Rheumatic heart disease
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Rheumatic heart disease, abbreviated RHD, is a relatively uncommon heart valve pathology that follows rheumatic fever.
General
- Classically leads to mitral valve stenosis.
- Disease less frequent today - as streptococcal pharynigits is treated with antibiotics.
Gross
- "Fish-mouth appearance".
- Slit-like morphology; elliptical cross-sectional flow area (mitral valve) has an abnormally small semi-minor axis[3] axis due to valve thickening.
- Image: Fish-mouth appearance - pipe (principia-eng.com).
- Significant valvular thickening.
- Thickening and shortening of the cordae tendinae.
DDx:
Images
RHD - showing valvular thickening and thickening of the cordae tendinae. (WC)
RHD - showing valvular thickening - aortic valve. (WC)
Microscopic
Features:[5]
- Caterpillar cells (AKA Anitschkow cells)
- Abundant eosinophilic cytoplasm.
- Moderately-poorly defined cell border.
- Well-defined central ovoid nucleus with a prominent wavy ribbon-like chromatin -- looks vaguely like a caterpillar with some imagination.
- Pathognomonic for rheumatic fever.
- Aschoff bodies - usually in the heart itself:
- Jumbled collagen, eosinophilic.
- Surrounded by lymphocytes (T cells) +/- plasma cells.
Notes:
- Anitschkow cells are thought to be histocytes and Aschoff bodies are thought to be granulomas.[6]
- This is disputed.[7]
Images
RHD - intermed. mag. (WC/Nephron)
RHD - high mag. (WC/Nephron)
RHD - very high mag. (WC/Nephron)
Aschoff body (WC/Uthman)
Anitschkow myocytes (WC/Uthman)
IHC
Features (Aschoff bodies & Anitschkow cells):[6]
- S100 -ve.
- Muscle specific actin -ve.
- Desmin -ve.
- NF -ve.
- Vimentin +ve.
- CD45 +ve (weak).
See also
References
- ↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 594. ISBN 0-7216-0187-1.
- ↑ Chopra, P.; Gulwani, H. (Oct 2007). "Pathology and pathogenesis of rheumatic heart disease.". Indian J Pathol Microbiol 50 (4): 685-97. PMID 18306530.
- ↑ URL: http://en.wikipedia.org/wiki/Ellipse. Accessed on: 13 November 2010.
- ↑ Rose, Alan G. (2008). Atlas of Gross Pathology with Histologic Correlation (1st ed.). Cambridge University Press. pp. 25. ISBN 978-0521868792.
- ↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 593. ISBN 0-7216-0187-1.
- ↑ 6.0 6.1 Love, GL.; Restrepo, C. (Jul 1988). "Aschoff bodies of rheumatic carditis are granulomatous lesions of histiocytic origin.". Mod Pathol 1 (4): 256-61. PMID 3070554.
- ↑ Stehbens, WE.; Zuccollo, JM. (May 1999). "Anitschkow myocytes or cardiac histiocytes in human hearts.". Pathology 31 (2): 98-101. PMID 10399163.