RESUMEN
Heart myxoma is the most common cardiac neoplasm in adult, even if its biologic profile remains uncertain. The clinicopathologic features of 6 cardiac myxomas in patients ranging in age from 42 to 58 years are described: 5 cases were located in atria, 1 occurred in the right ventricular wall, attached by a thin pedicle to the wall next to the pulmonary artery. Grossly myxomas are generally pedunculated and average 2 to 8 cm in diameter. They appear gelatinous and polypoid, sometimes with areas of hemorrhage. Microscopic examination of specimens of myxomas removed at operation reveals the myxomatous nature of the stroma composed of abundant mucopolysaccharidic matrix, containing stellate or polyhedral cells, singly or in small clusters, and occasional blood vessels. In other cases, the matrix stains more deeply and reticulin fibers and occasional strands of collagen are evident. Immunohistochemical study reveals tumoral positivity for smooth muscle actin cells and for vimentin. In addition, endothelial cells in intramyxomatous vascular channels are positive for factor VIII and CD-34 endothelial markers. Myxomas were diagnosed in patients in whom the symptoms and signs of cardiac tumor may have been attributed to other causes. The clinical pictures produced by cardiac myxomas include non specific manifestations and mechanical interference with cardiac function. The symptoms may simulate a wide variety of other cardiac conditions (mitral valve disease, embolic phemomena, tricuspid valve disease, sudden unexpected death). A wide local excision is needed to assure that the myxoma does not recur.
Asunto(s)
Neoplasias Cardíacas/patología , Mixoma/patología , Adulto , Femenino , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana EdadRESUMEN
Involvement of the cardiovascular system in patients affected by acromegaly is an important factor in morbidity and mortality. The diagnosis in these subjects is acromegalic cardiomyopathy with cardiac decompensation, arrhythmias and sudden death. The pathologic substrate has rarely been described. The present study reports the findings in a case of sudden death in a 54-year-old man, affected by acromegaly. Subsequent diagnostic investigation revealed the characteristic aspects of acromegalic cardiomyopathy in the common myocardium and the presence of hyperacute myocardial infarct of the antero-septal wall of the left ventricle. Examination of conduction tissue revealed slight fibrolipomatosis and dispersion of the atrio-ventricular node (AVN), which extended to the His bundle and bifurcation. The right branch was prematurely intramural with sclerosis and lipomatosis. This location in atrio-ventricular conduction system has seldom been reported in the literature and if so, with different lesions from those found in the case we investigated. The results of microscopic examination convalidate the hypothesis of electrical instability in the heart, as confirmed by the subject's history of ventricular extrasystoles, left branch block and attacks of angina after effort. Death was correlated to hyperacute myocardial infarction of the anteroseptal wall of the left ventricle, in a subject with history of angina, affected by acromegalic cardiomegaly and electric instability. In this case, sudden death could also be considered arrhythmogenic in relation to the additional workload by persistent hormonal stimulation.
Asunto(s)
Acromegalia/complicaciones , Muerte Súbita Cardíaca/etiología , Acromegalia/patología , Muerte Súbita Cardíaca/patología , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Sudden death during sports activities in non-professional athletes is a rare occurrence, however it is of great interest in clinical pathology and forensic medicine. We performed chemico-toxicologic and histopathologic investigations in three cases of sudden cardiac death in non-professional athletes, focusing in particular on the cardiac conduction system. Examination of conduction tissue was performed on sections seriated every 150 microns, stained alternately with hematoxylin-eosin and Heidenhain's trichrome (azan). In all three cases diagnostic evidence showed hyperacute myocardial infarction, due to spasm of coronaries with mild atherosclerosis, and myocardial lesions due to reperfusive necrosis. The pathogenesis of sudden death in young athletes is not related only to ischemic-coronary damage that is not exclusively mechanical, but also a dynamic event (spasm and reperfusion), but also to fatal arrhythmias related to abnormal findings in the conduction system. Such findings can therefore be considered the morphologic substrate of sudden cardiac death.
Asunto(s)
Muerte Súbita Cardíaca/patología , Sistema de Conducción Cardíaco/patología , Infarto del Miocardio/patología , Deportes , Adulto , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/patología , Vasoespasmo Coronario/complicaciones , Vasoespasmo Coronario/patología , Muerte Súbita Cardíaca/etiología , Humanos , Masculino , Artes Marciales , Infarto del Miocardio/etiología , Reperfusión Miocárdica , Carrera , Coloración y Etiquetado , Levantamiento de PesoRESUMEN
Since the initial description by Klinger in 1931 and confirmation by Wegener in 1936, Wegener's granulomatosis has emerged as an uncommon disease entity of unknown aetiology. This disease is characterized by a granulomatous-necrotizing general vasculitis, which most frequently affects the respiratory tract, and by a usually focal necrotizing glomerulonephritis. We report one case of Wegener's granulomatosis with reference to heart conduction system involvement and to nervous plexuses localized in the heart. Specialized conduction system of the heart is little investigated in Wegener's granulomatosis. The blocks of tissue containing the sinoatrial node, the atrio-ventricular node, His bundle, the bifurcation and both bundle branches were fixed in buffered formalin 10% and embedded in paraffin, cut serially at 150 mu intervals and stained alternately with hematoxylin-eosin and Heidenhain trichromic (azan). This heart showed fibrosis near distal His bundle, coronaric arteriolar severe stenosis and fibrotic involvement of the root of the left branch. This histological picture is plausibly and result of scarring of arteriolar specific granulomatous process, also in relation to the low grade of coronarosclerosis. Sclerosis of specific conduction tissue, in addition to cardiac intramural arteriolar subocclusion and to aspecific inflammation of nervous plexuses, can be considered as a plausible arrhythmogenic base of death.
Asunto(s)
Granulomatosis con Poliangitis/fisiopatología , Sistema de Conducción Cardíaco/fisiopatología , Sistema de Conducción Cardíaco/patología , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Muerte Súbita Cardíaca/patología , Sistema de Conducción Cardíaco/patología , Autopsia/métodos , Tronco Encefálico/patología , Cuerpo Carotídeo/patología , Ganglios Autónomos/patología , Corazón/inervación , Humanos , Contracción Miocárdica/fisiología , Miocardio/patología , Manejo de Especímenes/métodos , Coloración y EtiquetadoRESUMEN
It is well known from autopsy series that metastatic tumors of the heart can be found in 1.5% to 21% of patients with malignancies and the incidence of cardiac metastases is showing a gradual increase in recent years. The most common cause of metastatic heart disease is bronchial carcinoma followed by carcinoma of the breast, pleural mesothelioma, malignant melanoma, leukemia and lymphoma, in decreasing order of frequency. However metastatic cancer to the heart is not commonly diagnosed prior to death. Atrial extension has been reported as a common route of local spread in patients with bronchial carcinoma, but cardiac conduction system invasion is infrequent. The purpose of this report is to describe an unusual case of pulmonary adenocarcinoma that presented with cardiac manifestations mimicking atrioventricular (AV) block. This AV block was corrected by pacemaker. Chest radiography and bidimensional echocardiography didn't visualize important lesions. The cardiac findings at autopsy were remarkable not only for the severity of epicardial, myocardial and endocardial involvement, but for the metastatic implants into the His bundle and for the elective and wide infiltration of bifurcating His bundle. On addition histological examination revealed neoplastic emboli in the myocardial lymphatics. No valvular involvement was noted. Technical annotation: histological examination of the conduction system of the heart has been carried out on serial sections with the technique devised by one of the present authors. Bichromic (hematoxylin-eosin) and trichromic (Heidenhain-azan) stainings have been routinely employed.
Asunto(s)
Adenocarcinoma/complicaciones , Adenocarcinoma/secundario , Bloqueo Cardíaco/etiología , Neoplasias Cardíacas/complicaciones , Neoplasias Cardíacas/secundario , Neoplasias Pulmonares/patología , Adenocarcinoma/patología , Anciano , Fascículo Atrioventricular , Neoplasias Cardíacas/patología , Humanos , MasculinoRESUMEN
Cardiac metastatic malignant melanoma. Secondary tumors frequently involve the heart, but the main data about incidence, rate and localization into the specialized myocardium are poor and fragmentary. Post-mortem examination of the conduction system of arrhythmic hearts was studied in two cases of malignant melanoma. In the first case signed by AV block and fibrillation, metastases involved the myocardium over atrioventricular (AV) node and the left and right bundle branch (L and RBB). The second case had not arrhythmias in the clinical picture, but a large metastatic mass involved the junctions between sinoatrial (SA) node and myocardium of the crista terminalis, the junctions between atrium and AV node and the left branch.
Asunto(s)
Neoplasias Cardíacas/secundario , Melanoma/secundario , Anciano , Arritmias Cardíacas/etiología , Neoplasias de la Coroides/patología , Neoplasias Cardíacas/complicaciones , Humanos , Masculino , Miocardio/patología , Neoplasias Cutáneas/patologíaRESUMEN
A 26-day-old infant dying suddenly and diagnosed as sudden infant death syndrome (SIDS). Conduction system abnormalities were found, consisting of accessory atrioventricular (AV) pathways of Mahaim type, which can be regarded as arrhythmogenic in nature.
Asunto(s)
Nodo Atrioventricular/anomalías , Muerte Súbita del Lactante/etiología , Humanos , Recién Nacido , Masculino , Miocardio/patología , Muerte Súbita del Lactante/patologíaRESUMEN
Kinetic cellular methods were used in 53 cases of various sizes of astrocytomas and glioblastomas to obtain reliable prognostic information. Kinetic analysis revealed a wide variation of proliferative activity, with a gradual increase of the mean value from the most differentiated astrocytomas to glioblastomas. DNA content was significantly correlated with the degree of histological differentiation. Chromosomic patterns, which were detected in a few cases, were generally aspecific. The sole recurrent alteration in the karyotype was a small metacentric marker. The comparison of results obtained with the follow-up of patients showed that the labeling index offers a more accurate estimate of the proliferative potential of individual tumours, and thus of the probability of survival, than histological diagnosis and the evaluation of other biological parameters such as ploidy and karyotype.
Asunto(s)
Astrocitoma/diagnóstico , ADN de Neoplasias/análisis , Glioblastoma/diagnóstico , Glioma/diagnóstico , Índice Mitótico , Ploidias , Adolescente , Adulto , Anciano , Aneuploidia , Astrocitoma/genética , Astrocitoma/mortalidad , Autorradiografía , Niño , Preescolar , Densitometría , Diploidia , Femenino , Glioblastoma/genética , Glioblastoma/mortalidad , Glioma/genética , Glioma/mortalidad , Humanos , Cariotipificación , Masculino , Persona de Mediana Edad , Pronóstico , Factores de TiempoRESUMEN
Streptokinase fibrinolysis is a widely accepted and applied therapy in acute myocardial infarction with good clinical and ECG results. Nevertheless this therapy is not devoid of complications that sometimes can be very serious. In this paper the Authors report the case of a patient 52 years old who has been treated with streptokinase for an acute myocardial infarction with good ECG results but that about eight hours later showed an important cholesterol embolization syndrome with visceral and lower extremity lesions. The patient died about 36 hours later. The Authors emphasize the necessity to exclude aortic aneurysm before using thrombolytic agents and to evaluate carefully the possibility to abstain from this procedure in the presence of certain aneurysmal lesions.
Asunto(s)
Embolia/etiología , Infarto del Miocardio/tratamiento farmacológico , Estreptoquinasa/efectos adversos , Terapia Trombolítica/efectos adversos , Colesterol , Humanos , Masculino , Persona de Mediana EdadRESUMEN
A 4-month-old infant dying suddenly is diagnosed as sudden infant death syndrome (SIDS). Important modifications of the cardiac conduction system were found, consisting of conspicuous accessory atrioventricular (AV) pathways of Mahaim and Kent type, which can be regarded as arrhythmogenic in nature.
Asunto(s)
Nodo Atrioventricular/anomalías , Muerte Súbita del Lactante/etiología , Nodo Atrioventricular/patología , Humanos , Lactante , MasculinoRESUMEN
Syndrome caused by multiple cholesterol embolism can be seen as a complication in patients affected by acute myocardial infarction, treated with streptokinase thrombolytic therapy. Fragments of atheromatous plaques may embolize and occlude arterial vessels in different organs. Only the histological examination can give a reliable diagnosis, because symptomatology changes according to different localization of the emboli. An emblem case of this pathology observed by the Authors is described in this article.
Asunto(s)
Colesterol , Embolia/etiología , Infarto del Miocardio/tratamiento farmacológico , Estreptoquinasa/administración & dosificación , Humanos , Infusiones Parenterales , Masculino , Persona de Mediana Edad , Síndrome , Terapia Trombolítica/efectos adversosRESUMEN
Four cases of myocarditis from toxoplasma gondii were observed at autopsy among 18 consecutive cases of acquired immunodeficiency syndrome (AIDS). All cases showed spotty inflammatory myocardial infiltration, consisting mainly of T lymphocytes and, to a lesser extent, of B lymphocytes, histiocytes, mastocytes and eosinophilic granulocytes, with presence of toxoplasma gondii in the cytoplasm of a few myocardial cells. The incidence of toxoplasmic myocarditis in heart involvement in AIDS was 22% in our cases, manifold higher than in preceding reports from the literature. This suggests that cardiac toxoplasmosis is far from rare in patients with AIDS.