medicine Medicine is the science and Praxis (process), practice of caring for patients, managing the Medical diagnosis, diagnosis, prognosis, Preventive medicine, prevention, therapy, treatment, Palliative care, palliation of their injury or disease, ...

, Aschoff bodies are nodules found in the

heart The heart is a muscular Organ (biology), organ found in humans and other animals. This organ pumps blood through the blood vessels. The heart and blood vessels together make the circulatory system. The pumped blood carries oxygen and nutrie ...

s of individuals with rheumatic fever. They result from

inflammation Inflammation (from ) is part of the biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. The five cardinal signs are heat, pain, redness, swelling, and loss of function (Latin ''calor'', '' ...

in the heart muscle and are characteristic of rheumatic heart disease. These nodules were discovered independently by

Ludwig Aschoff Karl Albert Ludwig Aschoff (10 January 1866 – 24 June 1942) was a German physician and pathologist. He is considered to be one of the most influential pathologists of the early 20th century and is regarded as the most important German patholo ...

and Paul Rudolf Geipel, and for this reason they are occasionally called Aschoff–Geipel bodies.

Appearance

Microscopically, Aschoff bodies are areas of

of the

connective tissue Connective tissue is one of the four primary types of animal tissue, a group of cells that are similar in structure, along with epithelial tissue, muscle tissue, and nervous tissue. It develops mostly from the mesenchyme, derived from the mesod ...

of the

, or focal interstitial inflammation. Fully developed Aschoff bodies are

granuloma A granuloma is an aggregation of macrophages (along with other cells) that forms in response to chronic inflammation. This occurs when the immune system attempts to isolate foreign substances that it is otherwise unable to eliminate. Such sub ...

tous structures consisting of

fibrin Fibrin (also called Factor Ia) is a fibrous protein, fibrous, non-globular protein involved in the Coagulation, clotting of blood. It is formed by the action of the protease thrombin on fibrinogen, which causes it to polymerization, polymerize. ...

oid change, lymphocytic infiltration, occasional

plasma cell Plasma cells, also called plasma B cells or effector B cells, are white blood cells that originate in the lymphoid organs as B cells and secrete large quantities of proteins called antibodies in response to being presented specific substances ca ...

s, and characteristically abnormal

macrophage Macrophages (; abbreviated MPhi, φ, MΦ or MP) are a type of white blood cell of the innate immune system that engulf and digest pathogens, such as cancer cells, microbes, cellular debris and foreign substances, which do not have proteins that ...

s surrounding necrotic centres. Some of these macrophages may fuse to form multinucleated giant cells. Others may become Anitschkow cells or "caterpillar cells," so named because of the appearance of their

chromatin Chromatin is a complex of DNA and protein found in eukaryote, eukaryotic cells. The primary function is to package long DNA molecules into more compact, denser structures. This prevents the strands from becoming tangled and also plays important r ...

. They are pathognomic foci of fibrinoid necrosis found in many sites, most often the myocardium. Initially they are surrounded by lymphocytes, macrophages, and a few plasma cells, but they are slowly replaced by a fibrous scar. Aschoff bodies are found in all the three layers of the heart, least chance in the pericardium.

Presence in cardiac lesions

The cardiac manifestations of rheumatic fever are in the form of focal inflammatory involvement of the interstitial tissue in all 3 layers of the heart, a pathological change named pancarditis. The

pathognomonic Pathognomonic (synonym ''pathognomic'') is a term, often used in medicine, that means "characteristic for a particular disease". A pathognomonic sign is a particular sign whose presence means that a particular disease is present beyond any doubt. ...

feature of pancarditis in the case of rheumatic heart disease is the presence of Aschoff nodules or Aschoff bodies.

Detailed description

The Aschoff nodules are foci of T lymphocytes, occasional plasma cells, and activated macrophages (Anitschkow cells) pathognomonic of rheumatic fever. These macrophages have abundant cytoplasm and central round nuclei in which chromatin condenses into a central, slender, wavy ribbon, the reason why they are sometimes called "caterpillar cells". They are especially found in the vicinity of small blood vessels in the myocardium and endocardium and occasionally in the pericardium, and also the

adventitia The adventitia ( ) is the outer layer of fibrous connective tissue surrounding an organ. The outer layer of connective tissue that surrounds an artery, or vein – the tunica externa, is also called the ''tunica adventitia''. To some degree, i ...

of the proximal part of the aorta. Lesions similar to the Aschoff nodules may also be found in extra-cardiac tissues.

Evolution of nodules

Evolution of Aschoff nodules typically involve 3 stages of development all of which may be present in the heart at the same time of inspection. Stage 1. Early exudative / degenerative stage the earliest sign of injury to the heart in rheumatic fever is apparent by fourth week of illness. Initially there is edema of the

and increase in acid mucopolysaccharide in the ground substance. This results in a separation of the

collagen Collagen () is the main structural protein in the extracellular matrix of the connective tissues of many animals. It is the most abundant protein in mammals, making up 25% to 35% of protein content. Amino acids are bound together to form a trip ...

fibre by accumulating

ground substance Ground substance is an amorphous gel-like substance in the extracellular space of animals that contains all components of the extracellular matrix (ECM) except for fibrous materials such as collagen and elastin. Ground substance is active in the d ...

eventually the collagen fibres are fragmented and disintegrated and the affected focus takes the appearance and staining characteristics of

. Stage 2. Intermediate proliferative / granulomatous stage. It is at this stage of Aschoff bodies, which is

of rheumatic fever. This stage is apparent in 4 to 13 weeks of illness. The early stage of fibrinoid change is replaced by infiltration of lymphocyte T cells, plasma cells, neutrophils and the characteristic cardiac histiocytes / Anitschkow cells at the margin of the lesion. Cardiac Histiocytes / Anitschkow are present in small numbers in the heart but their numbers are increased in Aschoff nodules. therefore they are not characteristic of rheumatic heart disease Stage 3. Late fibrosis stage. It is the stage of healing by which the fibrosis of the Aschoff nodules occur in 12 to 16 weeks after the illness. The nodule becomes oval or fusiform in shape about 200 micrometer x 600 micrometer in width and length. With passage of months and years the Aschoff nodules becomes less cellular and collagenous tissue is increased. Eventually it is replaced by a small fibrocollagenous scar with little cellularity frequently located perivascularly.

History

The Aschoff bodies were discovered independently by the German pathologist

1904K. A. L. Aschoff. Zur Myocarditisfrage. Verhandlungen der deutschen pathologischen Gesellschaft, Stuttgart, 1904, 8: 46-53. Translated in Willius & Keys, Cardiac Classics, 1941, pp. 733-739. and one year later by Paul Rudolf Geipel.

References

{{DEFAULTSORT:Aschoff Body Histopathology