Lymphocytic myocarditis: A histopathologic definition and classification from the society for cardiovascular pathology and association for European cardiovascular pathology. II: Surgical and autopsy specimens

IF 2.3 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Joseph J. Maleszewski , Jytte Banner , Hans de Boer , Monica De Gaspari , Michael C. Fishbein , Sarah Parsons , Barbara Sampson , Mary N. Sheppard , Allard C. Van der Wal , James R. Stone , Katarzyna Michaud
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引用次数: 0

Abstract

Background and aim

Lymphocytic myocarditis, characterized by lymphocyte-predominant myocardial inflammation with associated myocyte injury, is a term that has decades-old histopathologic criteria when encountered on endomyocardial biopsy. However, the interpretation of non-biopsy specimens such as surgical resections and autopsy samples has lacked standardized histopathologic criteria, despite their growing clinical and forensic relevance. The aim was to develop and establish criteria for the diagnosis and classification of lymphocytic myocarditis in non-biopsy ventricular myocardial specimens.

Methods and results

An international panel of cardiovascular pathologists representing the Society for Cardiovascular Pathology (SCVP) and the Association for European Cardiovascular Pathology (AECVP) developed a new classification system, which was completed at a final meeting in the Seaport area of Boston. These “Seaport” criteria for non-biopsy specimens formally define lymphocytic myocarditis as myocardial inflammation predominantly composed of lymphocytes, accompanied by myocyte injury not attributable to other causes. Recommendations address specimen type, technical handling, diagnostic thresholds, and qualifiers of chronicity. Diagnostic categories include active myocarditis and lymphocytic infiltrate of uncertain significance (LIUS). The document also outlines the interpretive challenges in attributing causality in autopsy settings, provides guidance on the use of ancillary techniques, and highlights the limitations of current histopathologic approaches.

Conclusion

These consensus-based criteria offer a standardized framework for diagnosing lymphocytic myocarditis in non-biopsy specimens. Adoption of these guidelines is expected to improve diagnostic consistency, enhance research comparability, and inform clinical and forensic evaluations. Future efforts should aim to refine definitions of myocyte injury, validate ancillary techniques, and elucidate the clinical significance of inflammation in the absence of injury.
淋巴细胞性心肌炎:来自心血管病理学会和欧洲心血管病理协会的组织病理学定义和分类。II:外科和尸检标本。
背景和目的:淋巴细胞性心肌炎,以淋巴细胞为主的心肌炎症和相关的心肌细胞损伤为特征,是一个有几十年历史的术语,当在心肌内膜活检中遇到时,它是一个组织病理学标准。然而,对非活检标本(如手术切除和尸检样本)的解释缺乏标准化的组织病理学标准,尽管它们的临床和法医相关性越来越大。目的是发展和建立非活检心室心肌标本中淋巴细胞性心肌炎的诊断和分类标准。方法和结果:代表心血管病理学会(SCVP)和欧洲心血管病理协会(AECVP)的国际心血管病理学家小组开发了一个新的分类系统,该系统在波士顿海港地区的最后一次会议上完成。这些非活检标本的“海港”标准正式将淋巴细胞性心肌炎定义为主要由淋巴细胞组成的心肌炎症,并伴有非其他原因引起的心肌细胞损伤。建议涉及标本类型、技术处理、诊断阈值和慢性限定词。诊断类别包括活动性心肌炎和意义不确定的淋巴细胞浸润(LIUS)。该文件还概述了在尸检设置中归因于因果关系的解释性挑战,提供了使用辅助技术的指导,并强调了当前组织病理学方法的局限性。结论:这些基于共识的标准为非活检标本中淋巴细胞性心肌炎的诊断提供了一个标准化的框架。这些指南的采用有望提高诊断的一致性,增强研究的可比性,并为临床和法医评估提供信息。未来的努力应旨在完善肌细胞损伤的定义,验证辅助技术,并阐明炎症在无损伤情况下的临床意义。
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来源期刊
Cardiovascular Pathology
Cardiovascular Pathology 医学-病理学
CiteScore
7.50
自引率
2.70%
发文量
71
审稿时长
18 days
期刊介绍: Cardiovascular Pathology is a bimonthly journal that presents articles on topics covering the entire spectrum of cardiovascular disease. The Journal''s primary objective is to publish papers on disease-oriented morphology and pathogenesis from clinicians and scientists in the cardiovascular field. Subjects covered include cardiovascular biology, prosthetic devices, molecular biology and experimental models of cardiovascular disease.
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