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| CURRICULUM IN CARDIOLOGY - IMAGES |
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| Year : 2016 | Volume
: 2
| Issue : 3 | Page : 190-191 |
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Cardiovascular pathology quiz
Sudheer Arava, Pradeep Immanuel, Ruma Ray
Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| Date of Web Publication | 2-Mar-2017 |
Correspondence Address:
Sudheer Arava
Department of Pathology, All India Institute of Medical Sciences, New Delhi - 110 029
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2395-5414.201380
How to cite this article:
Arava S, Immanuel P, Ray R. Cardiovascular pathology quiz. J Pract Cardiovasc Sci 2016;2:190-1 |
| Question | |  |
Following are the endomyocardial biopsies (EMCBs) of two patients for comparison and interpretation.
Case 1
A 34-year-old male presented with the clinical diagnosis of restrictive cardiomyopathy. EMCB for interpretation [Figure 1]. | Figure 1: Endomyocardial biopsy from restrictive cardiomyopathy (question). (a) H and E, ×40, (b) H and E, ×100, (c) H and E, ×40 (immunohistochemistry) - smooth muscle actin.
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Case 2
A 45-year-old female presented with dilated cardiomyopathy. EMCB for interpretation [Figure 2]. | Figure 2: Endomyocardial biopsy in dilated cardiomyopathy. (a) H and E, ×40, (b) H and E, ×100, (c) H and E, ×40 (immunohistochemistry) - smooth muscle actin.
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 View Answer
| Answer 1 | | |
ExplanationHematoxylin and eosin stained slides [Figure 3]a and [Figure 3]b, arrow] show a sparsely cellular fibrous tissue fragments (blue-colored spindle-shaped cells are fibroblasts) with absence of endocardial and myocardial tissue. Immunostain for smooth muscle actin (SMA) [Figure 3]c highlights the vascular channels (brown color, arrow) in the fibrous tissue. It represents a thickened and vascularized endocardium. In the clinical context of restrictive heart disease, these features are suggestive of endomyocardial fibrosis. [1],[2] | Figure 3: Endomyocardial biopsy from restrictive cardiomyopathy (question). (a) H and E, ×40, (b) H and E, ×100, (c) H and E, ×40 (immunohistochemistry) smooth muscle actin (Answer).
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| Answer 2 | | |
ExplanationHematoxylin and eosin stained slides [Figure 4]a and [Figure 4]b, arrow] show a cellular fibrous tissue fragment (indicates lamina fibrosa layer of the heart valve) with lack of myocardial tissue (compare the amount of blue-colored spindle-shaped cells with pictures of case 1). Immunostain for SMA [Figure 4]c reveals absence of permeating vascular channels indicating the avascular valve tissue (compare the amount of brown-colored vessels with the case 1). The tricuspid valvular tissue was inadvertently biopsied while performing an EMCB. [3],[4] | Figure 4: Endomyocardial biopsy from restrictive cardiomyopathy (question). (a) H and E, ×40, (b) H and E, ×100, (c) H and E, ×40 (immunohistochemistry) smooth muscle actin (Answer).
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Financial support and sponsorshipNil. Conflicts of interestThere are no conflicts of interest.
| References | | |
| 1. | Mocumbi AO, Yacoub MH, Yokohama H, Ferreira MB. Right ventricular endomyocardial fibrosis. Cardiovasc Pathol 2009;18:64-5.  |
| 2. | Chopra P, Narula J, Talwar KK, Kumar V, Bhatia ML. Histomorphologic characteristics of endomyocardial fibrosis: An endomyocardial biopsy study. Hum Pathol 1990;21:613-6. |
| 3. | Hinton RB, Yutzey KE. Heart valve structure and function in development and disease. Annu Rev Physiol 2011;73:29-46. |
| 4. | Misfeld M, Sievers HH. Heart valve macro- and microstructure. Philos Trans R Soc Lond B Biol Sci 2007;362:1421-36. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
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