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. 2000 Feb;53(2):147–149. doi: 10.1136/jcp.53.2.147

Necropsy diagnosis of myocarditis: a retrospective study using CD45RO immunohistochemistry

K Feeley 1, J Harris 1, S Suvarna 1
PMCID: PMC1763290  PMID: 10767832

Abstract

Aim—To use CD45RO immunohistochemistry to investigate the numbers of T lymphocytes found in sections of myocardium from a routine necropsy series, and to determine the incidence of myocarditis in this series.

Methods—Myocardial sections from 163 routine hospital necropsies were stained with CD45RO and the numbers of positive lymphocytes/mm2 were counted. The results were correlated with the H/E opinion and the clinical context of the necropsy.

Results—Most (143) cases showed low numbers (0–3) of CD45RO positive lymphocytes/mm2. Fifteen cases showed 7–13 positive lymphocytes/mm2, comprising a wide variety of clinical conditions, generally with no specific cardiac pathology. Five cases showed 14 or more positive lymphocytes/mm2, comprising one case of active myocarditis, three cases of cardiac transplant rejection, and one post-transplant lymphoproliferative disorder, all conditions in which large numbers of lymphocytes would be expected.

Conclusions—The incidence of myocarditis in our series was 0.6%. In most cases the normal myocardium has a low T lymphocyte count (0–3/mm2). In some cases immunohistochemistry shows more positive cells than would have been expected on light microscopy. Immunohistochemistry is a useful and reliable means of confirming a diagnosis of myocarditis. The results support the conclusion of the 1997 ISFC task force that 14 or more lymphocytes or macrophages/mm2 of myocardium in the appropriate clinical context is a reliable threshold for the diagnosis of chronic myocarditis.

Key Words: myocarditis • immunohistochemistry • T lymphocytes • necropsy

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Figure 1 Graphical representation of myocardial CD45RO+ cell density/mm2 by case frequency.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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