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Unusual presentation of more common disease/injury
CASE REPORT
Epithelial to mesenchymal transition in endomyocardial biopsies from orthotopic heart transplant recipients
  1. Bistees George1,
  2. Maria Del Mar Rivera Rolon1,
  3. Sharma Mohit2 and
  4. Heather L Stevenson1
  1. 1 Department of Pathology, University of Texas Medical Branch, Galveston, Texas, USA
  2. 2 Department of Cardiology, University of Texas Medical Branch, Galveston, Texas, USA
  1. Correspondence to Dr Heather L Stevenson, hlsteven{at}utmb.edu

Abstract

Epithelial to mesenchymal transition (EMT) occurs when cells lose morphological features of epithelial cells, such as cell-to-cell adhesion, and gain features of mesenchymal cells, including elongation and flattening. These cells also lose expression of epithelial immunohistochemical markers. In this report, we present a 55-year-old Caucasian male patient who underwent orthotopic heart transplant and immunosuppressant therapy with tacrolimus and mycophenolic acid. Seven and a half months later, an endomyocardial biopsy revealed a hypercellular, atypical lesion. Evaluation was negative for acute cellular rejection and post-transplant lymphoproliferative disorder. Histopathologic features and immunohistochemical stains were consistent with EMT. We subsequently identified four additional cases of EMT in patients who underwent orthotopic heart transplantation and received a similar immune suppression regimen. EMTs have been reported to occur in lung and kidney allografts; however, this is the first known report describing this entity in a heart transplant recipient.

  • pathology
  • cardiovascular medicine
  • heart failure

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bcr-2018-229175

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    Footnotes

    • Contributors BG wrote the manuscript and reviewed the literature. MDMRR, SM, and HLS critically revised the manuscript for important intellectual content, supervised the process and approved the final draft.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Obtained.