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The Histological Basis of Frank’s Sign

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Abstract

Frank’s sign is a diagonal crease of the ear lobe, supposedly related to cardiac pathology, and has strongly been associated with coronary artery atherosclerosis. A total of 45 consecutive adult patients referred for autopsy in a one-and-a-half-year period were extensively studied. Samples from both the ear lobes were obtained for histopathology, as well as cardiac samples from all four cardiac compartments. When compared patients with Frank’s sign and those without it had no statistical difference in age (p = 0.0575). There was however a statistically significant increased cardiac weight (p = 0.0005), left ventricular wall thickness (p = 0.0002), and right ventricular wall thickness (p = 0.0043). Histopathology obtained from the ear lobes revealed myoelastofibrosis in an arterial vessel, located at the base of the crease, diffuse fibrosis, and Wallerian-like degeneration, with eosinophilic inclusions in the peripheral nerves. These changes suggest a time-related progression of the crease-associated changes. Our data suggest a significant correlation between the morphological changes of the myocardium and the presence of the ear lobe creases, with arterial myoelastofibrosis, Wallerian-like degeneration in peripheral nerves and deep tissue fibrosis found in the base of the crease.

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Acknowledgements

The authors would like to thank the reviewers for their comment and suggestion, which represent an enormous contribution to the manuscript.

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Authors and Affiliations

  1. Department of General and Clinical Pathology, Forensic Medicine and Deontology, Faculty of Medicine, Medical University - Varna “Prof. Dr. Paraskev Stoyanov”, Marin Drinov 55 str., 9002, Varna, Bulgaria

    George S. Stoyanov, Deyan Dzhenkov & Lilyana Petkova

  2. Division of ENT Diseases Faculty of Medicine, Department of Neurosurgery and ENT Diseases, Medical University - Varna “Prof. Dr. Paraskev Stoyanov”, Marin Drinov 55 str., Varna, Bulgaria

    Nikolay Sapundzhiev

  3. Division of Cardiology, First Department of Internal Diseases, Faculty of Medicine, Medical University - Varna “Prof. Dr. Paraskev Stoyanov”, Marin Drinov 55 str., Varna, Bulgaria

    Svetoslav Georgiev

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  1. George S. Stoyanov
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  2. Deyan Dzhenkov
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  3. Lilyana Petkova
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  4. Nikolay Sapundzhiev
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  5. Svetoslav Georgiev
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by GS, LP, and DD. The first draft of the manuscript was written by GS and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to George S. Stoyanov.

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The authors declare that they have no competing interest.

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All procedures contributing to this work complied with the ethical standards of the Helsinki declaration of 1964 and its seventh revision from 2013, the ethical standards of the Bulgarian Ministry of Healthcare, as well as the ethical standards and protocols of the St. Marina University Hospital, Varna, Bulgaria.

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Stoyanov, G.S., Dzhenkov, D., Petkova, L. et al. The Histological Basis of Frank’s Sign. Head and Neck Pathol 15, 402–407 (2021). https://doi.org/10.1007/s12105-020-01205-4

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  • DOI: https://doi.org/10.1007/s12105-020-01205-4

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