Cardiac Path Online
Reporting of Endomyocardial Biopsy- Inflammatory Diseases
Reporting of cardiac biopsies
in patients with inflammatory conditions and infiltrative diseases :
Clinical details of the patient:
- Clinical presentation :
Age and sex ;
Presenting features and duration ;
Occupation of the patient ;
History of alcohol intake and smoking ;
Relationship of disease to pregnancy ;
Family history of heart disease etc.
- History of previous or current treatment : Radiotherapy ; Intake of drugs such as cyclophosphamide and adriamycin;
- Examination to rule out any disease : Example: Haemochromatosis ; Amyloidosis ; Storage disorders;
- Investigations : Radiological features and diagnosis ; Results of microbiological and virological investigations .
- Other relevant history : History of immunosuppression ; systemic malignancy ; relevant travel abroad .
The pathologist should comment on the following features in the histopathology report :
Changes in the Endocardium:
- Inflammation : Type and severity of the inflammation: chronic non-specific - viral myocarditis; granulomatous - sarcoidosis, severity- comparison with previous biopsies. Sequential biopsies are taken to compare the severity and extent of the inflammation with the previous biopsy .
-Fibrosis and elastosis : pattern and extent
-Presence of mural thrombus :
-Presence of foreign material such as from intravenous substance abuse.
Changes in the Myofibres:
- Variation in size (measured quantitatively if appropriate);
- Nuclei: Pleomorphism ; Presence of bizarre forms especially in hypertrophy;
- Disarray: when widespread and in the appropriate clinical setting, this suggests hypertrophic cardiomyopathy.
- Degeneration: Vacuolation ; Basophilia ; Myocytolysis;
- Depositions: Lipofuscin ; Haemosiderin ; Calcium ; Crystals such as oxalate.
Changes in the Interstitium:
- Type of inflammation :
Chronic non-specific ; Granulomatous ;
Giant cell (sarcoid and idiopathic giant cell myocarditis) ;
Eosinophilic (endomyocardial fibroelastosis , parasitic infections) ;
Histiocytic ; Aschoff nodules (rheumatic fever) ;
- Severity : comparison with previous biopsies if necessary;
- Fibrosis : Distribution and extent;
- Depositions : Haemosiderin ; Calcium ; Crystals such as oxalate ; Amyloid.
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