Vascular pathology. dr. Budiana Tanurahardja.,SpPA
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1 Vascular pathology dr. Budiana Tanurahardja.,SpPA DEPARTMENT of ANATOMIC PATHOLOGY FACULTY of MEDICINE UNIVERSITY of INDONESIA Center of Anatomic Pathology Studies
2 Vascular Pathology Normal blood vessels. Aneurysms. Hypertension. Vasculitis. Varices. Neoplasms.
3 Normal blood vessels Arteries : - large/elastic - medium size/muscular/distribute - small arteries ( < 2 mm ). Arterioles : u. Capillaries: 7-8 u. Postcapillary venules. Collecting venule.
4 Normal blood vessels Veins : - small. - medium. - large. Lymphatic. The main components : - endothelial cells. - smooth muscles. Tn. intima, tn.media, tn.adventitia.
5 Normal blood vessels
6 Normal blood vessels
7 Normal blood vessels Main cellular components : endothelial cells, smooth muscle cells 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 mecha : - narrowing/complete obstruction - weakening of the walls : dilatation/rupture
8 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 dis., immunologic. Dissecting aneurysm: blood enters the wall of the artery, dissecting the layers.
9 Berry aneurysm Occurrence among patient with heritable systemic disorders ( autosomal dominant polycystic kidney, Ehlers-Danlos syndrome type IV,neurofibromatosis type I, Marfan syndrome), and fibromuscular dysplasia of arteries and coarctation of aorta. Cigarette smoking and hypertension ( 54 % of the patient)
10 Berry aneurysm Saccular 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.
11 Berry aneurysm
12 Berry aneurysm
13 Aneurysm
14 Dissecting aneurysm
15 Hypertensive vascular disease Hypertension : elevated blood pressure diastole : > 90 mm Hg. Systole : > 140 mm Hg. 90%-95%: idiopathic (essential hypertension} 5%-10 : secondary : renal,endocrine, cardiovascular, neurologic.
16 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 < diastolic < > > 120
17 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.
18 Arteriolosclerosis Elderly patient: normal/hypertensive. Diabetes. Leakage plasma component,matrix production by smooth muscle cells -> hyaline deposition. benign nephrosclerosis.
19 Arteriolosclerosis Acute /severe hypertension. Onion skin often : accompanied by deposits of fibrinoid and acute necrosis --> necrotizing arteriolitis(kidney)
20 Vasculitis Inflammation of the walls of the vessels. Classification :-direct infection: bacterial, rickettsial, spirochaetal, fungal, viral. Immunologic:-immunecomplex mediated:sle, RA -ANCA(antineutrophil cytoplasmic autoab mediated: Wegener granlms,microscopic polyangiitis, Churg-Strauss syndr. -direct antibody attack mediated: Goodpasture, Kawasaki (antiendothelial)
21 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 cell vasculitis(wegener ).
22 Vasculitis
23 Thromboangiitis obliterans
24 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.
25 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. Micros : variation in thickness dilation and hypertrophy of smooth muscle and subintimal fibrosis, degeneration of elastic tissue, and spotty calcification in the media (phlebosclerosis).
26 Varices Statis dermatitis. Varicose ulcers.
27 Neoplasm Benign : -hemangioma: capillary,cavernous. -lymphangioma: capillary,cavernous. -pyogenic granuloma(lobular capillary) -glomus tumor. Intermediate grade neoplasms. - Kaposi sarcoma. - Hemangioendothelioma - hemangiopericytoma. Malignant neoplasm. - angiosarcoma.
28 Congenital cavernous hemangioma
29 Haemangioma
30 Angiosarcoma
31
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ATHEROSCLEROSIS زيد ثامر جابر Zaid. Th. Jaber Objectives 1- Review the normal histological features of blood vessels walls. 2-define the atherosclerosis. 3- display the risk factors of atherosclerosis.