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A case of giant cell myocarditis and malignant thymoma: a postmortem diagnosis by needle biopsy
C M Kilgallen1, E Jackson, M Bankoff
1Department of Pathology, New England Medical Center, Boston, Massachusetts 02111, USA.
Insights
Fulminant giant cell myocarditis, a rare heart inflammation, was diagnosed in a patient with malignant thymoma. A novel needle biopsy technique successfully obtained diagnostic cardiac tissue for confirmation.
Area of Science:
- Cardiology
- Oncology
- Pathology
Background:
- Giant cell myocarditis is a rare and aggressive form of myocardial inflammation.
- Malignant thymoma is a tumor of the thymus gland, often associated with paraneoplastic syndromes.
- Myocarditis can present with diverse clinical manifestations, posing diagnostic challenges.
Observation:
- A 46-year-old woman presented with symptoms suggestive of fulminant myocarditis.
- The patient had a concurrently diagnosed malignant thymoma.
- Diagnosis of giant cell myocarditis was confirmed postmortem, necessitating a specialized biopsy technique.
Findings:
- A novel percutaneous needle biopsy technique using a bone marrow trephine needle was successfully employed to obtain adequate myocardial tissue.
- High-quality tissue preservation was achieved, allowing for detailed immunohistochemical analysis.
- Immunohistochemistry confirmed the giant cells in the myocardium were of macrophage derivation.
Implications:
- This case highlights the association between malignant thymoma and fulminant giant cell myocarditis.
- The developed needle biopsy technique offers a minimally invasive method for diagnosing cardiac conditions when larger biopsies are not feasible.
- Understanding the macrophage origin of giant cells aids in elucidating the pathogenesis of this rare condition.
Abstract:
This paper reports a case of fulminant giant cell myocarditis arising in association with a malignant thymoma causing death in a 46-year-old woman. Although the diagnosis was suspected in life, postmortem examination was required for confirmation of giant cell myocarditis. Consent was obtained only for percutaneous needle biopsy of the heart. In order to respect the family's wishes and harvest sufficient diagnostic myocardium, a simple needle-based biopsy technique was devised. A bone marrow trephine needle was attached to a 20 ml syringe and, with suction, multiple passes were used to fill 15 tissue cassettes. The cores were placed immediately in formalin and B5 fixatives. High-quality tissue preservation was obtained without crush artefact. Immunohistochemical studies of the biopsy tissue confirmed that the giant cells were of macrophage derivation.