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Indirect pathological indicators for cardiac sarcoidosis on endomyocardial biopsy

Journal of Pathology and Translational Medicine 2020년 54권 5호 p.396 ~ 410
차명진, 서정욱, 오세일, 박은아, 이상한, 김문영, 박재영,
소속 상세정보
차명진 ( Cha Myung-Jin ) - Seoul National University Hospital Department of Internal Medicine
서정욱 ( Seo Jeong-Wook ) - Seoul National University College of Medicine Department of Pathology
오세일 ( Oh Se-Il ) - Seoul National University College of Medicine Department of Internal Medicine
박은아 ( Park Eun-Ah ) - Seoul National University Hospital Department of Radiology
이상한 ( Lee Sang-Han ) - Kyungpook National University School of Medicine Department of Forensic Medicine
김문영 ( Kim Moon-Young ) - SMG-SNU Boramae Medical Center Department of Radiology
박재영 ( Park Jae-Young ) - Sejong Hospital Department of Pathology

Abstract


Background: The definitive pathologic diagnosis of cardiac sarcoidosis requires observation of a granuloma in the myocardial tissue. It is common, however, to receive a “negative” report for a clinically probable case. We would like to advise pathologists and clinicians on how to interpret “negative” biopsies.

Methods: Our study samples were 27 endomyocardial biopsies from 25 patients, three cardiac transplantation and an autopsied heart with suspected cardiac sarcoidosis. Pathologic, radiologic, and clinical features were compared.

Results: The presence of micro-granulomas or increased histiocytic infiltration was always (6/6 or 100%) associated with fatty infiltration and confluent fibrosis, and they showed radiological features of sarcoidosis. Three of five cases (60%) with fatty change and confluent fibrosis were probable for cardiac sarcoidosis on radiology. When either confluent fibrosis or fatty change was present, one-third (3/9) were radiologically probable for cardiac sarcoidosis. We interpreted cases with micro-granuloma as positive for cardiac sarcoidosis (five of 25, 20%). Cases with both confluent fibrosis and fatty change were interpreted as probable for cardiac sarcoidosis (seven of 25, 28%). Another 13 cases, including eight cases with either confluent fibrosis or fatty change, were interpreted as low probability based on endomyocardial biopsy.

Conclusions: The presence of micro-granuloma could be an evidence for positive diagnosis of cardiac sarcoidosis. Presence of both confluent fibrosis and fatty change is necessary for probable cardiac sarcoidosis in the absence of granuloma. Either of confluent fibrosis or fatty change may be an indirect pathological evidence but they are interpreted as nonspecific findings.

키워드

Myocarditis; Arrhythmogenic right ventricular dysplasia; Tachycardia, ventricular; Sarcoidosis; Cardiac muscle

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