—  SPECIALTY CONFERENCE  — Cardiovascular Pathology Tuesday, March 4, 2008 , 7:30 PM Convention Center 103 Click the button above to add this event to your Itinerary Planner... Moderator: ALLEN BURKE University of Maryland School of Medicine Baltimore, MD Clinical histories are displayed below. For the fastest viewing of virtual slides, click: under each thumbnail image below. You must have Aperio ImageScope installed on your PC. If you do not already have Aperio ImageScope, Windows users with administrator privileges may download and install a free version in order to view USCAP Virtual Slides. Click the icon on the right to get your free copy:   Or, click on slide thumbnail images to view each slide in a Web-based slide viewer, which is somewhat slower. If you have any difficulties viewing these slides, email or call George Clay at +1.724.449.1137. Case 1 Submitted by: Cristina Basso Clinical Summary: Z.A., Male 15 Year Old Circumstances of death. Athlete, sudden death while sleeping Previous medical history. Asymptomatic. Annual screening for competitive sport activity: Normal physical examination No symptoms (palpitations, syncope) Normal 12-lead ECG The last 12-lead resting ECG, performed eight months before death for sports eligibility, was available and showed (fig.1): Incomplete right bundle branch block Mild ST segment elevation in V1-V2 Negative T wave in V1 Q wave in D2, D3 and AVF Medico-legal autopsy ruled out unnatural and extracardiac causes of death. Gross examination of the heart: Heart weight of 300 gr, transverse diameter 9,5 cm, longitudinal diameter 9,5 cm. LV wall thickness 13 mm, septal thickness 14 mm, RV free wall 3 mm. Origin and course of coronary arteries are normal, patent. Semilunar and atrioventricular valves are normal. No evidence myocardial hypertrophy, cavity enlargement, fatty infiltration and aneurysm formation (fig.2a) Presence of an "infarct-like" withish band in the outer mid subepicardial layer of the postero-septal and postero-lateral walls of the left ventricle (fig.2b). Multiple samples of the myocardium are taken for histology as well as for molecular pathology investigation, including spleen and blood (frozen -80°). Histology of the myocardium. (fig.3a,b,c,d) Acute-subacute myocyte necrosis associated with inflammation. The inflammatory infiltrate was polymorphous and was associated with contraction band necrosis, myocardlysis, granulation tissue and loose fibrous and fatty tissue repair. Few months later the index case of the same family, a guy who had an aborted sudden death at the age of 18, was found... The underlying disease at risk of sudden death and differential diagnosis with other conditions will be discussed. Molecular pathology findings as well as results of family screening will be presented. Case 1 - Slide 1 Click to view with ImageScope Click to view with a Web-Based Viewer Case 1 - Figure 1 Case 1 - Figure 2 Case 1 - Figure 3A & B Case 1 - Figure 3C & D Case 2 Submitted by: Gaetano Thiene Clinical Summary: P.E., Male 16 Year Old Circumstances of death While watching a soccer game on television, he exulted at the goal and soon after he had sudden loss of consciousness (10:30 PM). Prompt cardiopulmonary resuscitation (CPR) manoeuvers were unsuccessful and death was ascertained 1 hour later (11:30 PM). Previous medical history. At the age of 3, tonsillectomy At the age of 9, surgical repair of left inguinal hernia. Regular sport activity (karate) since the age of 8. At the age of 12, first syncopal episode on emotion (watching television): cardiological check-up (physical examination and 12 lead ECG) normal (fig.1). No family history of cardiac diseases or juvenile sudden death. Medico-legal autopsy ruled out unnatural and extracardiac causes of death. Gross examination of the heart: Heart weight 380 gr, transverse diameter 9,5 cm, longitudinal diameter 9,5 cm. LV wall thickness 13 mm, septal thickness 14 mm, RV free wall 3 mm (fig.2). Normal origin and course of the coronary arteries, patent. Semilunar and atrioventricular valve are normal, except for mild myxoid degeration of mitral valve leaflets (Fig.3a,b). Grossly normal heart (no hypertrophy, scar, acute myocardial infarction, fatty infiltration, aneurysms). Multiple samples of the myocardium are taken for histology as well as for molecular pathology investigation, including spleen and blood (frozen -80°). Histology of the myocardium. Diffuse interstitial oedema with scarce interstitial inflammatory cells, in the absence of myocyte damage (fig.4a,b,c,d). No replacement-type fibrosis, fatty infiltration, small vessel disease, myocardial disarray. Differential diagnosis among heart diseases at risk of sudden death on emotion will be discussed Molecular pathology findings as well as results of family screening will be presented. Case 2 - Slide 1 Click to view with ImageScope Click to view with a Web-Based Viewer Case 2 - Figure 1 Case 2 - Figure 2 Case 2 - Figure 3 Case 2 - Figure 4A & B Case 2 - Figure 4 C & D Case 3 Submitted by: Bill Edwards - Mayo Clinic, Rochester, MN Clinical Summary: A 59-year-old woman was staying in Rochester, Minnesota, with her husband while he was recuperating following surgery at the Mayo Clinic. On the night of her death, she was last seen alive at 9:30 p.m. and was found dead in bed by her daughter at 12:30 a.m. There was no evidence of suicide or foul play. The county coroner ordered an autopsy. According to the husband and daughter, she had been in good general health but had recently complained of nausea, exhaustion, and swollen feet. She was obese. There was also a long-standing history of polycythemia vera and a remote history of poliomyelitis. Case 3 - Slide 1 Click to view with ImageScope Click to view with a Web-Based Viewer Case 3 - Figure 1 Case 3 - Figure 2 Case 3 - Figure 3 Case 3 - Figure 4 Case 3 - Figure 5 Case 3 - Figure 6 Case 3 - Figure 7 Case 3 - Figure 8 Case 3 - Figure 9 Case 3 - Figure 10 Case 4 Submitted by: Allen Burke - CVPath Institute, Gaithersburg, MD Clinical Summary: A 33-year-old Asian woman complained of dizziness for several months. She did not seek medical care, and had no prior medical history other than for obstetric care, which was uncomplicated. There was no family history of cardiovascular disease or sudden death. She died suddenly and unexpectedly after a witnessed collapse. A forensic autopsy was performed. Case 4 - Slide 1 Click to view with ImageScope Click to view with a Web-Based Viewer Case 4 - Figure 1 Case 4 - Figure 2 Case 4 - Figure 3 Case 4 - Figure 4 Case 4 - Figure 5 Case 4 - Figure 6 Case 4 - Figure 7 Case 4 - Figure 8 Case 4 - Figure 9 f there are glass slides for a conference, they will be available for study in the microscope room in the Convention Center Room 101 for participants who wish to review them prior to the evening session. Handouts for all Specialty Conferences will be accessible via the "Educational Materials" section on the homepage the morning after each respective conference. Printed copies of the handout will not be available at the meeting. However, we will provide a booklet at the meeting which will have a page for each Specialty Conference, listing the names of speakers and space for the important "take home messages".