Cardiovascular Pathology最新文献

{"title":"A machine learning algorithm improves the diagnostic accuracy of the histologic component of antibody mediated rejection (AMR-H) in cardiac transplant endomyocardial biopsies","authors":"Matthew Glass ,&nbsp;Zhicheng Ji ,&nbsp;Richard Davis ,&nbsp;Elizabeth N. Pavlisko ,&nbsp;Louis DiBernardo ,&nbsp;John Carney ,&nbsp;Gregory Fishbein ,&nbsp;Daniel Luthringer ,&nbsp;Dylan Miller ,&nbsp;Richard Mitchell ,&nbsp;Brandon Larsen ,&nbsp;Yasmeen Butt ,&nbsp;Melanie Bois ,&nbsp;Joseph Maleszewski ,&nbsp;Marc Halushka ,&nbsp;Michael Seidman ,&nbsp;Chieh-Yu Lin ,&nbsp;Maximilian Buja ,&nbsp;James Stone ,&nbsp;David Dov ,&nbsp;Carolyn Glass","doi":"10.1016/j.carpath.2024.107646","DOIUrl":"10.1016/j.carpath.2024.107646","url":null,"abstract":"<div><h3>Background</h3><p>Pathologic antibody mediated rejection (pAMR) remains a major driver of graft failure in cardiac transplant patients. The endomyocardial biopsy remains the primary diagnostic tool but presents with challenges, particularly in distinguishing the histologic component (pAMR-H) defined by 1) intravascular macrophage accumulation in capillaries and 2) activated endothelial cells that expand the cytoplasm to narrow or occlude the vascular lumen. Frequently, pAMR-H is difficult to distinguish from acute cellular rejection (ACR) and healing injury. With the advent of digital slide scanning and advances in machine deep learning, artificial intelligence technology is widely under investigation in the areas of oncologic pathology, but in its infancy in transplant pathology. For the first time, we determined if a machine learning algorithm could distinguish pAMR-H from normal myocardium, healing injury and ACR.</p></div><div><h3>Materials and Methods</h3><p>A total of 4,212 annotations (1,053 regions of normal, 1,053 pAMR-H, 1,053 healing injury and 1,053 ACR) were completed from 300 hematoxylin and eosin slides scanned using a Leica Aperio GT450 digital whole slide scanner at 40X magnification. All regions of pAMR-H were annotated from patients confirmed with a previous diagnosis of pAMR2 (&gt;50% positive C4d immunofluorescence and/or &gt;10% CD68 positive intravascular macrophages). Annotations were imported into a Python 3.7 development environment using the OpenSlide™ package and a convolutional neural network approach utilizing transfer learning was performed.</p></div><div><h3>Results</h3><p>The machine learning algorithm showed 98% overall validation accuracy and pAMR-H was correctly distinguished from specific categories with the following accuracies: normal myocardium (99.2%), healing injury (99.5%) and ACR (99.5%).</p></div><div><h3>Conclusion</h3><p>Our novel deep learning algorithm can reach acceptable, and possibly surpass, performance of current diagnostic standards of identifying pAMR-H. Such a tool may serve as an adjunct diagnostic aid for improving the pathologist's accuracy and reproducibility, especially in difficult cases with high inter-observer variability. This is one of the first studies that provides evidence that an artificial intelligence machine learning algorithm can be trained and validated to diagnose pAMR-H in cardiac transplant patients. Ongoing studies include multi-institutional verification testing to ensure generalizability.</p></div>","PeriodicalId":9451,"journal":{"name":"Cardiovascular Pathology","volume":"72 ","pages":"Article 107646"},"PeriodicalIF":2.3,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140849738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Segmental arterial mediolysis leading to spontaneous rupture of splenic artery and fatal hemorrhage in pregnancy","authors":"Silvia Farkašová Iannaccone ,&nbsp;Ivana Kholová ,&nbsp;Alžbeta Ginelliová ,&nbsp;Lucia Fröhlichová ,&nbsp;Daniel Farkaš","doi":"10.1016/j.carpath.2024.107650","DOIUrl":"10.1016/j.carpath.2024.107650","url":null,"abstract":"<div><p>We report an unexpected death of a 22-year-old primigravida who was admitted to the hospital with sudden abdominal pain two days before a scheduled delivery. During an emergency caesarean section due to intrauterine asphyxia, intraabdominal bleeding was observed with no apparent source of bleeding. Newly formed blood clots in the subdiaphragmatic space and arterial bleeding near the splenic hilum required a surgery on the next day. Hemorrhagic shock led to multiple organ failure on the fourth day of admission. The autopsy revealed ruptured splenic artery at the pancreatic tail and near the splenic hilum. Microscopically, different stages of segmental arterial mediolysis were observed in partially thinned and aneurysmatic artery.</p></div>","PeriodicalId":9451,"journal":{"name":"Cardiovascular Pathology","volume":"71 ","pages":"Article 107650"},"PeriodicalIF":3.7,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1054880724000462/pdfft?md5=647ad1f2a549155580777893a934ea45&pid=1-s2.0-S1054880724000462-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140792746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid progression of a coronary artery aneurysm caused by IgG4-related disease","authors":"Yohei Miura ,&nbsp;Kohei Koyama ,&nbsp;Takashi Kohno ,&nbsp;Kyoko Soejima ,&nbsp;Sho Torii ,&nbsp;Gaku Nakazawa","doi":"10.1016/j.carpath.2024.107647","DOIUrl":"10.1016/j.carpath.2024.107647","url":null,"abstract":"<div><h3>Background</h3><p>IgG4-related disease (IgG4-RD) is a recently recognized fibro-inflammatory disorder that can affect almost any organ. IgG4-RD has also been reported in coronary arteries as periarteritis. IgG4-related coronary periarteritis may cause coronary artery aneurysms, and IgG4-related coronary artery aneurysms (IGCAs) are life-threatening. We describe a case of a patient with IGCA that highlights the usefulness and limitations of various IGCA evaluation modalities and provides insight into disease pathophysiology.</p></div><div><h3>Case summary</h3><p>A 60-year-old man with IgG4-RD diagnosed 2 years before and with IGCA at the proximal right coronary artery (RCA) on coronary angiography (CAG) 9 months prior to admission to the hospital presented with acute coronary syndrome. Emergent CAG revealed the rapid progression of IGCA at the RCA, an obstruction of the diagonal branch, and stenosis of the left anterior descending artery (LAD) and the high lateral branch (HL). The patient underwent percutaneous coronary intervention for the diagonal branch. The RCA aneurysm was resected and bypassed with a saphenous vein graft (SVG); coronary bypass grafting (left internal mammary artery to LAD and SVG to HL) was performed. Pathological findings showed inflammatory cell infiltration and disruption of the elastic plate.</p></div><div><h3>Conclusion</h3><p>IGCAs require careful follow-up with computed tomography scans for early detection of aneurysmal enlargement.</p></div>","PeriodicalId":9451,"journal":{"name":"Cardiovascular Pathology","volume":"71 ","pages":"Article 107647"},"PeriodicalIF":3.7,"publicationDate":"2024-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140797649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Behçet's syndrome masquerading as infective endocarditis: A diagnostic conundrum and therapeutic challenge","authors":"Wei Qu,&nbsp;Youping Chen,&nbsp;Zhenlu Zhang","doi":"10.1016/j.carpath.2024.107648","DOIUrl":"10.1016/j.carpath.2024.107648","url":null,"abstract":"<div><p>This case report presents a 20-year-old male patient initially diagnosed with infective endocarditis, later correctly identified as Behçet's syndrome. The patient's complex clinical presentation, including chest pain, aortic dilation, severe aortic regurgitation, and aortic root abscess, posed significant diagnostic and therapeutic challenges. Despite initial misdiagnosis and treatment difficulties, the patient's condition significantly improved with appropriate immunosuppressive therapy, underscoring the potential for successful management of this complex condition. This case serves as a valuable reminder of the diagnostic challenges posed by Behçet's syndrome and the importance of considering this condition in patients presenting with symptoms suggestive of infective endocarditis.</p></div>","PeriodicalId":9451,"journal":{"name":"Cardiovascular Pathology","volume":"71 ","pages":"Article 107648"},"PeriodicalIF":3.7,"publicationDate":"2024-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140859854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary vascular disease in Veterans with post-deployment respiratory syndrome","authors":"Sergey S. Gutor ,&nbsp;Bradley W. Richmond ,&nbsp;Vineet Agrawal ,&nbsp;Evan L. Brittain ,&nbsp;Ciara M. Shaver ,&nbsp;Pingsheng Wu ,&nbsp;Taryn K. Boyle ,&nbsp;Ravinder R. Mallugari ,&nbsp;Katrina Douglas ,&nbsp;Robert N. Piana ,&nbsp;Joyce E. Johnson ,&nbsp;Robert F. Miller ,&nbsp;John H. Newman ,&nbsp;Timothy S. Blackwell ,&nbsp;Vasiliy V. Polosukhin","doi":"10.1016/j.carpath.2024.107640","DOIUrl":"https://doi.org/10.1016/j.carpath.2024.107640","url":null,"abstract":"<div><p>Exertional dyspnea has been documented in US military personnel after deployment to Iraq and Afghanistan. We studied whether continued exertional dyspnea in this patient population is associated with pulmonary vascular disease (PVD). We performed detailed histomorphometry of pulmonary vasculature in 52 Veterans with biopsy-proven post-deployment respiratory syndrome (PDRS) and then recruited five of these same Veterans with continued exertional dyspnea to undergo a follow-up clinical evaluation, including symptom questionnaire, pulmonary function testing, surface echocardiography, and right heart catheterization (RHC). Morphometric evaluation of pulmonary arteries showed significantly increased intima and media thicknesses, along with collagen deposition (fibrosis), in Veterans with PDRS compared to non-diseased (ND) controls. In addition, pulmonary veins in PDRS showed increased intima and adventitia thicknesses with prominent collagen deposition compared to controls. Of the five Veterans involved in our clinical follow-up study, three had borderline or overt right ventricle (RV) enlargement by echocardiography and evidence of pulmonary hypertension (PH) on RHC. Together, our studies suggest that PVD with predominant venular fibrosis is common in PDRS and development of PH may explain exertional dyspnea and exercise limitation in some Veterans with PDRS.</p></div>","PeriodicalId":9451,"journal":{"name":"Cardiovascular Pathology","volume":"71 ","pages":"Article 107640"},"PeriodicalIF":3.7,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S105488072400036X/pdfft?md5=af04a4c5d2cbe6996241f751749ef6ec&pid=1-s2.0-S105488072400036X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140816263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rare cardiac inflammatory pseudotumor in a toddler: Complementary roles of cardiac magnetic resonance and positron emission tomography","authors":"Melissa Mejia-Bautista ,&nbsp;Jennifer Romanowicz ,&nbsp;Monica Hollowell ,&nbsp;Tal Geva ,&nbsp;Chrystalle Katte Carreon ,&nbsp;Rebecca S. Beroukhim","doi":"10.1016/j.carpath.2024.107639","DOIUrl":"10.1016/j.carpath.2024.107639","url":null,"abstract":"<div><p>We present a rare pediatric case of cardiac inflammatory pseudotumor (IPT) with a unique presentation of fever of unknown origin with markedly elevated inflammatory markers. A right atrial mass was discovered incidentally by echocardiography. The cardiac magnetic resonance (CMR) signal characteristics and mass location were not consistent with any of the common benign cardiac tumors of childhood. The presence of high signal intensity on T2 imaging and late gadolinium enhancement, in conjunction with intense metabolic activity at the mass site on positron emission tomography (PET), raised the possibility of an inflammatory or malignant mass. The diagnosis of IPT was confirmed by biopsy. Our case highlights the utility of PET imaging to confirm the inflammatory nature and extent of an IPT.</p></div>","PeriodicalId":9451,"journal":{"name":"Cardiovascular Pathology","volume":"71 ","pages":"Article 107639"},"PeriodicalIF":3.7,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140874499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The distribution of the depth of aortic dissection and the correlation of the dissection depth index with other parameters","authors":"Youping Chen ,&nbsp;Wei Qu ,&nbsp;Zhenlu Zhang ,&nbsp;Mengya Li ,&nbsp;Yang Wu","doi":"10.1016/j.carpath.2024.107637","DOIUrl":"10.1016/j.carpath.2024.107637","url":null,"abstract":"<div><h3>Background</h3><p>In patients with aortic dissection, the aortic wall is separated into two layers along a dissection plane. In this study, a survey was performed to investigate the distribution of the depth of dissection plane and its correlation with other clinical and pathological parameters to help understand and expand the current knowledge of aortic dissection.</p></div><div><h3>Methods</h3><p>Pathology information system were searched for patients with aortic dissection who had undergone aortic replacement between 2019 and 2022 in Wuhan Asia General Hospital. The depth of dissection plane and dissection depth index were measured in the area around the edge of dissection plane. Correlation between parameters was calculated using Spearman's rank correlation coefficient.</p></div><div><h3>Results</h3><p>124 patients were included in this study. The depth of dissection plane ranged from 533 to 2335 microns, and the 5th percentile was 778 microns. The dissection depth index ranged from 0.320 to 0.972, and the 5th percentile was 0.503. The correlation coefficients were -0.305 (<em>P</em>=.0007), -0.259 (<em>P</em>=0.0111), 0.188 (<em>P</em>=0.0367), 0.189 (<em>P</em>=0.0359) respectively for male gender, the length of aortic dissection, atherosclerosis, and translamellar mucoid extracellular matrix accumulation.</p></div><div><h3>Conclusions</h3><p>In 95% of patients with aortic dissection, the depth of dissection plane is larger than 778 microns, and the dissection depth index is greater than 0.503. In other words, aortic dissection rarely occurs in the inner 50.3% of the aortic media. The dissection depth index is negatively correlated with male gender and the length of aortic dissection, and positively correlated with atherosclerosis and translamellar mucoid extracellular matrix accumulation.</p></div>","PeriodicalId":9451,"journal":{"name":"Cardiovascular Pathology","volume":"71 ","pages":"Article 107637"},"PeriodicalIF":3.7,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140326364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erdheim-Chester disease requires extensive prospective and thorough work-up for multisystem involvement","authors":"Josef Finsterer","doi":"10.1016/j.carpath.2024.107638","DOIUrl":"10.1016/j.carpath.2024.107638","url":null,"abstract":"","PeriodicalId":9451,"journal":{"name":"Cardiovascular Pathology","volume":"71 ","pages":"Article 107638"},"PeriodicalIF":3.7,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140329599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of quadricuspid pulmonary valves at postmortem examination","authors":"Michael Duffy ,&nbsp;Sarah Parsons ,&nbsp;Joseph Westaby ,&nbsp;Mary Sheppard","doi":"10.1016/j.carpath.2024.107636","DOIUrl":"10.1016/j.carpath.2024.107636","url":null,"abstract":"<div><p>Quadricuspid pulmonic valve is a rare congenital abnormality and because of its difficult non-invasive assessment, it is usually discovered incidentally at autopsies (reported prevalence in post-mortem specimens ranges from 1 in 400 to 1 in 2000). Unlike a bicuspid pulmonary valve, it rarely presents with clinical complications, such as valvular insufficiency or stenosis. Abnormal function is rarely reported in cases that are not associated with other congenital heart disease. With increased sophistication of imaging coincidental quadricuspid valves autopsy studies are important to understand the anatomical consequences of this finding. Our case series identified 21 QPV cases from the Victorian Institute of Forensic Medicine, Melbourne and St George's University of London, Department of Cardiovascular Pathology. Cases were identified through local database searches and review of autopsy/cardiac examination reports over a 20-year period. Available photographs were also systematically examined. Fifteen cases had causes of death with no direct causality to cardiac valvular pathology alone. Six cases were considered unascertained or similar (sudden arrhythmic death syndrome and sudden unexpected death in epilepsy). The presence of QPV in these instances were uncertain but thought to be unlikely contributory to death, due to the absence of pulmonary valvular complications.</p></div>","PeriodicalId":9451,"journal":{"name":"Cardiovascular Pathology","volume":"71 ","pages":"Article 107636"},"PeriodicalIF":3.7,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1054880724000322/pdfft?md5=056849791224664bc51f8689ba2850fb&pid=1-s2.0-S1054880724000322-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140193433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cellular and molecular mechanisms driving cardiac tissue fibrosis: On the precipice of personalized and precision medicine","authors":"Ali Fatehi Hassanabad ,&nbsp;Anna N. Zarzycki ,&nbsp;Paul W.M. Fedak","doi":"10.1016/j.carpath.2024.107635","DOIUrl":"10.1016/j.carpath.2024.107635","url":null,"abstract":"<div><p>Cardiac fibrosis is a significant contributor to heart failure, a condition that continues to affect a growing number of patients worldwide. Various cardiovascular comorbidities can exacerbate cardiac fibrosis. While fibroblasts are believed to be the primary cell type underlying fibrosis, recent and emerging data suggest that other cell types can also potentiate or expedite fibrotic processes. Over the past few decades, clinicians have developed therapeutics that can blunt the development and progression of cardiac fibrosis. While these strategies have yielded positive results, overall clinical outcomes for patients suffering from heart failure continue to be dire. Herein, we overview the molecular and cellular mechanisms underlying cardiac tissue fibrosis. To do so, we establish the known mechanisms that drive fibrosis in the heart, outline the diagnostic tools available, and summarize the treatment options used in contemporary clinical practice. Finally, we underscore the critical role the immune microenvironment plays in the pathogenesis of cardiac fibrosis.</p></div>","PeriodicalId":9451,"journal":{"name":"Cardiovascular Pathology","volume":"71 ","pages":"Article 107635"},"PeriodicalIF":3.7,"publicationDate":"2024-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1054880724000310/pdfft?md5=afffe98beb64b2e22e82148b9eff4598&pid=1-s2.0-S1054880724000310-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140173841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}