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An Immunohistopathologic Study to Profile the Folate Receptor Beta Macrophage and Vascular Immune Microenvironment in Giant Cell Arteritis
Published on: February 8, 2019
[Histological and ultrastructural features of giant cell myocarditis: report of 3 cases]
Yang Sun1, Hong Zhao2, Laifeng Song
1State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Insights
Giant cell myocarditis is a rare adult disease. Cardiac transplantation can improve outcomes, and endomyocardial biopsy is crucial for diagnosis, revealing macrophage-derived giant cells.
Area of Science:
- Cardiology
- Immunology
- Pathology
Background:
- Giant cell myocarditis (GCM) is a rare and aggressive form of heart muscle inflammation.
- Understanding its clinical and pathological features is essential for diagnosis and treatment.
Observation:
- This study analyzed three adult patients with GCM.
- Clinical, gross, histopathological, immunohistological, and ultrastructural findings were documented.
Findings:
- Multifocal myocardial involvement and dilated chambers were observed.
- Histology showed inflammatory infiltrates with CD68+, CD11b+, CD163- multinucleated giant cells, originating from fused macrophages.
- All patients improved after heart transplantation, though one experienced rejection and another showed early post-transplant GCM.
Implications:
- Cardiac transplantation offers a potential treatment for GCM.
- Multinucleated giant cells in GCM are macrophage-derived and involved in immune response.
- Endomyocardial biopsy is vital for diagnosing GCM.
Objective:
To identify clinical and pathological features of giant cell myocarditis.
Methods:
Clinical presentation and follow-up data of three patients with giant cell myocarditis were collected.Gross, histopathological, immunohistological and ultrastructural findings of extransplantated hearts of the patients were documented.
Results:
Grossly, multifocal involvement of the myocardium with variably dilated cardiac chambers were observed in all 3 cases.Histological examination revealed pronounced focal inflammatory infiltrates with multinucleated giant cells. Multinucleated giant cells were positive for CD68 and CD11b immunostains but were negative for CD163 in all cases. Transmission electron microscopy showed that the multinucleated giant cells derived from fusion of several macrophages with adherent lymphocytes and secretary cells. Clinically, the overall patient condition improved in all three cases after heart transplantation.One patient experienced acute cellular rejection (2R level) 4 months after transplantation, but recovered after treatment. One patient developed multinucleated giant cells observed in heart biopsy two weeks after transplantation.
Conclusions:
Giant-cell myocarditis is a rare disease of adult, and cardiac transplantation could improve the clinical outcome. Multinucleated giant cell in the myocarditis lesions were derived from macrophages, likely participating in the immune response. Endomyocardial biopsy is important for the diagnosis of giant cell myocarditis.
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