Takemura G, Takatsu Y, Ono K, Miyatake T, Ono M, Izumi T, Fujiwara H
Department of Internal Medicine, Hyogo Prefectural Amagasaki Hospital, Japan.
Heart Vessels. 1995;10(5):275-8. doi: 10.1007/BF01744907.
A 49-year-old man with cardiac sarcoidosis is presented. He suffered from congestive heart failure, and left ventricular asynergy and reduced function was evident by echocardiogram and left ventriculogram. A light microscopic examination of the endomyocardial biopsy revealed nonspecific myocarditis without giant cells or noncaseating granulomas. Under an electron microscope, however, several epithelioid cells were found in the specimen. The serum level of lysozyme was elevated. The patient had a past history of sarcoidosis of the eyes and lungs 22 years previously. Cardiac diseases presenting epithelioid cells other than sarcoidosis were clinically ruled out. Thus, the diagnosis of cardiac sarcoidosis was made based on both clinical and ultrastructural findings, and corticosteroid therapy was initiated. In the second biopsy, performed 4 months later, a noncaseating granuloma was found. Generally, the incidence of histological diagnosis of cardiac sarcoidosis by light microscopy is relatively low in endomyocardial biopsy specimens. The present case suggests that the addition of an ultrastructural examination may improve the diagnostic usefulness of the endomyocardial biopsy in cardiac sarcoidosis, since electron microscopy can clearly identify the presence of even one epithelioid cell.
本文报告了一名49岁的心脏结节病男性患者。他患有充血性心力衰竭，超声心动图和左心室造影显示左心室运动不协调且功能减退。心内膜活检的光镜检查显示为非特异性心肌炎，未见巨细胞或非干酪样肉芽肿。然而，在电子显微镜下，标本中发现了几个上皮样细胞。溶菌酶血清水平升高。该患者22年前有眼和肺结节病病史。临床上排除了除结节病外出现上皮样细胞的心脏疾病。因此，根据临床和超微结构检查结果诊断为心脏结节病，并开始使用皮质类固醇治疗。4个月后进行的第二次活检发现了一个非干酪样肉芽肿。一般来说，心内膜活检标本通过光镜进行心脏结节病组织学诊断的发生率相对较低。本病例表明，增加超微结构检查可能会提高心内膜活检对心脏结节病的诊断价值，因为电子显微镜甚至可以清晰地识别出一个上皮样细胞的存在。
