Giant Cell Myocarditis Diagnosed at Autopsy: Case Series
DOI:
https://doi.org/10.17986/blm.1602Keywords:
Giant Cell Myocarditis, Sudden Death, AutopsyAbstract
Objective: In our study, we aimed to determine the accompanying cardiac pathologies and accompanying findings in other organs in the cases of giant cell myocarditis.
Methods: The histopathology reports of autopsied cases between 2011 and 2020 were reviewed. Cases diagnosed with myocarditis were evaluated retrospectively according to their histopathological pattern. According to histopathological pattern, it was divided into subgroups as neutrophilic, lymphocytic, lymphohistiocytic, eosinophilic, myocarditis accompanied by granulomas, and giant cell myocarditis. Age and gender distribution, death patterns, autopsy findings, concomitant cardiac pathologies, and histopathological findings in other organs of cases diagnosed with giant cell myocarditis were evaluated retrospectively.
Results: Between 2011 and 2020, 558 of 49,612 autopsies performed in Morgue Department of the Council of Forensic Medicine were diagnosed as myocarditis in the histopathological examination. 1.02% (n=6) were giant cell myocarditis. Three of the cases with giant cell myocarditis were male and three were female. Histopathological findings were similar in all cases diagnosed with giant cell myocarditis. The mean age was found to be 55.66 (31-80). Heart weight ranged from 433-740 gram. Mononuclear cells, polymorphonuclear leukocytes and, eosinophils accompanying giant cells were seen in the inflammatory infiltrate with necrosis. On macroscopic examination, variegated discoloration and scarring on the ventricular wall was the most common finding. Giant cell myocarditis resulted was the cause of death in four cases. Lobular pneumonia was observed in the lungs in two cases. One case had acalculous cholecystitis.
Conclusion: Autopsy and histopathological diagnosis in sudden and unexpected deaths gain importance to diagnose giant cell myocarditis.
Downloads
References
Saltykow S. Über diffuse myokarditis. Virchows Arch Pathol Anat Physiol Klin Med. 1905;182(1):1-39. http://dx.doi.org/10.1007/BF01995636. DOI: https://doi.org/10.1007/BF01995636
Shanmugam J, Kumar PS, Panicker VK, Duvooru P. Sudden Death Due to Giant Cell Myocarditis: A Case Report. Cardiol Res. 2015;6(6):372-375. doi:10.14740/cr446e DOI: https://doi.org/10.14740/cr446e
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;336:1860–1866. https:// doi. org/ 10. 1056/ NEJM1 99706 26336 2603 DOI: https://doi.org/10.1056/NEJM199706263362603
Cooper LT Jr, ElAmm C. Giant cell myocarditis. Diagnosis and treatment Herz 2012;37:632–636. https:// doi. org/ 10. 1007/s00059- 012- 3658-1 DOI: https://doi.org/10.1007/s00059-012-3658-1
Umei TC, Murata Y, Momiyama Y. Sudden cardiac death due to ventricular fibrillation in a case of giant cell myocarditis. J Cardiol Cases. 2020;21(6):224-226. Published 2020 Mar 12. doi:10.1016/j.jccase.2020.02.005 DOI: https://doi.org/10.1016/j.jccase.2020.02.005
Hamilton RA, Sullivan L, Wolf BC. Sudden cardiac death due to giant cell inflammatory processes. J Forensic Sci. 2007;52(4):943-948. doi:10.1111/j.1556-4029.2007.00455.x DOI: https://doi.org/10.1111/j.1556-4029.2007.00455.x
Blauwet LA, Cooper LT. Myocarditis. Prog Cardiovasc Dis. 2010;52:274–88. DOI: https://doi.org/10.1016/j.pcad.2009.11.006
Aretz H. Myocarditis: the Dallas criteria. Hum Pathol. 1987;18:619–624. DOI: https://doi.org/10.1016/S0046-8177(87)80363-5
Baughman KL. Diagnosis of myocarditis: death of Dallas criteria. Circulation. 2006;113:593–5. DOI: https://doi.org/10.1161/CIRCULATIONAHA.105.589663
Kitulwatte Indira D, Patrick J H Kim, Pollanen Michael S. Sudden death related
myocarditis: a study of 56 cases. Forensic Sci Med Pathol. 2010;6:13–19. DOI: https://doi.org/10.1007/s12024-009-9125-5
Tesluk H. Giant cell versus granulomatous myocarditis. Am J Clin Pathol. 1956;26(11):1326-33. http://dx.doi.org/10.1093/ajcp/26.11.1326. PMid:13381715. DOI: https://doi.org/10.1093/ajcp/26.11.1326
Davies MJ, Pomerance A, Teare RD. Idiopathic giant cell myocarditis: a distinctive clinico-pathological entity. Br Heart J. 1975;37(2):192-5. http://dx.doi.org/10.1136/hrt.37.2.192. PMid:1122272. DOI: https://doi.org/10.1136/hrt.37.2.192
Kumari MK, Mysorekar VV, Praveen S. Idiopathic giant cell myocarditis: a case report. J Clin Diagn Res. 2012;6(8):1425-7. http://dx.doi.org/10.7860/JCDR/2012/4298.2377. PMid:23205365. DOI: https://doi.org/10.7860/JCDR/2012/4298.2377
Ratner SJ, Fenoglio JJ, Ursell PC. Utility of endomyocardial biopsy in the diagnosis of cardiac sarcoidosis. Chest 1986;90:528–33. DOI: https://doi.org/10.1378/chest.90.4.528
Cooper LT, Berry GJ, Rizeq M, Schroeder JS. Giant cell myocarditis. J Heart Lung Transplant 1995;14:394–401.
Theaker JM, Gatter KC, Brown DC, Heryet A, Davies MJ. An investigation into the nature of giant cells in cardiac and skeletal muscle. Hum Pathol 1988;19:974–9. DOI: https://doi.org/10.1016/S0046-8177(88)80015-7
Ursell PC, Fenoglio JJ Jr. Spectrum of cardiac disease diagnosed by endomyocardial biopsy. Path Ann 1984;19:197–219.
Ziegler JP, Batalis NI, Fulcher JW, Ward ME. Giant cell myocarditis causing sudden death in a patient with sarcoidosis. Autops Case Rep. 2020;10(4):e2020238. doi:10.4322/acr.2020.238 DOI: https://doi.org/10.4322/acr.2020.238
19. Özdemir-Kara D, Pehlivan S, Türkkan D, Alkan-Alkurt H, Akduman B, Karapirli M. Idiopathic giant cell myocarditis in a newborn: case report. Turk J Pediatr. 2016;58(4):429-431. doi:10.24953/turkjped.2016.04.015 DOI: https://doi.org/10.24953/turkjped.2016.04.015
Downloads
Published
Issue
Section
License
Copyright (c) 2023 The Bulletin of Legal Medicine
This work is licensed under a Creative Commons Attribution 4.0 International License.
The Journal and content of this website is licensed under the terms of the Creative Commons Attribution (CC BY) License. The Creative Commons Attribution License (CC BY) allows users to copy, distribute and transmit an article, adapt the article and make commercial use of the article. The CC BY license permits commercial and non-commercial re-use of an open access article, as long as the author is properly attributed.
