ECP 2023 Abstracts

S173 Virchows Archiv (2023) 483 (Suppl 1):S1–S391 13 rejection (n=2) and constrictive pericarditis (n=1) in hearts with allo- graft vasculopathy. Conclusion: Forensic anatomo-pathological studies contribute to the distinction between violent versus natural death and to the detection of heart transplant outcomes, mostly in out-of-hospital deaths. E-PS-03-005 Is it intimal sarcoma or cardiac undifferentiated pleomorphic sar- coma: a case report S. Kaymaz*, A.M. Önenerk Men, A.B. Öz, Ş. Batur, Ç.T. Üstünışık, N. Çomunoğlu *İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi Tıbbi Patoloji Ana- bilim Dalı, Turkey Background & objectives: Recent reports claim that cardiac undif- ferentiated pleomorphic sarcoma (UPS) with MDM2 amplification is identical to cardiac intimal sarcoma (IS). We report a case of IS located in left ventricle and review the literature. Methods: A 59 year old woman presented with orthopnea, dyspnea and fatigue. It was revealed that she had a 3,9 cm mass originating from mitral valve and extending into the left atrium. The patient was operated. Macroscopic examination of the mass was nonspecific. Microscopic examination revealed a hypercellular tumour infiltrating myocardium. Results: The tumour had a nodular growth pattern and there were areas of tumour necrosis that corresponds to 5% of the tumour. The tumour was composed of spindle cells that make short fascicles within a myxoid stroma, there were also diffuse sheets and solid areas. Immu- nohistochemical studies showed that tumour cells stained positively with SMA, Desmin and CDK4. Also we detected MDM2 amplification with FISH analysis. Conclusion: 5th Edition of WHO Classification of Tumours accepts provisional use of IS for tumours with undifferentiated morphology and MDM2 amplification. This change will have significant impact on the classification of cardiac sarcomas and IS is going to be the most common sarcoma of the heart. Although, current therapy options do not differ between different cardiac sarcoma types, accurate diagnosis will be essential with the emerging targeted therapies in the near future. Therefore, awareness of this entity is important for pathologists. E-PS-03-006 Autonomic innervation in caval vein myocardial sleeves and car- diovascular death I. Kholova*, D. Depes, A. Mennander, T. Paavonen *Tampere University and Fimlab Laboratories, Tampere, Finland Background & objectives: Quantitative changes in myocardial auto- nomic innervation may contribute to the pathogenesis of various car- diovascular diseases. Myocardial sleeves around caval veins (CVs) are highly innervated structures with heterogeneous morphological and electrophysiological characteristics. Our present analysis studied auto- nomic nerve density of CVs. Methods: The study cohort consisted of 24 autopsied adult hearts (mean age 65.3±12.7 (SD) years and M:F ratio 13:11). Immunohistochemical analysis was performed using antibodies against tyrosine hydroxylase (TH, sympathetic nerve marker), choline acetyltransferase (CHAT, para- sympathetic marker), and growth-associated protein 43 (GAP43). Results: The mean density of TH-positive nerves in the superior vena cava myocardial sleeves was significantly decreased between groups with documented underlying cardiovascular vs. non-cardiovascular cause of death (mean density ± SD: 704.81±1016.41 μm2/mm2 vs. 2391.01±1841.37 μm2/mm2; P=0.008). The nerve density of GAP43- positive nerves in the superior vena cava myocardial sleeves was also significantly lower in subjects with documented underlying cardiovas- cular cause of death (mean density ± SD: 884.74±1240.16 μm2/mm2 vs. 2132.89±1845.89 μm2/mm2; P=0.040). No differences were found in nerve densities of TH-positive, CHAT-positive, and GAP43-positive nerves in the inferior vena cava between the groups. There was no association found in nerve densities between subjects with documented atrial fibrillation. Conclusion: Decrease of superior vena cava myocardial sleeve sym- pathetic nerves may be associated with cardiovascular mortality. No difference in autonomic innervation in CVs was found between subjects with documented atrial fibrillation vs. sinus rhythm. Funding: VTR grant, Aarne Koskelo Foundation E-PS-03-007 Morphometric and immunohistochemical study of left ventricular cardiomyocytes’ morphology during remodelling in progressing ischemic heart failure (HF) M. Kupryte*, V. Lesauskaitė, D. Pangonytė *Lithuanian University of Health Sciences, Institute of Cardiology, Lithuania Background & objectives: Ischemic injury initiates cardiomyocytes’ compensatory remodelling causing cellular resilience and hemody- namic function changes towards HF. Cardiomyocyte geometry and non- sarcomeric filament desmin expression analysis in different ischemic HF stages (adult heart model) is attempt to identify morphologic cri- teria monitoring HF progress. Methods: Cardiomyocyte’s length-diameter ratio and immunohisto- chemical reaction against desmin in left cardiac ventriclular segments were analysed in test groups (deceased or after heart transplantation due to ischemic injury): 1st – A, 2nd – B, 3rd – C/D stages of HF by ACC/AHA; control group – samples of patients with no cardiovascu- lar disorders. Statistical analysis – ANOVA with post-hoc LSD tests (p<0.05). Results: Mean value of cardiomyocyte length-diameter ratio was smaller in 1st group compared to control (5.137 (0.374) vs. 5.392 (0.354), p=0.015). It increased in 3rd group compared to 1st and 2nd groups (5.582 (0.448) vs. 5.137 (0.374) and 5.3 (0.245), p<0.05). Cardiomyocytes of 1st group had more intensive immu- nohistochemical reaction against desmin compared to control group (p<0.001), also more intensive in 3rd compared to 2nd group (p<0.001), and control group (p<0.001), whereas intensity was similar in 1st and 2nd groups (p=0.159). Positive weak correlation between changes in cardiomyocyte geometry and expression of desmin was detected (r=0.2453, p=0.012). Conclusion: Morphofunctional changes of cardiomyocyte geometry and desmin expression during remodelling in response to ischemic injury are detected before HF, and progress in symptomatic HF, presenting morpho- metric and immunohistochemical diagnostic criteria to monitor myocardial disease progress at its earliest structural manifestation. E-PS-03-008 An extensively interrogated, diagnostically challenging, fatal high grade cardiac sarcoma with intestinal and cerebral involvement in a 50 year-old man S.H. Lai*, L.S. Punjabi, A.X.F. Chia, P.Y.K. Pang, J. Chiang *Anatomical Pathology, Singapore General Hospital, Singapore Background & objectives: This case illustrates the diagnostic dilemma and extensive pathological and molecular characterisation of an extremely rare primary cardiac sarcoma. Consent from the patient has been obtained for this publication. Methods: The patient was a previously healthy 50 year-old man who presented with congestive heart failure. Transthoracic echocar- diogram revealed a 4.3x3.2cm left atrial mass. Surgical resection was performed. Pathological examination showed a highly cellular, poorly differentiated sarcoma composed mainly of plump epithelioid cells with amphophilic cytoplasm and vesicular nuclei with frequent mitotic figures. In other areas, spindled morphology is seen.