Cardiac Path Online

Reporting of Endomyocardial Biopsy-  Inflammatory Diseases 

Dr Sampurna Roy MD





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;

- Necrosis:

- 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;

- Oedema:

- Fibrosis : Distribution and extent;

- Depositions : Haemosiderin ; Calcium ; Crystals such as oxalate ; Amyloid.


Reporting of Endomyocardial Biopsy (Allograft Rejection)

Reporting of Endomyocardial biopsy (Inflammatory Condition) 

Histopathological reporting of the specimens of Pericardium


Further reading:

An approach to endomyocardial biopsy interpretation.

Endomyocardial biopsy-guided diagnosis and treatment of inflammatory cardiomyopathies.

Endomyocardial biopsy for non-transplant-related disorders.

Cardiac amyloidosis diagnosed by endomyocardial biopsy. Clinical, histopathological, immunohistochemical and ultrastructural studies.




Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)







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