Vascular pathology

Budiana Tanurahardja/ Rahmiati/Lisnawati DEPARTMENT of ANATOMIC PATHOLOGY FACULTY OF MEDICINE UNIVERSITY of INDONESIA 2013

Vascular Pathology
Normal blood vessels. Aneurysms. Hypertension. Vasculitis. Varices. Neoplasms.

Normal blood vessels

Arteries : large/elastic medium size/muscular/distribute small arteries ( < 2 mm ). Arterioles : 20 - 100 u .

Normal blood vessel

Capillaries: 7 - 8 u.
Postcapillary venules. Collecting venule.

Normal blood vessels

Veins : Small medium large.
Lymphatic. The main components : endothelial cells. smooth muscles Tunica intima, tn. media, tn.adventitia

Normal blood vessel

Normal blood vessels

Normal blood vessel

Normal blood vessels

Normal blood vessel

Normal blood vessels

Main cellular components :
endothelial cells smooth muscle cells

Normal blood vessel

Endothel :
Weibel- Palade bodies 0,1x0,3u storage organelle for vWF.

IHC : antibody to vWF (factor VIII related Ag) ; CD31

Vascular abnormalities caused by 2 mechanism :
narrowing/complete obstruction

weakening of the walls : dilatation/rupture

Aneurysm

Aneurysm

Aneurysm is localized abnormal dilatation of blood vessel. True and false Saccular and fusiform. Etiology: atherosclerosis, cystic medial degeneration, congenital, infection (mycotic aneurysm), syphilis, trauma,systemic disease, immunologic. Dissecting aneurysm: blood enters the wall of the artery, dissecting the layers.

Berry aneurysm
Occurrence among patient with

Berry aneurysm

heritable systemic disorders ( autosomal dominant polycystic kidney, Ehlers-Danlos syndrome type IV,neurofibromatosis type I, Marfan syndrome) fibromuscular dysplasia of arteries coarctation of aorta

Cigarette smoking and hypertension ( 54 % of the patient)

Berry aneurysm
Saccular aneurysm.

Berry aneurysm

The most frequent cause of subarachnoid haemorrhage circle of Willis.

The 4th most common CVA after : atherosclerotic thrombosis, embolism and hypertensive haemorrhage.
2 % in autopsy.

Pathogenesis: unknown.
Genetic factor may be important.

Berry aneurysm

Berry aneurysm

Berry aneurysm

Berry aneurysm

Aneurysm

Aneurysm

Dissecting aneurysm

Dissecting Aneurysm

Hypertensive vascular disease

Hypertension :
elevated blood pressure diastole : > 90 mm Hg.

Hypertensive vascular disease

Systole : > 140 mm Hg.

90%-95%: idiopathic (essential hypertension} 5%-10 : secondary
renal ,endocrine, cardiovascular, neurologic.

Classification of blood pressure in adults

Category
Normal High normal Hypertension: Stage 1 (mild) Stage 2 (moderate) Stage 3 (severe ) Stage 4 (very severe)

systolic
< 130 130-139 140-159 160-179 180-209 > 210

diastolic
< 85 85-89 90-99 100-109 110-119 > 120

Morphology
Hyaline arteriolosclerosis:
in elderly patients normotensive or hypertensive, but more generalized and severe in hypertensive.

common in diabetes. Hyperplastic arteriolosclerosis:

related to severe acute elevation of blood pressure (diastole > 110 mmHg). laminated thickening of the walls of arteriole that consist of smooth muscle cells and reduplicated basement membrane.

Arteriolosclerosis
Elderly patient: normal/hypertensive.

Diabetes.
Leakage plasma component ,matrix production by smooth muscle cells hyaline deposition. benign nephrosclerosis.

Arteriolosclerosis
Acute /severe hypertension. Onion skin often : accompanied by deposits of fibrinoid and acute necrosis necrotizing arteriolitis(kidney)

Vasculitis
Inflammation of the walls of the vessels.

Vasculitis

Classification : direct infection: bacterial, rickettsial, spirochaetal, fungal, viral. Immunologic: immunecomplex mediated : SLE, RA, ANCA (antineutrophil cytoplasmic autoAb )mediated: Wegener granulomas,microscopic polyangiitis, ChurgStrauss syndrome direct antibody attack mediated: Goodpasture, Kawasaki (antiendothelial)

Vasculitis

Vasculitis

cell mediated: allograft organ rejection, IBD, paraneoplastic vasculitis.

unknown: giant cell temporal arteritis, Takayasu arteritis, PAN. Other classification:
large vessel vasculitis (giant cell,Takayasu) medium-sized vessel vasculitis (PAN, Kawasaki) Small vessel vasculitis (Wegener ).

Vasculitis

Vasculitis

Thromboangiitis obliterans

Vein and lymphatics

Varicose veins (varices): abnormally dilated, tortuous veins produced by prolonged, increased intraluminal pressure.
Thrombophlebitis and phlebothrombosis. Lymphangitis and lymphedema : lymphangitis caused by bacterial infection group A beta hemolytic streptococcus. Lymphedema caused by occlusion of lymphatic drainage.

Varicose veins
Pathogenesis: obese persons have greater tendency poor tissue support.

The most important factor is posture long periods of standing . Even in normal person simple orthostatic edema.
Other conditions : pregnancy, intravascular thrombosis, tumor mass. Microscopically : variation in thickness dilation and hypertrophy of smooth muscle and subintimal fibrosis, degeneration of elastic tissue, and spotty calcification in the media (phlebosclerosis).

Varices
Statis dermatitis.
Varicose ulcers.

Neoplasm
Benign :
hemangioma: Capillary, cavernous. lymphangioma: capillary, cavernous.

pyogenic granuloma(lobular capillary) glomus tumor.

Neoplasm
Intermediate grade neoplasms.
Kaposi sarcoma.

Hemangioendothelioma Hemangiopericytoma.
Malignant neoplasm.
angiosarcoma.

Congenital cavernous hemangioma

Haemangioma

cavernous

capillary

Angiosarcoma

Thank you