REPORTING OF ENDOMYOCARDIAL BIOPSY (ALLOGRAFT REJECTION): CLICK

HISTOPATHOLOGICAL REPORTING OF THE SPECIMENS OF PERICARDIUM: CLICK

Right, or occasionally left, heart biopsies taken by catheter are most

often performed to evaluate graft status in cardiac transplant patients

and less commonly to evaluate cardiomyopathies.

Rarely, an endomyocardial biopsy will be performed to diagnose

an intracavitary or myocardial tumour.

Processing the specimen:

1)  Describe the specimen, including the number of fragments

carefully check lid and sides of container), size and colour -

    (myocardium = tan ; scar = white ; clot = red/brown).    

 Describing the needles that may accompany the specimen is

 not necessary. However, there should be an equal number of

needles and tissue fragments.

Four fragments of myocardium (>50% of each fragment) are

required to adequately assess for rejection.

2)  Wrap in lens paper and submit in one cassette.

1) Transplant recipients:These are urgent cases.

Order for three H &E and one unstained sections .

Tissue should be saved for special studies (Eg. Electron microscopy) 

2) All other cases : These specimens are not urgent cases,

except by special request.

Order for H&E, one Masson’s trichrome, and two unstained sections

(to be available for iron, or amyloid stains if needed).

 A piece of tissue is submitted to the Electron microscopy laboratory

 if received in gluteraldehyde (Karnovsky’s fixative).

Semi-thin sections are examined on all such cases with a decision

 for further analysis after examination. 

A good sampling consists of three fragments for light microscopy,

one fragment for Electron microscopy and an additional fragment

for freezing, if there is a suspicion of a metabolic disease.

When evaluation for adriamycin toxicity is the major consideration,

all tissue is submitted to the Electron laboratory for embedding

in plastic.

Endomyocardial Biopsies - Consultation:

 Endomyocardial biopsy consultations consist of slides or wet tissue (in formalin or gluteraldehyde or both).

 -  Formalin-fixed wet tissue is submitted for processing .

 Order one H & E, one Masson’s trichrome, and three blank slides. 

 -  If slides and/or formalin fixed wet tissue (at least 3 pieces total)

are available then gluteraldehyde fixed tissue is sent to the electron

microscopy  laboratory for processing to semi-thin sections.

A subsequent decision will be made whether to examine ultrathin

sections in the transmission electron microscope.

 - If only gluteraldehyde-fixed wet tissue is available (ie. no slides or

formalin fixed tissues are received), then consult with the cardiac

pathologist before processing.