitial cortical fibrosis) (correct answer)
  • ci1 (6% - 25% interstitial cortical fibrosis)
  • ci2 (26% -50% interstitial cortical fibrosis)
  • ci3 (> 50% interstitial cortical fibrosis)

 

4.  The specimen meets adequacy criteria for the evaluation of PVN (see footnote 2):

  • Yes
  • No (correct answer)

 

5.  Is there any concern of acute or chronic rejection? 

  • Yes
  • No (correct answer)

 

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