Pub Date : 2024-12-18DOI: 10.1016/j.carpath.2024.107710
María Gracia de Garnica García , Laura Mola Mola Solà , Claudia Pérez-Martínez , Luis Duocastella Codina , María Molina Crisol , Alex Gómez Castel , Armando Pérez de Prado
{"title":"Corrigendum to “Comparative evaluation of local and downstream responses in two commercially available paclitaxel-coated balloons in healthy peripheral arteries of a swine model”","authors":"María Gracia de Garnica García , Laura Mola Mola Solà , Claudia Pérez-Martínez , Luis Duocastella Codina , María Molina Crisol , Alex Gómez Castel , Armando Pérez de Prado","doi":"10.1016/j.carpath.2024.107710","DOIUrl":"10.1016/j.carpath.2024.107710","url":null,"abstract":"","PeriodicalId":9451,"journal":{"name":"Cardiovascular Pathology","volume":"75 ","pages":"Article 107710"},"PeriodicalIF":2.3,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We present an autopsy case of a child with Takayasu arteritis who succumbed due to cerebrovascular accident with an interesting finding in the inflamed aorta. On account of necro-inflammatory changes in the media of the distal descending thoracic aorta coupled with the shear stress of accelerated hypertension, there was a medial detachment, which migrated and lay between the intima and media of the abdominal aorta. This displacement was visualized on gross and histopathological examination as a ‘laminated’ appearance of coils of discontinuous inflamed tunica media, reminiscent of a hydatid cyst, which has been designated as medio-medial intussusceptions.
{"title":"Takayasu arteritis with medio-medial intussusception?","authors":"Pradeep Vaideeswar , Pranav Bhatia , Bharati Malankar","doi":"10.1016/j.carpath.2024.107709","DOIUrl":"10.1016/j.carpath.2024.107709","url":null,"abstract":"<div><div>We present an autopsy case of a child with Takayasu arteritis who succumbed due to cerebrovascular accident with an interesting finding in the inflamed aorta. On account of necro-inflammatory changes in the media of the distal descending thoracic aorta coupled with the shear stress of accelerated hypertension, there was a medial detachment, which migrated and lay between the intima and media of the abdominal aorta. This displacement was visualized on gross and histopathological examination as a ‘laminated’ appearance of coils of discontinuous inflamed tunica media, reminiscent of a hydatid cyst, which has been designated as medio-medial intussusceptions.</div></div>","PeriodicalId":9451,"journal":{"name":"Cardiovascular Pathology","volume":"75 ","pages":"Article 107709"},"PeriodicalIF":2.3,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1016/j.carpath.2024.107701
Justin Burk, Cory T. Bernadt, Jon Ritter, Chieh-Yu Lin
Introduction
Heart transplantations are lifesaving for patients with end-stage heart failure. It is pertinent for the multidisciplinary care team to understand how heart transplant patients succumbed to death and the complications that occurred. In this study, we performed a comprehensive retrospective review of all the autopsies performed in our institute for heart transplant patients and report the trend of demographic data, cause of death, and autopsy findings.
Materials and methods
Reports, photos, and slides of autopsies performed at our institute from 1990 to 2023 for heart transplant patients were reviewed. Pertinent demographic data (age, gender, pretransplant diagnosis), clinical data (clinical history of rejection, complication, time interval from transplant to death, clinical cause of death) and pathological findings (allograft pathology, infectious etiology, other findings related to cause of death) were reviewed, documented, and analyzed.
Results
We identified 88 cases, consisting of 53 male and 35 female patients. The median age at transplant was 26 years, while 28.5 years was the median age at death. The median interval from transplant to death was 10 months. The cases were classified in three categories based on length of survival post-transplant: Superacute (<1 month, 21%), Early (1 month-12 months, 30%), and Late (> 12 months, 49%). Slides were unavailable for review in 15 cases, which were excluded from cause of death (COD) evaluation. We categorized 41.1% of cases as allograft-related COD and 58.9% as non-allograft-related COD. Six of the CODs were not perceived premortem. These unexpected CODs included moderate/severe acute cellular rejection in a patient with a recently negative biopsy, dehiscent suture caused by a fungal abscess, an aorto-bronchial fistula, CMV myocarditis, acute abdominal bleeding, and ruptured atherosclerotic plaques with acute myocardial infarction.
Conclusion
We systematically reviewed 33 years of heart transplant autopsies. We found that 41.1% of deaths were allograft related, with infection being the most frequent COD. While the rate of unexpected findings was low, the findings demonstrate the continued utility of autopsy in patient evaluation.
{"title":"Cause of death for heart transplant patients, an autopsy study","authors":"Justin Burk, Cory T. Bernadt, Jon Ritter, Chieh-Yu Lin","doi":"10.1016/j.carpath.2024.107701","DOIUrl":"10.1016/j.carpath.2024.107701","url":null,"abstract":"<div><h3>Introduction</h3><div>Heart transplantations are lifesaving for patients with end-stage heart failure. It is pertinent for the multidisciplinary care team to understand how heart transplant patients succumbed to death and the complications that occurred. In this study, we performed a comprehensive retrospective review of all the autopsies performed in our institute for heart transplant patients and report the trend of demographic data, cause of death, and autopsy findings.</div></div><div><h3>Materials and methods</h3><div>Reports, photos, and slides of autopsies performed at our institute from 1990 to 2023 for heart transplant patients were reviewed. Pertinent demographic data (age, gender, pretransplant diagnosis), clinical data (clinical history of rejection, complication, time interval from transplant to death, clinical cause of death) and pathological findings (allograft pathology, infectious etiology, other findings related to cause of death) were reviewed, documented, and analyzed.</div></div><div><h3>Results</h3><div>We identified 88 cases, consisting of 53 male and 35 female patients. The median age at transplant was 26 years, while 28.5 years was the median age at death. The median interval from transplant to death was 10 months. The cases were classified in three categories based on length of survival post-transplant: Superacute (<1 month, 21%), Early (1 month-12 months, 30%), and Late (> 12 months, 49%). Slides were unavailable for review in 15 cases, which were excluded from cause of death (COD) evaluation. We categorized 41.1% of cases as allograft-related COD and 58.9% as non-allograft-related COD. Six of the CODs were not perceived premortem. These unexpected CODs included moderate/severe acute cellular rejection in a patient with a recently negative biopsy, dehiscent suture caused by a fungal abscess, an aorto-bronchial fistula, CMV myocarditis, acute abdominal bleeding, and ruptured atherosclerotic plaques with acute myocardial infarction.</div></div><div><h3>Conclusion</h3><div>We systematically reviewed 33 years of heart transplant autopsies. We found that 41.1% of deaths were allograft related, with infection being the most frequent COD. While the rate of unexpected findings was low, the findings demonstrate the continued utility of autopsy in patient evaluation.</div></div>","PeriodicalId":9451,"journal":{"name":"Cardiovascular Pathology","volume":"74 ","pages":"Article 107701"},"PeriodicalIF":2.3,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142458690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-05DOI: 10.1016/j.carpath.2024.107700
Cecilia Salzillo , Monica De Gaspari , Cristina Basso , Mariantonietta Francavilla , Francesco De Leonardis , Andrea Marzullo
Coronary artery vasculitis is a rare pathological condition and is often a manifestation of systemic vasculitis, such as Polyarteritis Nodosa, Kawasaki Disease, Takayasu Arteritis, and Giant Cell Arteritis, with Kawasaki Disease being the most common cause in children.
We present the autopsy case of a 6-year-old boy with classic Hodgkin lymphoma who died of sudden cardiac death due to thrombosis caused by vasculitis, which exclusively affected the coronary arteries and was suggestive of Kawasaki Disease.
To further investigate the histological features of Kawasaki Disease across all age groups, we conducted a literature review using the search terms “Kawasaki AND vasculitis AND histopathology” and “Kawasaki vasculitis histopathology” in Scopus, Google Scholar, and PubMed, covering the period from 1967 to 2023.
The inclusion criteria were as follows: coronary histology (inflammation and/or aneurysm and/or thrombosis), postmortem studies, English language, free articles, all age groups, case reports, and case series.
{"title":"Sudden cardiac death caused by Kawasaki coronary artery vasculitis in a child with Hodgkin's lymphoma. Case report and literature review","authors":"Cecilia Salzillo , Monica De Gaspari , Cristina Basso , Mariantonietta Francavilla , Francesco De Leonardis , Andrea Marzullo","doi":"10.1016/j.carpath.2024.107700","DOIUrl":"10.1016/j.carpath.2024.107700","url":null,"abstract":"<div><div>Coronary artery vasculitis is a rare pathological condition and is often a manifestation of systemic vasculitis, such as Polyarteritis Nodosa, Kawasaki Disease, Takayasu Arteritis, and Giant Cell Arteritis, with Kawasaki Disease being the most common cause in children.</div><div>We present the autopsy case of a 6-year-old boy with classic Hodgkin lymphoma who died of sudden cardiac death due to thrombosis caused by vasculitis, which exclusively affected the coronary arteries and was suggestive of Kawasaki Disease.</div><div>To further investigate the histological features of Kawasaki Disease across all age groups, we conducted a literature review using the search terms “Kawasaki AND vasculitis AND histopathology” and “Kawasaki vasculitis histopathology” in Scopus, Google Scholar, and PubMed, covering the period from 1967 to 2023.</div><div>The inclusion criteria were as follows: coronary histology (inflammation and/or aneurysm and/or thrombosis), postmortem studies, English language, free articles, all age groups, case reports, and case series.</div></div>","PeriodicalId":9451,"journal":{"name":"Cardiovascular Pathology","volume":"74 ","pages":"Article 107700"},"PeriodicalIF":2.3,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-30DOI: 10.1016/j.carpath.2024.107699
Serkan Mola , Alp Yıldırım , Nilüfer Onak Kandemir , Gökay Deniz , Enis Burak Gül , Ertekin Utku Ünal
Background
This study investigates the impact of different harvesting techniques on the morphology and endothelial function of the left internal mammary artery (LIMA) grafts in coronary artery bypass grafting (CABG).
Methods
Fifty-three patients undergoing elective CABG were randomly assigned to two groups based on the harvesting technique: traditional clipping and nonclipping. Histological analyses revealed that arteries in the nonclipped group exhibited greater dilation and preserved endothelial integrity compared to the control group.
Results
The nonclipped group exhibited greater arterial dilation and preserved endothelial integrity compared to the clipped group. Immunostaining for endothelial nitric oxide synthase (eNOS) showed significantly higher expression in the nonclipped group, conversly COX-2 staining showed fewer expression in the nonclipped group indicating better endothelial function preservation.
Conclusion
These findings suggest that maintaining perfusion during LIMA harvesting may improve endothelial function and potentially enhance graft patency in the long term. Further research is warranted to validate these results and optimize harvesting techniques for CABG procedures.
背景：本研究探讨了不同采集技术对冠状动脉旁路移植术（CABG）中左乳内动脉（LIMA）移植物形态和内皮功能的影响：方法：53 名接受择期冠状动脉旁路移植术的患者根据采集技术随机分为两组：传统剪切组和非剪切组。组织学分析表明，与对照组相比，未剪切组的动脉扩张程度更大，内皮完整性得到保留：结果：与剪切组相比，未剪切组的动脉扩张程度更大，内皮完整性得到了保护。内皮一氧化氮合酶（eNOS）的免疫染色显示，非夹闭组的表达量明显更高，而 COX-2 的染色显示，非夹闭组的表达量更少，这表明内皮功能得到了更好的保护：这些研究结果表明，在采集 LIMA 时保持灌注可改善内皮功能，并有可能提高移植物的长期通畅性。有必要进一步研究以验证这些结果，并优化 CABG 手术的采集技术。
{"title":"Unlocking vascular vitality: Exploring the impact of LIMA harvesting technique on endothelial health","authors":"Serkan Mola , Alp Yıldırım , Nilüfer Onak Kandemir , Gökay Deniz , Enis Burak Gül , Ertekin Utku Ünal","doi":"10.1016/j.carpath.2024.107699","DOIUrl":"10.1016/j.carpath.2024.107699","url":null,"abstract":"<div><h3>Background</h3><div>This study investigates the impact of different harvesting techniques on the morphology and endothelial function of the left internal mammary artery (LIMA) grafts in coronary artery bypass grafting (CABG).</div></div><div><h3>Methods</h3><div>Fifty-three patients undergoing elective CABG were randomly assigned to two groups based on the harvesting technique: traditional clipping and nonclipping. Histological analyses revealed that arteries in the nonclipped group exhibited greater dilation and preserved endothelial integrity compared to the control group.</div></div><div><h3>Results</h3><div>The nonclipped group exhibited greater arterial dilation and preserved endothelial integrity compared to the clipped group. Immunostaining for endothelial nitric oxide synthase (eNOS) showed significantly higher expression in the nonclipped group, conversly COX-2 staining showed fewer expression in the nonclipped group indicating better endothelial function preservation.</div></div><div><h3>Conclusion</h3><div>These findings suggest that maintaining perfusion during LIMA harvesting may improve endothelial function and potentially enhance graft patency in the long term. Further research is warranted to validate these results and optimize harvesting techniques for CABG procedures.</div></div>","PeriodicalId":9451,"journal":{"name":"Cardiovascular Pathology","volume":"74 ","pages":"Article 107699"},"PeriodicalIF":2.3,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sudden infant death syndrome (SIDS) “gray zone” or borderline cases are those in which it is challenging to define whether the pathological findings are sufficiently severe to lead to death. We report a case of a 17-day old male newborn who came to our attention for unexplained death. A complete autopsy was performed, including close examination of the cardiac conduction system. Lungs presented diffuse alveolar damage and interstitial inflammation, the cardiac conduction system showed fetal dispersion, resorptive degeneration, junctional tissue islands and cartilaginous hypermetaplasia of the central fibrous body. The final cause of death was a “gray zone” SIDS. This case report will highlight the intersection of SIDS and pneumonia in newborns, exploring the challenges and controversies surrounding the diagnosis and management of this complex condition.
{"title":"Sudden infant death syndrome “Gray Zone” in newborn with pneumonia","authors":"Tobia Tomasello , Beatrice Paradiso , Tommaso Rizzuti , Alessandro Del Gobbo , Lorenza Pugni , Giulia Ottaviani","doi":"10.1016/j.carpath.2024.107698","DOIUrl":"10.1016/j.carpath.2024.107698","url":null,"abstract":"<div><div>Sudden infant death syndrome (SIDS) “gray zone” or borderline cases are those in which it is challenging to define whether the pathological findings are sufficiently severe to lead to death. We report a case of a 17-day old male newborn who came to our attention for unexplained death. A complete autopsy was performed, including close examination of the cardiac conduction system. Lungs presented diffuse alveolar damage and interstitial inflammation, the cardiac conduction system showed fetal dispersion, resorptive degeneration, junctional tissue islands and cartilaginous hypermetaplasia of the central fibrous body. The final cause of death was a “gray zone” SIDS. This case report will highlight the intersection of SIDS and pneumonia in newborns, exploring the challenges and controversies surrounding the diagnosis and management of this complex condition.</div></div>","PeriodicalId":9451,"journal":{"name":"Cardiovascular Pathology","volume":"74 ","pages":"Article 107698"},"PeriodicalIF":2.3,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-06DOI: 10.1016/j.carpath.2024.107689
Estibaliz Castillero , Chiara Camillo , Dov Levine , Alex M. D'Angelo , Yaagnik Kosuri , Juan B. Grau , Robert J. Levy , Giovanni Ferrari
Increased serotonin (5HT) concentration and signaling, can lead to pathological remodeling of the cardiac valves. We previously showed that a reduction of the 5HT transporter (SERT) expression in the mitral valve (MV) contributes to the progression of degenerative MV regurgitation (MR). We sought to investigate the myocardial and valvular phenotype of SERT-/- mice in order to identify remodeling mechanisms specific to the MV and left ventricular (LV) remodeling. Using 8- and 16-week-old WT and SERT-/- mice we show that male and female animals deficient of SERT have pathological remodeling of the cardiac valves, myocardial fibrosis, diminished ejection fraction and altered left ventricular dimensions. In the MV and intervalvular area of the aortic valve (AV)-MV, gene expression, including Col1a1 mRNA, was progressively altered with age up until 16 weeks of age. In contrast, in the AV and myocardium, most gene expression changes occurred earlier and plateaued by 8 weeks. To explore basal differences in susceptibility to remodeling stimuli among cardiac valves, valve interstitial cells (VIC) were isolated from AV, MV, tricuspid valve (TV), pulmonary valve (PV) and fibroblasts (Fb) from the myocardial apex from 16 weeks old wild type (WT) mice. After 24h stimulation with 10 µM of 5HT, the gene expression of Col1a1 and Acta2 were upregulated in MVIC to a higher degree than in VIC from other valves and Fb. Treatment with TGFβ1 similarly upregulated Cola1 and Acta2 in MVIC and AVIC, while the increase was milder in right heart VIC and Fb. Experiments were also carried out with human VIC. In comparison to mice, human left heart VIC were more sensitive to 5HT and TGFβ1, upregulating COL1A1 and ACTA2; TGFβ1 upregulated HTR2B expression in all VIC. Our results support the hypothesis that a deleterious cardiac effect of SERT downregulation may be mediated by increased susceptibility to HTR2B-dependent pro-fibrotic mechanisms, which are distinct among VIC populations and cardiac fibroblasts, regardless of SERT activity. Given that HTR2B mechanisms involved in VIC and myocardial remodeling response are due to both 5HT and also to downstream related TGFβ1 and TNFα activity, targeting HTR2B could be a therapeutic strategy for dual treatment of MR and LV remodeling.
{"title":"Serotonin transporter deficiency in mice results in an increased susceptibility to HTR2B-dependent pro-fibrotic mechanisms in the cardiac valves and left ventricular myocardium","authors":"Estibaliz Castillero , Chiara Camillo , Dov Levine , Alex M. D'Angelo , Yaagnik Kosuri , Juan B. Grau , Robert J. Levy , Giovanni Ferrari","doi":"10.1016/j.carpath.2024.107689","DOIUrl":"10.1016/j.carpath.2024.107689","url":null,"abstract":"<div><div>Increased serotonin (5HT) concentration and signaling, can lead to pathological remodeling of the cardiac valves. We previously showed that a reduction of the 5HT transporter (SERT) expression in the mitral valve (MV) contributes to the progression of degenerative MV regurgitation (MR). We sought to investigate the myocardial and valvular phenotype of SERT<sup>-/-</sup> mice in order to identify remodeling mechanisms specific to the MV and left ventricular (LV) remodeling. Using 8- and 16-week-old WT and SERT<sup>-/-</sup> mice we show that male and female animals deficient of SERT have pathological remodeling of the cardiac valves, myocardial fibrosis, diminished ejection fraction and altered left ventricular dimensions. In the MV and intervalvular area of the aortic valve (AV)-MV, gene expression, including Col1a1 mRNA, was progressively altered with age up until 16 weeks of age. In contrast, in the AV and myocardium, most gene expression changes occurred earlier and plateaued by 8 weeks. To explore basal differences in susceptibility to remodeling stimuli among cardiac valves, valve interstitial cells (VIC) were isolated from AV, MV, tricuspid valve (TV), pulmonary valve (PV) and fibroblasts (Fb) from the myocardial apex from 16 weeks old wild type (WT) mice. After 24h stimulation with 10 µM of 5HT, the gene expression of Col1a1 and Acta2 were upregulated in MVIC to a higher degree than in VIC from other valves and Fb. Treatment with TGFβ1 similarly upregulated Cola1 and Acta2 in MVIC and AVIC, while the increase was milder in right heart VIC and Fb. Experiments were also carried out with human VIC. In comparison to mice, human left heart VIC were more sensitive to 5HT and TGFβ1, upregulating COL1A1 and ACTA2; TGFβ1 upregulated HTR2B expression in all VIC. Our results support the hypothesis that a deleterious cardiac effect of SERT downregulation may be mediated by increased susceptibility to HTR2B-dependent pro-fibrotic mechanisms, which are distinct among VIC populations and cardiac fibroblasts, regardless of SERT activity. Given that HTR2B mechanisms involved in VIC and myocardial remodeling response are due to both 5HT and also to downstream related TGFβ1 and TNFα activity, targeting HTR2B could be a therapeutic strategy for dual treatment of MR and LV remodeling.</div></div>","PeriodicalId":9451,"journal":{"name":"Cardiovascular Pathology","volume":"74 ","pages":"Article 107689"},"PeriodicalIF":2.3,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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