The Many Faces of Cardiac Sarcoidosis
1Department of Pathology and Laboratory Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ.
American Journal of Clinical Pathology
|November 27, 2019
Summary
Diagnosing cardiac sarcoidosis is challenging due to varied presentations. This review highlights key pathological features and diagnostic criteria to improve accuracy in identifying this heart condition.
Area of Science:
- Cardiovascular Pathology
- Immunopathology
- Systemic Inflammatory Diseases
Background:
- Cardiac sarcoidosis presents with diverse clinical and pathological features, often complicating diagnosis.
- Variable phenotypes observed in explant and biopsy evaluations necessitate a thorough understanding of the disease spectrum.
Purpose of the Study:
- To review and illustrate the diagnostically challenging features of cardiac sarcoidosis.
- To enhance diagnostic accuracy by emphasizing variable phenotypes and reviewing ancillary studies.
Main Methods:
- A comprehensive literature review was conducted.
- Two illustrative cases of cardiac sarcoidosis were presented and analyzed.
Main Results:
- Cardiac sarcoidosis exhibits a wide pathological spectrum, with irregular left ventricular free wall involvement being most common.
- Early granulomas show loosely associated macrophages, progressing to fibrosis and heart failure in chronic stages.
- Low endomyocardial biopsy sensitivity is attributed to sampling errors and variable histology.
Conclusions:
- Current diagnostic guidelines integrate clinical, radiologic, and immunohistologic criteria.
- Familiarity with these guidelines is crucial for pathologists to accurately diagnose cardiac sarcoidosis.
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