#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Histopathological diagnosis of myocarditis


Authors: Ondřej Fabián 1;  Cyril Štěchovský 2
Authors‘ workplace: Ústav patologie a molekulární medicíny 2. LF UK a FN Motol, Praha 1;  Kardiologická klinika 2. LF UK a FN Motol, Praha 2
Published in: Čes.-slov. Patol., 55, 2019, No. 4, p. 218-223
Category: Reviews Article

Overview

Histopathological assessment of the endomyocardial biopsy represents a gold standard in diagnosis of myocarditis (MC). For a long time, the microscopic diagnosis relied on Dallas criteria. They defined MC on morphological grounds as a presence of inflammatory infiltrate accompanied by signs of myocyte damage. However, these criteria were abandoned due to large proportion of false negative results and substantial interpersonal variability in the histopathological evaluation. The immunohistochemistry was implemented in the diagnostic process as well. Morphological classification of MC is based on the type of the inflammatory infiltration. The most common type of MC in the routine bioptic practice is lymphocytic MC. Giant cell, granulomatous, neutrophilic and eozinophilic MC are less frequent. The aim of this work is to inform about the current level of knowledge in histopathological diagnostics of MC and, in relation to previous article “ Štěchovský, Adla, Bonaventura: Clinical perspective on the myocarditis and cardiomyopathies”, discuss also a different clinical and pathological view on this group of diseases.

Keywords:

histopathology – myocarditis – endomyocardial biopsy – Dallas criteria


Sources

1. Kühl U, Schultheiss HP. Myocarditis: early biopsy allows for tailored regenerative treatment. Dtsch Arztebl Int 2012; 109(20): 361-368.

2. Sekhri V, Sanal S, Delorenzo LJ, Aronow WS, Maguire GP. Cardiac sarcoidosis: a comprehensive review. Arch Med Sci 2011; 7(4): 546-554.

3. Chow LH, Radio SJ, Sears TD, McManus BM. Insensitivity of right ventricular endomyocardial biopsy in the diagnosis of myocarditis.J Am Coll Cardiol 1989; 14(4): 915-920.

4. Frustaci A, Bellocci F, Olsen EG. Results of biventricular endomyocardial biopsy in survivors of cardiac arrest with apparently normal hearts. Am J Cardiol 1994; 74(9): 890-895.

5. Mavrogeni S, Dimitroulas T, Kitas GD. Multimodality imaging and the emerging role of cardiac magnetic resonance in autoimmune myocarditis. Autoimmun Rev 2012; 12(2): 305-312.

6. Pieroni M, Smaldone C, Bellocci F: Myocarditis presenting with ventricular arrhythmias: role of electroanatomical mapping-guided endomyocardial biopsy in differential diagnosis. In: Cihakova D. Myocarditis. InTechOpen; 2011: 365-386.

7. Stone JR, Basso C, Baandrup UT et al. Recommendations for processing cardiovascular surgical pathology specimens: a consensus statement from the Standards and Definitions Committee of the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology. Cardiovasc Pathol 2012; 21(1): 2-16.

8. Cunningham KS, Veinot JP, Butany J. An approach to endomyocardial biopsy interpretation. J Clin Pathol 2006; 59(2): 121-129.

9. Caforio AL, Pankuweit S, Arbustini E et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J 2013; 34(33): 2636-2648.

10. Cooper LT, Baughman KL, Feldman AM et al. The role of endomyocardial biopsy in the management of cardiovascular disease: a scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology. Endorsed by the Heart Failure Society of America and the Heart Failure Association of the European Society of Cardiology. J Am Coll Cardiol 2007; 50(19): 1914-1931.

11. Xu J, Brooks EG. Giant Cell Myocarditis: A Brief Review. Arch Pathol Lab Med 2016; 140(12): 1429-1434.

12. Aretz HT, Billingham ME, Edwards WD et al. Myocarditis. A histopathologic definition and classification. Am J Cardiovasc Pathol 1987; 1(1): 3-14.

13. Chimenti C, Frustaci A. Histopathology of myocarditis. Diagnostic Histopathology 2008; 14(8): 401-407.

14. Baughman KL. Diagnosis of myocarditis: death of Dallas criteria. Circulation 2006; 113(4): 593-595.

15. Cooper LT Jr. Myocarditis. N Engl J Med 2009; 360(15): 1526-1538.

16. Richardson P, McKenna W, Bristow M et al. Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of cardiomyopathies. Circulation 1996; 93(5): 841-842.

17. Woudstra L, Biesbroek PS, Emmens RW et al. CD45 is a more sensitive marker than CD3 to diagnose lymphocytic myocarditis in the endomyocardium. Hum Pathol 2017; 62: 83-90.

18. Leone O, Veinot JP, Angelini A et al. 2011 consensus statement on endomyocardial biopsy from the Association for European Cardiovascular Pathology and the Society for Cardiovascular Pathology. Cardiovasc Pathol 2012; 21(4): 245-274.

19. Grasmeyer S, Madea B. Immunohistochemical diagnosis of myocarditis on (infantile) autopsy material: Does it improve the diagnosis? Forensic Sci Med Pathol 2015; 11(2): 168-176.

20. Dettmeyer R, Baasner A, Schlamann M et al. Role of virus-induced myocardial affections in sudden infant death syndrome: a prospective postmortem study. Pediatr Res 2004; 55(6): 947-952.

21. Rognum TO, Arnestad M, Bajanowski T et al. State of the art conference on the stratification of SUDI. Consensus on diagnostic criteria for the exclusion of SIDS. Nordisk Rettsmedisin 2003; 3/4: 49-88.

22. Angelini A, Crosato M, Boffa GM et al. Active versus borderline myocarditis: clinicopathological correlates and prognostic implications. Heart 2002; 87(3): 210-215.

23. Donoso Mantke O, Meyer R, Prösch S et al. High prevalence of cardiotropic viruses in myocardial tissue from explanted hearts of heart transplant recipients and heart donors: a 3-year retrospective study from a German patients’ pool. J Heart Lung Transplant 2005; 24(10): 1632-1638.

24. Schenk T, Enders M, Pollak S, Hahn R, Huzly D. High Prevalence of Human Parvovirus B19 DNA in Myocardial Autopsy Samples from Subjects without Myocarditis or Dilative Cardiomyopathy. J Clin Microbiol 2009; 47(1): 106-110.

25. Kühl U, Pauschinger M, Noutsias M et al. High prevalence of viral genomes and multiple viral infections in the myocardium of adults with “idiopathic” left ventricular dysfunction. Circulation 2005; 111(7): 887-893.

26. Guarner J, Bhatnagar J, Shieh WJ et al. Histopathologic, immunohistochemical, and polymerase chain reaction assays in the study of cases with fatal sporadic myocarditis. Hum Pathol 2007; 38(9): 1412-1419.

27. Tracy S, Chapman NM, McManus BM, Pallansch MA, Beck MA, Carstens J. A molecular and serologic evaluation of enteroviral involvement in human myocarditis. J Mol Cell Cardiol 1990; 22(4): 403-414.

28. Koepsell SA, Anderson DR, Radio SJ. Parvovirus B19 is a bystander in adult myocarditis. Cardiovasc Pathol 2012; 21(6): 476-481.

29. Pankuweit S, Klingel K. Viral myocarditis: from experimental models to molecular diagnosis in patients. Heart Fail Rev 2013; 18(6): 683-702.

30. Bock CT, Klingel K, Kandolf R. Human parvovirus B19-associated myocarditis. N Engl J Med 2010; 362(13): 1248-1249.

31. Kindermann I, Barth C, Mahfoud F et al. Update on myocarditis. J Am Coll Cardiol 2012; 59(9): 779-792.

32. Basso C, Calabrese F, Angelini A, Carturan E, Thiene G. Classification and histological, immunohistochemical, and molecular diagnosis of inflammatory myocardial disease. Heart Fail Rev 2013; 18(6): 673-681.

33. Leuschner F, Katus HA, Kaya Z. Autoimmune myocarditis: past, present and future. J Autoimmun 2009; 33(3-4): 282-289.

34. Rose NR. Myocarditis: infection versus autoimmunity. J Clin Immunol 2009; 29(6): 730-737.

35. Blauwet LA, Cooper LT. Myocarditis. Prog Cardiovasc Dis 2010; 52(4): 274-288.

36. Sagar S, Liu PP, Cooper LT Jr. Myocarditis. Lancet 2012; 379(9817): 738-747.

37. Buja LM, Butany J. Cardiovascular Pathology (4th ed). United States: Academic Press; 2015: 348-349, 406.

38. Cooper LT Jr. Acute heart failure due to fulminant and giant cell myocarditis. Herz 2006; 31(8): 767-770.

39. Cooper LT Jr. Giant cell and granulomatous myocarditis. Heart Fail Clin 2005; 1(3): 431-437.

40. Blauwet LA, Cooper LT. Idiopathic giant cell myocarditis and cardiac sarcoidosis. Heart Fail Rev 2013; 18(6): 733-746.

41. Shields RC, Tazelaar HD, Berry GJ, Cooper LT Jr. The role of right ventricular endomyocardial biopsy for idiopathic giant cell myocarditis. J Card Fail 2002; 8(2): 74-78.

42. Larsen BT, Maleszewski JJ, Edwards WD et al. Atrial giant cell myocarditis: a distinctive clinicopathologic entity. Circulation 2013; 127(1): 39-47.

43. Bose AK, Bhattacharjee M, Martin V, Kendall S. Giant cell myocarditis of the left atrium. Cardiovasc Pathol 2010; 19(2): e37-38.

44. Cooper LT Jr. Giant cell myocarditis: diagnosis and treatment. Herz 2000; 25(3): 291-298.

45. Litovsky SH, Burke AP, Virmani R. Giant cell myocarditis: an entity distinct from sarcoidosis characterized by multiphasic myocyte destruction by cytotoxic T cells and histiocytic giant cells. Mod Pathol 1996. 9(12): 1126-1134.

46. Lagana SM, Parwani AV, Nichols LC. Cardiac sarcoidosis: a pathology-focused review. Arch Pathol Lab Med 2010; 134(7): 1039-1046.

47. Ginsberg F, Parrillo JE. Eozinophilic myocarditis. Heart Fail Clin 2005; 1(3): 419-429.

48. Al Ali AM, Straatman LP, Allard MF, Ignaszewski AP. Eozinophilic myocarditis: case series and review of literature. Can J Cardiol 2006; 22(14): 1233-1237.

49. Murphy JG, Wright RS, Bruce GK et al. Eozinophilic-lymphocytic myocarditis after smallpox vaccination. Lancet 2003; 362(9393): 1378-1380.

50. Benezet-Mazuecos J, de la Fuente A, Marcos-Alberca P, Farre J. Loeffler endocarditis: what have we learned? Am J Hematol 2007; 82(10): 861-862.

51. Thongsri T, Chularojanamontri L, Pichler WJ. Cardiac involvement in DRESS syndrome. Asian Pac J Allergy Immunol 2017; 35(1): 3-10.

52. Morikawa D, Hiraoka E, Obunai K, Norisue Y. Myocarditis Associated with Drug Reaction with Eozinophilia and Systemic Symptoms (DRESS) Syndrome: A Case Report and Review of the Literature. Am J Case Rep 2018; 19: 978-984.

53. Burke A, Tavola F. Practical Cardiovascular Pathology (Har/Psc ed). United States: Lippincott Williams & Wilkins; 2011: 241-242.

Labels
Anatomical pathology Forensic medical examiner Toxicology
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#