case_images: PMC6378422_01
case_images: Gross examination of the heart on the present possibly late-onset ARVC. (A) On gross examination, the hypertrophic and balloon-like appearing heart shows markedly yellowish to yellow-whitish predominantly in the dilated and thinned right ventricle. Bar = 5 cm. (B) The myocardial cut surface characteristically reveals a diffuse fatty/fibrofatty replacement in not only the overtly yellow-whitish and thinned right ventricular wall but also the variably thickened left ventricular myocardium. The coronary arteries show mild atherosclerosis with wide patency, and foci of myocardial infarction are absent. Bar = 1 cm. (C) On the scanning magnification of myocardial cut surface, the cross section makes foci of the fatty/fibrofatty replacement very clear (H&E stains). (D) Correspondingly, the schema of fatty/fibrofatty replacement (yellow) with an outer lymphoplasmacytic infiltrate (purple) in the right and left ventricles is shown, partly revealing the disappearance/absence of the right ventricular myocardium. ARVC indicates arrhythmogenic right ventricular cardiomyopathy.
case_images: 10.1177_1179547619828715-fig1.jpg
case_images: PMC6378422_02_10.1177_1179547619828715-fig1.jpg
case_images: fig1-1179547619828715
case_images: Microscopic findings uniquely showed a transmural fatty (Figure 2A) and fibrofatty (Figure 2B) replacement in the markedly thinned right ventricular wall, accompanied by an outer lymphoplasmacytic infiltrate (Figure 2A and C), as shown in Figure 1D.
case_images: PMC6378422_02
case_images: Gross examination of the heart on the present possibly late-onset ARVC. (A) On gross examination, the hypertrophic and balloon-like appearing heart shows markedly yellowish to yellow-whitish predominantly in the dilated and thinned right ventricle. Bar = 5 cm. (B) The myocardial cut surface characteristically reveals a diffuse fatty/fibrofatty replacement in not only the overtly yellow-whitish and thinned right ventricular wall but also the variably thickened left ventricular myocardium. The coronary arteries show mild atherosclerosis with wide patency, and foci of myocardial infarction are absent. Bar = 1 cm. (C) On the scanning magnification of myocardial cut surface, the cross section makes foci of the fatty/fibrofatty replacement very clear (H&E stains). (D) Correspondingly, the schema of fatty/fibrofatty replacement (yellow) with an outer lymphoplasmacytic infiltrate (purple) in the right and left ventricles is shown, partly revealing the disappearance/absence of the right ventricular myocardium. ARVC indicates arrhythmogenic right ventricular cardiomyopathy.
case_images: 10.1177_1179547619828715-fig1.jpg
case_images: PMC6378422_02_10.1177_1179547619828715-fig1.jpg
case_images: fig1-1179547619828715
case_images: Microscopic findings uniquely showed a transmural fatty (Figure 2A) and fibrofatty (Figure 2B) replacement in the markedly thinned right ventricular wall, accompanied by an outer lymphoplasmacytic infiltrate (Figure 2A and C), as shown in Figure 1D.
case_images: Microscopic examination of the heart on the present possibly late-onset ARVC. (A) Low-power view uniquely shows a transmural fatty and fibrofatty replacement in the markedly thinned right ventricular wall, accompanied by an outer chronic inflammatory cells infiltrate. Bar = 1 mm. (B) These fibrous foci are overtly blue-stained with Masson's trichrome staining. Bar = 500 microm. (C) On high-power view, those infiltrating inflammatory cells predominantly consists of B-lymphocytes and plasma cells. Bar = 200 microm. (D) The remnant, hypertrophic right ventricular cardiomyocytes occasionally have bizarre nuclei. Bar = 50 microm. ARVC indicates arrhythmogenic right ventricular cardiomyopathy.
case_images: 10.1177_1179547619828715-fig2.jpg
case_images: PMC6378422_02_10.1177_1179547619828715-fig2.jpg
case_images: fig2-1179547619828715
case_images: Microscopic findings uniquely showed a transmural fatty (Figure 2A) and fibrofatty (Figure 2B) replacement in the markedly thinned right ventricular wall, accompanied by an outer lymphoplasmacytic infiltrate (Figure 2A and C), as shown in Figure 1D. By contrast, the remnant right ventricular cardiomyocytes were overtly hypertrophic, occasionally containing bizarre nuclei (Figure 2D).
case_images: Analysis of the lipid contents for the cardiac muscle from our possibly late-onset ARVC and the control subject. (A) Intriguingly, the TG content in our patient's RV and LV cardiac muscle is 3-folds higher than that in the control subject. But, the TG contents in the cardiac muscle from the IVS show no remarkable change between our ARVC case and the control. (B) Surprisingly, the total cholesterol (Cho) contents in the cardiac muscle from RV/IVS/LV are not relatively large in volume and have no remarkable change between the current possibly late-onset ARVC case and the control subject. ARVC indicates arrhythmogenic right ventricular cardiomyopathy; IVS, interventricular septum; LV, left ventricular; RV, right ventricular; TG, triglyceride.
case_images: 10.1177_1179547619828715-fig3.jpg
case_images: PMC6378422_02_10.1177_1179547619828715-fig3.jpg
case_images: fig3-1179547619828715
case_images: TG content (Figure 3A), but not the total cholesterol content (Figure 3B), in our patient's right and left ventricular cardiac muscle was much higher than that in the control subject from the recent autopsy case of a late-60s elderly man without any evidence of cardiac diseases.