Budiana Tanurahardja/ Rahmiati/Lisnawati

DEPARTMENT of ANATOMIC PATHOLOGYDEPARTMENT of ANATOMIC PATHOLOGYFACULTY OF MEDICINE UNIVERSITY of INDONESIAFACULTY OF MEDICINE UNIVERSITY of INDONESIA

20132013

Vascular pathology

Vascular Pathology

Normal blood vessels.

Aneurysms.

Hypertension.

Vasculitis.

Varices.

Neoplasms.

Normal blood vessels

Arteries : large/elasticmedium size/muscular/distributesmall arteries ( < 2 mm ).

Arterioles : 20 - 100 u .

Capillaries: 7 - 8 u.

Postcapillary venules.

Collecting venule.

Normal blood vessel

Normal blood vessels

Veins :Smallmediumlarge.

Lymphatic.

The main components : endothelial cells.smooth musclesTunica 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

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

Normal blood vessel

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.

Aneurysm

Berry aneurysm

Occurrence among patient with heritable systemic disorders ( autosomal dominant

polycystic kidney, Ehlers-Danlos syndrome type IV,neurofibromatosis type I, Marfan syndrome)

fibromuscular dysplasia of arteries coarctation of aortaCigarette smoking and hypertension ( 54 % of the

patient)

Berry aneurys

m

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.

Berry aneurys

m

Berry aneurysm Berry aneurys

m

Berry aneurysm Berry aneurys

m

Aneurysm Aneurysm

Dissecting aneurysm Dissecting Aneurysm

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.

Hypertensive vascular

disease

Classification of blood pressure in adults

Category systolic diastolic

NormalHigh normalHypertension:Stage 1 (mild)Stage 2 (moderate)Stage 3 (severe )Stage 4 (very severe)

< 130130-139

140-159160-179180-209> 210

< 8585-89

90-99100-109110-119> 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.

ArteriolosclerosisElderly 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.

Classification :direct infection: bacterial, rickettsial, spirochaetal,

fungal, viral.Immunologic:

immunecomplex mediated : SLE, RA, ANCA (antineutrophil cytoplasmic

autoAb )mediated: Wegener granulomas,microscopic polyangiitis, Churg-Strauss 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 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.HemangioendotheliomaHemangiopericytoma.

Malignant neoplasm.angiosarcoma.

Congenital cavernous hemangioma

Haemangioma

cavernous capillary

Angiosarcoma

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