Autoptic findings of sudden cardiac death (SCD) in patients with arrhythmogenic ventricular cardiomiopathy (AVC) from left ventricle and biventricular involvement

Mansueto, Gelsomina; Benincasa, Giuditta; Capasso, Emanuele; Graziano, Vincenzo; Russo, Mario Salvatore; Niola, Massimo; Napoli, Claudio; Buccelli, Claudio

doi:10.1016/j.prp.2020.153269

Cited by 8 publications

(13 citation statements)

References 27 publications

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“…To properly answer these questions, it should be preliminarily stated that, although autopsies are still scarce compared to the entity of the pandemic, the most common pathological lesions in COVID-19 appear to be similar to those seen in the context of other viral and systemic diseases associated with cardiovascular involvement. Based on our autopsy experience [54][55][56][57][58] and current evidence from the literature, it seems that morphological data are still limited to a few cases of meningitis or necrotizing encephalopathy [3,30,58]. More recently, it has also been hypothesized that neuropathological changes might be the consequence of direct or immune-mediated damage of the virus, although a secondary lesion from the interaction through the ACE2 receptor or interference with the HEME formation cannot be excluded (Figure 1), as well as an indirect injury from a systemic dysfunction [50,[59][60][61][62][63].…”

Section: Autopsy Brain Sampling and Histopathological Assessment In Covid-19 Patientsmentioning

confidence: 99%

Neurological Sequelae in Patients with COVID-19: A Histopathological Perspective

Fisicaro

Napoli²,

Liberto

et al. 2021

IJERPH

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Background: Neuroinvasive properties of SARS-CoV-2 have allowed the hypothesis of several pathogenic mechanisms related to acute and chronic neurological sequelae. However, neuropathological correlates have been poorly systematically investigated, being retrieved from reports of single case or limited case series still. Methods: A PubMed search was carried out to review all publications on autopsy in subjects with “COronaVIrus Disease-19” (COVID-19). Among them, we focused on histological findings of the brain, which were compared with those from the authors’ autoptic studies performed in some COVID-19 patients. Results: Only seven studies reported histological evidence of brain pathology in patients deceased for COVID-19, including three with reverse transcription–quantitative polymerase chain reaction evidence of viral infection. All these studies, in line with our experience, showed vascular-related and infection-related secondary inflammatory tissue damage due to an abnormal immune response. It is still unclear, however, whether these findings are the effect of a direct viral pathology or rather reflect a non-specific consequence of cardiovascular and pulmonary disease on the brain. Conclusions: Notwithstanding the limited evidence available and the heterogeneity of the studies, we provide a preliminary description of the relationship between SARS-CoV-2 and brain sequelae. Systematic autoptic investigations are needed for accurate detection and adequate management of these patients.

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Section: Autopsy Brain Sampling and Histopathological Assessment In Covid-19 Patientsmentioning

confidence: 99%

Neurological Sequelae in Patients with COVID-19: A Histopathological Perspective

Fisicaro

Napoli²,

Liberto

et al. 2021

IJERPH

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“…The main findings of ARVC are adipose or fibro-adipose replacement of myocytes associated with ventricular atrophy [ 8 , 10 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. These patterns are predominantly described in the right ventricle, where the most common affected regions are referred to the so-called “triangle of dysplasia”: it is formed by the right ventricular inflow tract, apex and outflow tract [ 14 ].…”

Section: Resultsmentioning

confidence: 99%

Arrhythmogenic Right Ventricular Cardiomyopathy Post-Mortem Assessment: A Systematic Review

Cianci,

Forzese,

Sapienza

et al. 2024

IJMS

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Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic disorder characterized by the progressive fibro-fatty replacement of the right ventricular myocardium, leading to myocardial atrophy. Although the structural changes usually affect the right ventricle, the pathology may also manifest with either isolated left ventricular myocardium or biventricular involvement. As ARVC shows an autosomal dominant pattern of inheritance with variable penetrance, the clinical presentation of the disease is highly heterogeneous, with different degrees of severity and patterns of myocardial involvement even in patients of the same familiar group with the same gene mutation: the pathology spectrum ranges from the absence of symptoms to sudden cardiac death (SCD) sustained by ventricular arrhythmias, which may, in some cases, be the first manifestation of an otherwise silent pathology. An evidence-based systematic review of the literature was conducted to evaluate the state of the art of the diagnostic techniques for the correct post-mortem identification of ARVC. The research was performed using the electronic databases PubMed and Scopus. A methodological approach to reach a correct post-mortem diagnosis of ARVC was described, analyzing the main post-mortem peculiar macroscopic, microscopic and radiological alterations. In addition, the importance of performing post-mortem genetic tests has been underlined, which may lead to the correct identification and characterization of the disease, especially in those ARVC forms where anatomopathological investigation does not show evident morphostructural damage. Furthermore, the usefulness of genetic testing is not exclusively limited to the correct diagnosis of the pathology, but is essential for promoting targeted screening programs to the deceased’s family members. Nowadays, the post-mortem diagnosis of ARVC performed by forensic pathologist remains very challenging: therefore, the identification of a clear methodological approach may lead to both a reduction in under-diagnoses and to the improvement of knowledge on the disease.

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“…However, in this case, the specific morphology and immunohistochemical properties of the malignant cells characterized by atypical epithelioid or sarcomatoid CD68- and lysozyme-positive medium-sized cells are a reliable and fundamental tool for the differential diagnosis. Immunohistochemistry is a comforting method for diagnosis when morphology is not sufficient, especially in cases of myocardial damage, but also in head trauma and mechanical asphyxia [ 19 , 20 , 21 , 22 ]. In our case, nodal subversion together with the morphology of the visibly atypical cellular elements and therefore CD68 and lysozyme labelling ( Figure 2 ) are consistent with a diagnosis of HS and metastatic localization of cytologically atypical elements in the myocardium.…”

Section: Discussionmentioning

confidence: 99%

“…In each sudden unexpected death, pathologists and physicians are requested to find evidence of a specific cause of death, and in particular to establish whether cardiac death is secondary to arrhythmic or nonarrhythmic mechanisms or otherwise to heart failure [ 21 , 22 , 23 , 24 ]. To the best of our knowledge, this is the first reported case of sudden death with no remarkable macroscopic findings.…”

Section: Discussionmentioning

confidence: 99%

Sudden Unexpected Death Caused by Cardiac Metastasization from Histiocytic Sarcoma

Feola

Ciamarra

Simone

et al. 2021

IJERPH

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Background: Haematological malignancies, such as lymphoma and leukaemia, can have a variety of clinical manifestations. The most frequent cause of death from haematological malignancies is multiple organ failure due to neoplastic organ infiltration and/or septic shock. Histiocytic sarcoma (HS) is a rare malignant nodal or extranodal tumour with histiocytic immunophenotype that originates from a lymphohematopoietic precursor. The patients with HS usually have a poor prognosis due to its aggressive clinical behaviour. Rare cases of undiagnosed sudden HS death have been described in the literature. Methods: A forensic autopsy of a 46-year-old white male who died at home suddenly and unexpectedly without warning conditions or known diseases. Gross analysis, histology and toxicology were also performed. Results: The diagnosis of HS of the ileum with secondary nodal and cardiac metastatization was made. Conclusions: A prompt diagnosis of HS in life is paramount because it can make a difference in prognostic outcomes.

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Autoptic findings of sudden cardiac death (SCD) in patients with arrhythmogenic ventricular cardiomiopathy (AVC) from left ventricle and biventricular involvement

Cited by 8 publications

References 27 publications

Neurological Sequelae in Patients with COVID-19: A Histopathological Perspective

Neurological Sequelae in Patients with COVID-19: A Histopathological Perspective

Arrhythmogenic Right Ventricular Cardiomyopathy Post-Mortem Assessment: A Systematic Review

Sudden Unexpected Death Caused by Cardiac Metastasization from Histiocytic Sarcoma

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