Blood Vessel Diseases

Pathology-B LabRavi A Patel

M++Hemangioma-Liver

Coronary Artery Atherosclerosis

Atherosclerosis with thrombus- Aortic aneurysm

Atheromatous aorta

Tumour emboli in Lung

Monckeberg’s Sclerosis

Hemangioma-Liver***Hemangiomas are very common tumours characterized by increased number of Normal or

abnormal blood vessels filled with blood.

There are 2 types

1) Capillary Hemangioma- occurs in skin, subcutaneous tissue and mucous membranes of lips as well as liver,spleen and kidneys.

2) Cavernous Hemangioma (shown in lab for liver) - Characterized by large dilated vascular channels. Compared to capillary type, these are less well circumscribed and mostly involve deep structures.

Gross:- Red-Blue soft spongy mass

Microscopic:- Well defined but not encapsulated large cavernous blood filled vascular spaces.

• What is the cell of origin of this tumour ?Ans- Endothelial cells

Cavernous hemangiomas arise from the endothelial cells that line the blood vessels and consist of multiple, large vascular channels lined by a single layer of endothelial cells and supported by collagenous walls.

• How will the tumour give rise to clinical manifestations ?Ans- Abdominal pain & vomiting

PresentationThe vast majority of hemangiomas (as many as 85%) are asymptomatic; however, hemangiomas may cause symptoms because of the compression of adjacent structures, rupture, acute thrombosis, or consumptive coagulopathy (ie,Kasabach Meritt syndrome).

Pressure on the stomach and duodenum caused by large pedunculated hemangioma lesions may cause vague abdominal pain, early satiety, nausea, and vomiting. Pedunculated hemangiomas may twist and cause acute abdominal pain. Compression of the inferior vena cava may result in Budd chiari syndrome.Acute thrombosis may result in acute inflammatory changes that cause fever, abdominal pain, and abnormal results in liver function tests. Spontaneous or posttraumatic rupture is a catastrophic complication that occurs in about 1-4% of hemangiomas; this condition has a considerable mortality rate, as high as 60%.

• Why is it called cavernous(hollow) ?Ans- Because there are large blood filled spaces found

compared to capillary type where in there are no spaces found.

• Is it capable of spreading ?Ans- No (Malignant transformation occurs rarely)

• What examination would you request to show this tumour ?Ans- MRI, CT and US

Most hemangiomas are incidentally detected on imaging studies. Ultrasonography is a cost-effective imaging modality for the diagnosis of a hemangioma. However, computed tomography (CT) scanning and/or MRI may be required to specifically diagnose a hemangioma

• Identification of organ involved in low power

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Less circumscribed mass Fat vacuoles in liver

Description of the mass at the pointer

* well defined* Less circumscribed * Not encapsulated

* Large blood filled vascular spaces

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Description of the mass at the pointer

* well defined* Less circumscribed * Not encapsulated

* Large blood filled vascular spaces

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Lots ofNeutrophilsAt the pointer

Significant AmountOf fibroblastIn this slide

If it is a cirrhotic liver then the tumour will ultimately shrink as the fibroblast Wont allow the tumour to grow

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Blood filledVascular Space at The pointer

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Mild to moderate Amount of Connective Tissue inStromaBetween The vascularspaces

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Mild to moderate Amount of Connective Tissue inStromaBetween The vascularspaces

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Intravascular thrombosis

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NeutrophilsAt the pointerIn HPO

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Magnified HepatocytesWith some Fat vacuolesIn Hemangiomaslide

Coronary Artery Atherosclerosis

• Components of Atherosclerotic plaque

1) Fibrous cap – Smooth muscle cells, macrophages, lymphocytes, collagen, elastinproteoglycans.

2) Necrotic center- cell debris, foam cells,Cholesterol clefts,calcium.

3) Intact media

Complication expected with progression of Coronary artery atherosclerosis

• Rupture/Ulceration/erosion of luminal surface of the plaque exposes the blood stream to highly thrombogenic substances and induces thrombus formation.

• Such thrombi partially or completely occludes the lumen of the artery

• This will lead to Ischemic heart disease(IHD)

• And indeed Myocardial infarction(MI)

Examination request for CAA

1) Primary Angioplasty

2) Echocardiogram

• F – Fibrous cap• C – Necrotic center region• L – Lumen

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C F

C

F L

Plaque rupturesite

Identification of Plaque components at the pointer

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MagnifiedRupture site

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ScatteredInflammatoryCells inThe fibrouscap

Aortic aneurysm with thrombus & Atherosclerosis

• Thrombus:- Thrombi can develop anywhere in the cardiovascular system. A thrombus is focally attached to the underlying vascular surface. Propagating portion of the thrombus tends to be poorly attached and there for is prone to fragmentation generating an Embolus

• Emboli:- Embolus is a detached intravascular solid, liquid or gaseous mass that is carried by the blood to a site distant from the site of its origin.

Aneurysm

• It is a localized abnormal dilation of blood vessel or the heart.

Types of Aneurysms based on Morphological pathology

• True – If it involves all three layers of arterial wall or the wall of the heart.

----- True(Saccular)- spherical pouching involving only a portion of the vessel wall.. Varying from 5-20 cm in diameter often containing thrombi.

----- True(Fusiform)- Involves diffuse, circumferential dilation of a long vascular segment. Diameter (</= 20cm) and in length can involve extensive portions of the aortic arch, abdominal aorta, or even the iliacs.

• False(Pseudoaneurysm) –A Breach in the vascular wall leading to the extravascular hematoma.(Usually involves the endothelial layer)

Types of Aortic Aneurysms

A) Aortic route aneurysm

B) Thoracic aortic aneurysm

C) Abdominal aorticaneurysm

Other Aneurysms

• Brain Aneurysms

• Peripheral Aneurysms

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Site of vesselWall thinningRepresenting Aneurysm

Thrombus attached to The vascular wall

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Thrombus

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Atheromatous aorta

• Components of Atherosclerotic plaque

1) Fibrous cap – Smooth muscle cells, macrophages, lymphocytes, collagen, elastinproteoglycans.

2) Necrotic center- cell debris, foam cells, Cholesterol clefts, calcium deposits.

3) Intact media

• What will be the effect of this Clinically ?Ans. Most common is Hypertension and patient might

have angina along with HPN

• What laboratory tests would be associated ?Ans. Lipid profile, CBC ,Coagulation studies, serum

electrolytes, Glucose & liver function tests.

• What are the acute plaque changes ?Ans. Rupture,ulceration or erosion

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Tunica adventitia

Tunica Media

Plaque formationInvolvingIntima & subintima

F- Fibrous cap

C-Necrotic center

L- Lumen

F

C

L

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F- Fibrous cap

C-Necrotic center

F

C

Plaque component identification

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Cholesterol clefts

Cholesterol clefts in HPO

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Foam cells

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Foam cells

Gross specimen of Atheromatous Aorta

Tumour emboli in Lung

• Thrombus:- Thrombi can develop anywhere in the cardiovascular system. A thrombus is focally attached to the underlying vascular surface. Propagating portion of the thrombus tends to be poorly attached and there for is prone to fragmentation generating an Embolus

• Emboli:- Embolus is a detached intravascular solid, liquid or gaseous mass that is carried by the blood to a site distant from the site of its origin.

• What abnormal cellular features are seen ?Ans. Pleiomorphism

• What will be the effect of this lesion on lungs ?Ans. Pulmonary hypertension as common one due to the

tumour compressing the surrounding alveolar region.

• How will this manifest clinically ?Ans. Dyspnea

• Where do emboli like this usually arise ?Ans. There emboli are mostly intra cardial mural thrombi

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Alveoli surrounding The tumour

Monkeberg’s Sclerosis/Medial calcification

• It is characterized by calcific deposits in muscular arteries(Medium sized) in Tunica media.

• More frequent in patients over 50 yrs of age and Diabetics.

• Grossly it is rigid , there is loss of distensibility and there are palpable calcification.

• How does it differ from Psammoma bodies ?Ans. Psammoma bodies are characterized by concentrically

laminated calcified concretions , most commonly found in malignant conditions(Meningioma,Pappilary carcinoma)

and not necessarily found in Blood vessel wall..

• Will it give rise to systemic hypertension ?Ans. Yes

• This lesion usually occur in Medium sized arteries..

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