Öz
Giant cell myocarditis is a rapidly fatal disorder characterized by the presence of multinucleated giant cells and a lymphocytic inflammatory infiltrate, associated with myocyte necrosis. The diagnosis of giant cell myocarditis is usually determined at autopsy. We present a 35 years old female case of sudden death while playing tennis. On internal examination, the heart weighed 315 g and thickness of left ventricular wall was 1,4 cm ,that of right ventricle was 0,1-0,3 cm. Papillary muscles in both ventricles were fibrotic and showed disarrangement. There was an area of aneurysm with a diameter of 4 cm in left ventricle. Myocardial sections showed areas of fibrosis and dark-mottled areas. Microscopic examination of myocardial sections revealed connective tissue replacing normal myocardial muscle bundles, diffuse lymphohistiositic inflammatory cell infiltration, multinuclear giant cells, and scarce eosinophilic polymorhocytes. Microscopic sections of other internal organs showed no pathology other than hyperemia. On the basis of these findings, the final diagnosis was giant-cell myocarditis
Anahtar Kelimeler
Kaynakça
- Sheppard M, Davies MJ. Cardiac hypertrophy,myocarditis and cardiomyopathy in Practical Cardiovascular Pathology 1st.ed.Oxford University Pres.1998:103-148.
- Shariff S, Straatman L, Allard M, Ignaszewski A. Novel associations of giant cell myocarditis: two case reports and a review of the literature. Can J Cardiol 2004;20(5):557-61.
- Karapur PG, Dhaded AV, Udayakumar M. Idıopathic giant cell myocarditis-a case report and review of literature. Indian J Pathol Microbiol 2003; 46(2):241-243.
- Demir M, Tasal A, San M. Miyokardit. Turkiye Klinikleri J Med Sci 2006, 26:441-448.
- Frederick J. Schoen. The heart. In: Kumar V, Abbas AK, Fausto F, eds.Robbins and Cotran Pathological Basis of Disease. 7th ed. Philadelphia:Elsevier Saunders; 2005:608–609.
- Murty OP. Giant cell myocarditis with cardiac tamponade: a rare combination. Am J Forensic Med Pathol. 2008;29(3):245-8.
- Cooper LT Jr, Berry GJ, Shabetai R. Idiopathic giant-cell myocarditis-natural history and treatment. Multicenter Giant Cell Myocarditis Study Group Investigators. N Engl J Med 1997;336:1860-6.
- Davidoff R, Palacios I, Southern J, et al. Giant cell versus lymphocytic myocarditis: a comparison of their clinical features and long term outcomes. Circulation 1991;83:953–961. 9. Richardson P, McKenna W et al. Report of the 1995 World Health Organization/ International Society and Federation of Cardiology Task Force on the definition and classification of cardiomyopathies. Circulation 1996; 93: 841–42.
- Van Haelst PL, van Rossem M, Valentijn RM, Beijer GJ. Giant cell myocarditis: a fatal cause of dyspnea in pregnancy. Eur J Obstet Gynecol Reprod Biol. 2001;10;100(1):105-7.
- Kodama M, Zhang S, Hanawa H, Shibata A. Immunohistochemical characterization of infiltrating mononuclear cells in the rat heart with experimental autoimmune giant cell myocarditis. Clin Exp Immunol 1992;90(2):330-5.
- Silver MD, Gotlieb AI, Schoen FJ. Cardiomyopathies in Cardiovascular Pathology 3 rd edition. Churchill Livingstone Philadelphia, Pennsylvania 19106.2001;285-325.
Öz
Dev hücreli myokardit genellikle çok ani gelişen, ölümcül seyreden, multinükleer dev hücreler, lenfohistiositik infiltrasyon ve miyosit nekrozu ile karekterize bir hastalıktır. Tanısı genellikle otopsi ile konulabilir. Çalışmada 35 yaşında, tenis oynarken ani ölen kadın olgu bildirilmektedir. Yapılan otopside kalp 315gr. tartıldı. Sol ventrikül duvar kalınlığı 1,4 cm, sağ ventrikül duvar kalınlığı 0,1-0,3 cm ölçüldü. Her iki ventrikülde de papiller kaslarda belirgin düzensizlik, fibrotik görünüm ve sol ventrikülde 4 cm çapında anevrizma izlendi. Her iki ventrikül myokard kesitlerinde de beyaz renkli yaygın fibrozis alanları içinde koyu renkli alacalı görünümde alanlar izlendi. Myokard kesitlerinin mikroskobik incelemesinde geniş alanlarda kas liflerinin yerini alan bağ dokusu, yoğun lenfoplazmositer iltihabi hücre infiltrasyonu, multinükleer dev hücreler ve seyrek eozinofil polimorflar görüldü. Diğer iç organlarda hiperemi dışında mikroskobik bulgu saptanmadı. Bu bulgular eşliğinde olgu idiopatik dev hücreli myokardit olarak değerlendirildi.Sonuç olarak, literatürde de oldukça nadir bildirilen dev hücreli myokardit olgusu, ani ölüm olgularında ayırıcı tanıya alınması gereken bir antite olarak sunulmuştur
Anahtar Kelimeler
Kaynakça
- Sheppard M, Davies MJ. Cardiac hypertrophy,myocarditis and cardiomyopathy in Practical Cardiovascular Pathology 1st.ed.Oxford University Pres.1998:103-148.
- Shariff S, Straatman L, Allard M, Ignaszewski A. Novel associations of giant cell myocarditis: two case reports and a review of the literature. Can J Cardiol 2004;20(5):557-61.
- Karapur PG, Dhaded AV, Udayakumar M. Idıopathic giant cell myocarditis-a case report and review of literature. Indian J Pathol Microbiol 2003; 46(2):241-243.
- Demir M, Tasal A, San M. Miyokardit. Turkiye Klinikleri J Med Sci 2006, 26:441-448.
- Frederick J. Schoen. The heart. In: Kumar V, Abbas AK, Fausto F, eds.Robbins and Cotran Pathological Basis of Disease. 7th ed. Philadelphia:Elsevier Saunders; 2005:608–609.
- Murty OP. Giant cell myocarditis with cardiac tamponade: a rare combination. Am J Forensic Med Pathol. 2008;29(3):245-8.
- Cooper LT Jr, Berry GJ, Shabetai R. Idiopathic giant-cell myocarditis-natural history and treatment. Multicenter Giant Cell Myocarditis Study Group Investigators. N Engl J Med 1997;336:1860-6.
- Davidoff R, Palacios I, Southern J, et al. Giant cell versus lymphocytic myocarditis: a comparison of their clinical features and long term outcomes. Circulation 1991;83:953–961. 9. Richardson P, McKenna W et al. Report of the 1995 World Health Organization/ International Society and Federation of Cardiology Task Force on the definition and classification of cardiomyopathies. Circulation 1996; 93: 841–42.
- Van Haelst PL, van Rossem M, Valentijn RM, Beijer GJ. Giant cell myocarditis: a fatal cause of dyspnea in pregnancy. Eur J Obstet Gynecol Reprod Biol. 2001;10;100(1):105-7.
- Kodama M, Zhang S, Hanawa H, Shibata A. Immunohistochemical characterization of infiltrating mononuclear cells in the rat heart with experimental autoimmune giant cell myocarditis. Clin Exp Immunol 1992;90(2):330-5.
- Silver MD, Gotlieb AI, Schoen FJ. Cardiomyopathies in Cardiovascular Pathology 3 rd edition. Churchill Livingstone Philadelphia, Pennsylvania 19106.2001;285-325.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Case Report |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Aralık 2010 |
| Yayımlandığı Sayı | Yıl 2010Sayı: 4 |