pathology of vascular system - al-mustansiriya university05_20_51_pm.pdf · arteriosclerosis this...
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Pathology of vascular system
practical
DR.
AYSER HAMEED
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Congenital Anomalies 1- Berry aneurysms
in cerebral vessels; when ruptured these can cause fatal intracerebral hemorrhage.
2- Arteriovenous fistulas
They are abnormal, typically small, direct connections between arteries and veins that bypass the intervening capillaries.
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Arteriovenous fistula
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Circle of Willis with anterior, middle and posterior cerebral arteries linked by communicating vessels. Berry aneurysms are seen arising where the internal carotid bifurcates into middle and anterior cerebral arteries (arrow).
Berry aneurysms
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Blood is present in the sub-arachnoid space over the cerebellum. in
this case the aneurysm was arising at the tip of the basilar artery.
Ruptured Berry aneurysm with subarachnoid Hge
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ARTERIOSCLEROSIS
This generic term refers to a group of disorders having in common thickening and loss of elasticity of arterial walls leading to sclerosis i.e. hardening of the wall.
It includes:
I. Atherosclerosis.
II.Monckeberg medial calcific sclerosis.
III.Arteriolosclerosis, (Disease of small arteries & arterioles).
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Atherosclerosis
Disease of large elastic arteries and medium sized muscular arteries.
Its basic lesion is the atheroma .
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Pathology of atherosclerosis passes in three stages:
1)Fatty streaks.
2)Atheromatous plaques.
3)Advanced atheromatous lesions.
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A coronary artery has been opened longitudinally. The coronary extends from left to right across the middle of the picture and is surrounded by epicardial fat. This coronary shows only mild atherosclerosis, with only an occasional yellow-tan lipid plaques (arrows) and no narrowing.
Mild degree of coronary athersclerosis
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The lumen of the artery is at the top right corner, and the band of smooth muscle at the bottom is the atrophic media. The intima is enormously thickened, by the presence deep in it (centre and left) of amorphous material containing large numbers of cholesterol crystals (the unstained clefts). There are many foamy (lipid-filled) macrophages and chronic inflammatory cells in this zone and also in the thick layer of dense fibrous tissue layer (arrow) which separates it from the lumen.
Coronary artery atheromatous plaque: (HE) medium power
Media
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This high magnification of an atheroma shows numerous foam cells (arrows) and an occasional cholesterol cleft. A few dark blue inflammatory cells are scattered within the atheroma.
Atheromatous plaque. (HE) High power
Media
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Atheromatous plaque. (HE) High power
This is a high magnification of an atheroma with foam cells and cholesterol clefts.
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This coronary artery opened longitudinally shows yellowish atheromatous plaques over much of its intimal surface.
There is focal hemorrhage into a plaque, a complication of atherosclerosis that can acutely narrow the lumen.
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This microscopic cross
section of the aorta shows a
large luminal atheroma.
Cholesterol clefts are
numerous in this atheroma.
The surface shows
intraplaque hemorrhage.
Aorta: atheromatous plaque with
hemorrhage. (HE) low power
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CONSEQUENCES OF ATHEROSCLEROSIS
Depend on the size of the involved vessels:
In smaller arteries such as the coronary, cerebral the main effect is narrowing of the lumen leading to chronic ischemia.
In large arteries such as the aorta the main complications are :
1. Development of mural thrombi emboli.
2. Aneurysmal dilatation of the wall
3. Rupture of atheroma cholesterol emboli.
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Cholesterol emboli
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ATH (formation of aneurysm)
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Pathlogical Changes of hypertension:-
1. Accelerates ATH & induces degenerative changes in wall of large & medium size arteries.
2. Hypertension in small vessels is associated with two forms of vascular diseases
(arteriolosclerosis)
I. Hyalin. II. Hyperplastic.
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Arteriolosclerosis is typically seen in the kidneys. One form, called hyaline arteriolosclerosis, is demonstrated by the markedly thickened arteriole to the lower right of this glomerulus with PAS stain. Hyaline arteriolosclerosis is seen in the elderly, but more advanced lesions are seen in persons with diabetes mellitus and/or with hypertension.
Hyaline arterioloscelrosis Kidney
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Onion-skin concentric, laminated thickening of the arteriolar wall with progressive narrowing of the lumen.
Hyperplastic arterilosclerosis
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Aneurysm
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A, External view, gross
photograph of a large
aortic aneurysm that
ruptured (arrow). B,
Opened view, with the
location of the rupture
tract indicated by a probe.
The wall of the aneurysm is
exceedingly thin, and the
lumen is filled by a large
quantity of layered but
largely unorganized
thrombus.
Abdominal aortic aneurysm
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This aorta has been opened longitudinally to reveal an area of fairly limited dissection that is
organizing. The red-brown hematoma can be seen in on both sides of the section as it extends around
the aorta. The dissection creates a "double lumen" to the aorta. This aorta shows in addition severe
atherosclerosis.
Aortic dissection
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an opened aorta with proximal dissection originating
from a small, oblique intimal tear (identified by the
probe), allowing blood to enter the media and create
an intramural hematoma (narrow arrows). Note that
the intimal tear has occurred in a region largely free
of atherosclerotic plaque and that propagation of the
intramural hematoma is arrested at a site more
distally where atherosclerosis begins (broad arrow).
Aortic dissection
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The dissection goes into the muscular wall creating an aorta with double lumina.
Aortic dissection
Original lumen
Dissection
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Vasculitis I. Infectious.
II.Immunologic.
III.Unknown.
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Artery of a patient with temporal arteritis showing
a thickened, nodular, & prominent segment of a
vessel on the surface of head (arrow).
Temporal arteritis
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Giant cell (temporal) arteritis
Temporal arteritis is one manifestation of giant cell arteritis, which can affect mainly branches of external carotid artery. There is thickening of the wall by granulomatous inflammation (with several multinucleated giant cells) of the media. The lumen is markedly narrowed.
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PAN
coronaries
prominent
aneurysmal
dilatations
PAN of the coronary artery branches
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PAN of the a renal arterial branch
There are inflammatory cell infiltration scattered in and around the vessel. The wall shows fibrinoid necrosis with aneurysmal dilatation (arrow). The ANCA serology is usually positive.
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Wegener's granulomatosis with ear, nose and throat manifestations and
beginning mucosal ulcerations.
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Buerger’s disease
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Pyogenic granuloma
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Female infant shows a massive lesion
distorting the nose and cheek.
Disfiguring hemangioma of the face
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A, Hemangioma of the tongue. B, Histology of juvenile capillary hemangioma. C, Histology of cavernous hemangioma
Hemangioma
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Angiosarcoma
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Angiosarcoma Moderately well-differentiated angiosarcoma with dense
clumps of irregular, moderate anaplastic cells.
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Rt. Gross photograph, illustrating coalescent red-purple patches and plaques of the skin of foot.
Lt. in the nodular stage, the lesions become nodular, larger, and more numerous.
Kaposi sarcoma
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Low-power view of a lesion of Kaposi's sarcoma having a prominent nodular
shape.
Microscopic appearance of
Kaposi’s sarcoma. Elongated spindle
cells showing minimal atypia are separated by slits
containing red blood cells.
Kaposi sarcoma
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THANKS