title: Eosinophilic Coronary Periarteritis with Arterial Dissection: The Mast Cell Hypothesis.
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.
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital and Clinics, 1111 Highland Avenue, Madison, WI, 53705.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Mandal
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital and Clinics, 1111 Highland Avenue, Madison, WI, 53705.
authors.forename: Erin G
authors.initials: EG
authors.lastname: Brooks
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital and Clinics, 1111 Highland Avenue, Madison, WI, 53705.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Corliss
mesh_terms: D000328:Adult; D063194:Adventitia / Q000293:injuries / Q000473:pathology; D001167:Arteritis / Q000473:pathology*; D002452:Cell Count; D003331:Coronary Vessels / Q000293:injuries* / Q000473:pathology; D004804:Eosinophils / Q000166:cytology; D005260:Female; D006801:Humans; D007963:Leukocytes, Mononuclear / Q000166:cytology; D008214:Lymphocytes / Q000166:cytology; D008297:Male; D008407:Mast Cells / Q000166:cytology*; D008875:Middle Aged; D009504:Neutrophils / Q000166:cytology; D053802:Tryptases / Q000378:metabolism; D017540:Tunica Media / Q000293:injuries / Q000473:pathology
chemical_list: D053802:Tryptases
keywords: cardiac mast cells; eosinophil cardiotoxicity; eosinophilic coronary periarteritis; forensic science; sudden cardiac death; sudden coronary arterial dissection