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![Kaposi sarcoma (KS)
Forms of KS:
• Chronic KS (Classic)
• Lymphadenopathic KS
• Transplant associated KS
• AIDS associated KS
Pathogenesis:
• HHV8 (KSHV)
• Latent infection in endothelial cells > [p53
inhibitors + Cyclin-D equivalent + viral G protein
which induces VEGF] > Cellular proliferation
DEC-2014-CSBRP](https://image.slidesharecdn.com/cvs-misc-1-csbrp-151029115933-lva1-app6891/75/Cvs-misc-1-csbrp-41-2048.jpg)
Uploaded byPrasad CSBR
Cvs misc-1-csbrp
1. Raynaud's phenomenon is characterized by paroxysmal vasoconstriction of the digital arteries, typically in response to cold or stress, and results in color changes in the fingers. It can occur primary or secondary to conditions like SLE or scleroderma. 2. Buerger's disease (thromboangiitis obliterans) is a non-atherosclerotic inflammatory disease affecting small and medium arteries of the limbs. It mainly affects young male smokers and causes symptoms like claudication, pain relieved by hanging the leg over the bed, and Raynaud's phenomenon. 3. Varicose veins are abnormally dilated and tortuous veins most commonly seen
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Cvs misc-1-csbrp
- 1. CVS - Miscellaneous CSBR.Prasad,MD., DEC-2014-CSBRP
- 2. Raynaud’s phenomenon (RP) •Paroxysmal exaggerated vasoconstriction of digital arteries and arterioles • Results in cyanosis and pallor • Sometimes may affect: Nose, ear and lips • Types: – Primary RP • Response to cold / emotional stress • CF: Atrophic changes may develop in the course of time – Secondary RP • SLE, Scleroderma, Buerger’s disease DEC-2014-CSBRP
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- 4. Buerger’s disease Thromboangiitis obliterans- TAO • Def: It’s segmental, thrombosing arteritis affecting small & medium sized vessels of acute or chronic nature • Men <40yrs • Smokers • Arteries: Tibial, femoral, peroneal & popleteal • Upper limb involvement – 70% • More common in Asians than in Western countries DEC-2014-CSBRP
- 5. Buerger’s disease Thromboangiitis obliterans- TAO Morphology: • Thrombosis • Initially: Neutrophil exudate in all the layers – microabscesses • Later: lymphocytes and macrophages, occasionally giant cells • Musculature of the media and elastic laminae are preserved DEC-2014-CSBRP
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- 7. Buerger’s disease Thromboangiitis obliterans- TAO DEC-2014-CSBRP
- 8. Buerger’s disease Thromboangiitis obliterans- TAO Clinical features: • Intermittent claudication – In the instep – Less commonly in the calf – Rarely in the upper limbs • Later: pain comes on at night and is relieved by walking / hanging the leg over the side of bed • Pulse may be absent in the small vessels like Dorsalis pedis and Radial • Raynaud’s phenomenon – 50% of patients develop this when the hands are exposed to cold • Migratory superficial thrombophlebitis • Gangrene DEC-2014-CSBRP
- 9. Buerger’s disease Thromboangiitis obliterans- TAO DEC-2014-CSBRP
- 10. Buerger’s disease Thromboangiitis obliterans- TAO DEC-2014-CSBRP
- 11. Varicose veins • Abnormallydilated tortuous veins • Due to: – Prolonged increased pressure within – Loss of vessel wall support • Site: Superficial vessels of lower limbs are affected • Women more commonly affected • Obesity increases the risk • Familial tendencies are seen in some • CF: Edema, Stasis dermatitis, Ulceration, Thombosis NOTE: Embolism is not a feature of thrombosis of superficial veins. It’s commonly associated with DVTDEC-2014-CSBRP
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- 14. Varicose veins • Othersites for varocosities: – Esophageal varices (due to PHT) – Hemorrhoides (due to PHT, Pregnancy, Constipation) – Varicocele • Complication: Bleeding DEC-2014-CSBRP
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- 17. Varococele What is the importanceof ACUTE left sided varicocele ? DEC-2014-CSBRP
- 18. Thrombophlebitis & Phlebothrombosis •Interchangeable terms • Components: – Venous thrombosis and – Inflammation • Sites: – Deep veins of legs – Periprostatic plexus in male – Pelvic venous plexus in female – Large veins of skull & dural sinuses DEC-2014-CSBRP
- 19. Thrombophlebitis & Phlebothrombosis Causes: •Peritoneal infections – Appendicitis – Salpingitis • PLT hyperactivity – PCV – Myelofibrosis • Prolonged immobilization • Systemic hypercoagulability – Adenocarcinoma • Complications of DVT – Pulmonary embolism Trousseau’s sign (Migratory thrombophlebitis) DEC-2014-CSBRP
- 20. Known for: Trousseau signof malignancy Trousseau sign of latent tetany Trousseau-Lallemand bodies "use new drugs quickly, while they still work" During his later years Trousseau developed pancreatic cancer. Coincidentally, he previously described Trousseau sign of malignancy and developed a similar finding in himself. This cancer limited his activities and eventually proved fatal. Armand Trousseau (1801-1867) DEC-2014-CSBRP
- 21. Case: Identify theabnormality. Give your differentials. Marcos Duarte Siosaki, M.D., and Ana Tarsila Souza, M.D. N Engl J Med 2013; 368:e7February 7, 2013 DOI: 10.1056/NEJMicm1204740
- 22. Case: Identify theabnormality. Give your differentials. Marcos Duarte Siosaki, M.D., and Ana Tarsila Souza, M.D. N Engl J Med 2013; 368:e7February 7, 2013 DOI: 10.1056/NEJMicm1204740 Virchow's node or Troisier's node
- 23. Dr.Troisier The French pathologistCharles Emile Troisier noted in 1889 that other abdominal cancers, too, could spread to the Virchow’s node Cf DEC-2014-CSBRP
- 24. Tumors of bloodvessels DEC-2014-CSBRP
- 25. Hemangiomas • Very commontumors • Increased number of blood vessels filled with blood • Many of the capillary lesions seen in infancy may regress spontaneously as the child grows (by the age of 7years) • Some hemangiomas involve large portions of the body – Angiomatosis DEC-2014-CSBRP
- 26. Capilalry Hemangioma • Sites:Skin, subcutis, oral cavity, liver, spleen, kidney • Strawberry angioma – new borns Morphology: • Bright red to blue • Closely packed thin walled blood vessels • Lined by flat endothelium • Scant connective tissue • Hemorrhages, thrombosis, hemosiderin laden MØ DEC-2014-CSBRP
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- 28. Capillary angioma -Strawberry angioma DEC-2014-CSBRP
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- 30. Cavernous angioma • Largedilated vascular channels • Less well circumscribed • Frequently involve deep structures • May be a part of VHL, Muffucci syndromes Morphology: • Red blue soft spongy masses • Large intercommunicating vascular channels • Modest connective tissue stroma • Thrombosis and calcification DEC-2014-CSBRP
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- 32. Muffucci syndrome Cavernous angiomas+ Enchondromas DEC-2014-CSBRP
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- 34. Granuloma pyogenicum (Pregnancy tumor) •A form of capillary angioma • Rapidly growing • Pedunculated red nodule • Skin, gingiva, oral mucosa • “Bleeds on touch” • Capillaries arranged in lobular fashion • Finger like epidermal projections at the margins DEC-2014-CSBRP
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- 39. Bacillary Angiomatosis Bacillary angiomatosisis a vascular proliferation in immunocompromised hosts Caused by: • Bartonella henselae • Bartonella quintana Morphology: • Skin lesions are red papules and nodules, or rounded subcutaneous masses • Histologically: – Capillary proliferation with prominent epithelioid endothelial cells – Nuclear atypia and mitoses – Stromal neutrophils, nuclear dust, and the causal bacteria DEC-2014-CSBRP
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- 41. Kaposi sarcoma (KS) Formsof KS: • Chronic KS (Classic) • Lymphadenopathic KS • Transplant associated KS • AIDS associated KS Pathogenesis: • HHV8 (KSHV) • Latent infection in endothelial cells > [p53 inhibitors + Cyclin-D equivalent + viral G protein which induces VEGF] > Cellular proliferation DEC-2014-CSBRP
- 42. Kaposi sarcoma (KS) Morphology: •Patches / plaques / nodules • Red / purple / violaceous • Dermal accumulations of spindle cells with slit like spaces with extravasated RBCs • Hemosiderin laden macrophages • Mitotic figures are common in nodular form Nodular forms often heralds LN and visceral involvement IFN-α anti-VEGF are effective DEC-2014-CSBRP
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- 44. Kaposi sarcoma –Nodular form DEC-2014-CSBRP
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- 48. Angiosarcoma • Malignant endothelialneoplasm • Primarily affects older adults • Tumor may occur at any site – Skin, soft tissue, breast, and liver • Liver: Thorostrat, Vinyl chloride Morphology: • Skin: Asymptomatic red papules or nodules • Plump, atypical endothelial cells forming vascular Channels • Wildly undifferentiated tumors with a solid spindled appearance and no discernible blood vessels • IHC: CD31 or von Willebrand factor DEC-2014-CSBRP
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