On percutaneous needle biopsies, acute allograft rejection and mild CMV pancreatitis with scanty viral cytopathic changes show overlapping morphological features. The inflammatory infiltrates in CMV infection are predominantly lymphocytic and like rejection tend to associate tightly to the acinar parenchyma if this is involved. Some cases show only isolated inclusions in endothelial cells or stromal cells and minimal inflammatory response. Venous endotheliitis is rarely associated with CMV infections. Eosinophils may be rarely seen in CMV pancreatitis as well.
Neutrophils are present in association with areas of necrosis or acinar cell damage.
Relevant References Smets YF, van der Pijl JW, van Dissel JT et al. Native and graft pancreatitis following combined pancreas-renal transplantation. Treatment of recurrent CMV disease in patients receiving solid organ transplants. Papadimitriou JC, Drachenberg CB, Klassen DK, et al. All rights reserved.