Evrim Akça KAYA, Işıl PAKİŞ, Mehmet ÖZBAY, Yalçın BÜYÜK, Ceyhun KÜÇÜK

Dev Hücreli Miyokardite Bağlı Ani Ölüm

Dev hücreli myokardit genellikle çok ani gelişen, ölümcül seyreden, multinükleer dev hücreler, lenfohistiositik infiltrasyon ve miyosit nekrozu ile karekterize bir hastalıktır. Tanısı genellikle otopsi ile konulabilir. Çalışmada 35 yaşında, tenis oynarken ani ölen kadın olgu bildirilmektedir. Yapılan otopside kalp 315gr. tartıldı. Sol ventrikül duvar kalınlığı 1,4 cm, sağ ventrikül duvar kalınlığı 0,1-0,3 cm ölçüldü. Her iki ventrikülde de papiller kaslarda belirgin düzensizlik, fibrotik görünüm ve sol ventrikülde 4 cm çapında anevrizma izlendi. Her iki ventrikül myokard kesitlerinde de beyaz renkli yaygın fibrozis alanları içinde koyu renkli alacalı görünümde alanlar izlendi. Myokard kesitlerinin mikroskobik incelemesinde geniş alanlarda kas liflerinin yerini alan bağ dokusu, yoğun lenfoplazmositer iltihabi hücre infiltrasyonu, multinükleer dev hücreler ve seyrek eozinofil polimorflar görüldü. Diğer iç organlarda hiperemi dışında mikroskobik bulgu saptanmadı. Bu bulgular eşliğinde olgu idiopatik dev hücreli myokardit olarak değerlendirildi.Sonuç olarak, literatürde de oldukça nadir bildirilen dev hücreli myokardit olgusu, ani ölüm olgularında ayırıcı tanıya alınması gereken bir antite olarak sunulmuştur

Sudden Death Due To Giant Cell Myocarditis: a Case Report

Giant cell myocarditis is a rapidly fatal disorder characterized by the presence of multinucleated giant cells and a lymphocytic inflammatory infiltrate, associated with myocyte necrosis. The diagnosis of giant cell myocarditis is usually determined at autopsy. We present a 35 years old female case of sudden death while playing tennis. On internal examination, the heart weighed 315 g and thickness of left ventricular wall was 1,4 cm ,that of right ventricle was 0,1-0,3 cm. Papillary muscles in both ventricles were fibrotic and showed disarrangement. There was an area of aneurysm with a diameter of 4 cm in left ventricle. Myocardial sections showed areas of fibrosis and dark-mottled areas. Microscopic examination of myocardial sections revealed connective tissue replacing normal myocardial muscle bundles, diffuse lymphohistiositic inflammatory cell infiltration, multinuclear giant cells, and scarce eosinophilic polymorhocytes. Microscopic sections of other internal organs showed no pathology other than hyperemia. On the basis of these findings, the final diagnosis was giant-cell myocarditis

Keywords:

autopsy, giant cell myocarditis, sudden cardiac death,

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