Eosinophilic Coronary Periarteritis with Arterial Dissection: The Mast Cell Hypothesis

Journal of Forensic Sciences
Rakesh MandalRobert F Corliss

Abstract

A subset of coronary arterial dissections is associated with eosinophilic coronary periarteritis (ECPA); however, the pathogenesis of the process remains unclear. Mast cells normally reside in coronary arterial adventitia and are known mediators of eosinophilic inflammatory conditions such as type I hypersensitivity reactions. We report two cases in which coronary arterial dissection with ECPA was detected at autopsy. Tryptase, CD68, CD4, CD8, and CD1a immunohistochemical staining was performed to better characterize inflammation. While eosinophils represented a prominent periadventitial inflammatory cell, there were slightly more lymphocytes: CD4/CD8 ratios were within expected reference ranges. There were moderate numbers of macrophages, and few neutrophils or dendritic cells. Numbers of mast cells in dissected versus nondissected sections were compared: adventitial mast cell densities were threefold higher in dissected portions and showed a trend toward increased degranulation. These findings suggest that mast cells may play a role in orchestrating inflammation in cases of ECPA.

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Citations

Feb 24, 2018·Circulation·Sharonne N HayesUNKNOWN American Heart Association Council on Peripheral Vascular Disease; Council on Clinical Cardiology; Council on Cardiovascular
Mar 1, 2017·Forensic Science, Medicine, and Pathology·Roger W ByardNeil E I Langlois
Aug 19, 2018·Microcirculation : the Official Journal of the Microcirculatory Society, Inc·Domenico RibattiEnrico Crivellato
Sep 8, 2017·Frontiers in Immunology·Jason M SpringerKottarappat N Dileepan
Feb 12, 2020·Journal of Cardiology Cases·Payman IzadpanahAlireza Heiran
Jan 17, 2021·Trends in Cardiovascular Medicine·Stefania Angela Di FuscoFurio Colivicchi
Nov 7, 2020·Journal of the American College of Cardiology·David AdlamJacek Kadziela

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