Blood Vessel Diseases<br />Pathology-B Lab<br />Ravi A Patel<br />
M++<br />Hemangioma-Liver<br />Coronary Artery Atherosclerosis<br />Atherosclerosis with thrombus- Aortic aneurysm<br />At...
Hemangioma-Liver<br />***Hemangiomas are very common tumours characterized by increased number of Normal or abnormal blood...
What is the cell of origin of this tumour ?<br />Ans- Endothelial cells<br />Cavernous hemangiomas arise from the endothel...
Why is it called cavernous(hollow) ?<br />Ans- Because there are large blood filled spaces found compared to capillary typ...
<ul><li>Identification of organ involved in low power </li></ul>Less circumscribed  mass <br />Fat vacuoles in liver <br /...
Description of the mass at the pointer* well defined* Less circumscribed * Not encapsulated * Large blood filled vascular ...
Description of the mass at the pointer<br />* well defined* Less circumscribed * Not encapsulated * Large blood filled vas...
If it is a cirrhotic liver then the tumour will ultimately shrink as the fibroblast <br />Wont allow the tumour to grow<br...
Blood filled<br />Vascular <br />Space  at <br />The pointer<br />HPO<br />
Mild to moderate <br />Amount of <br />Connective <br />Tissue in<br />Stroma<br />Between <br />The vascular<br />spaces<...
Mild to moderate <br />Amount of <br />Connective <br />Tissue in<br />Stroma<br />Between <br />The vascular<br />spaces<...
Intravascular thrombosis<br />HPO<br />
Neutrophils<br />At the pointer<br />In HPO<br />HPO<br />
Magnified <br />Hepatocytes<br />With some <br />Fat vacuoles<br />In Hemangioma<br />slide<br />HPO<br />
Coronary Artery Atherosclerosis<br />Components of Atherosclerotic plaque<br />Fibrous cap – Smooth muscle cells, macropha...
Complication expected with progression of Coronary artery atherosclerosis<br />Rupture/Ulceration/erosion of luminal surfa...
Examination request for CAA<br />Primary Angioplasty<br />2)  Echocardiogram<br />
F – Fibrous cap<br />C – Necrotic center region<br />L – Lumen <br />Plaque rupture<br />site<br />LPO<br />F<br />L<br />...
Identification of Plaque components at the pointer<br />LPO<br />
Magnified<br />Rupture site<br />HPO<br />
Scattered<br />Inflammatory<br />Cells in<br />The fibrous<br />cap<br />HPO<br />
Aortic aneurysm with thrombus & Atherosclerosis<br />Thrombus:- <br />Thrombi can develop anywhere in the cardiovascular s...
Aneurysm<br />It is a localized abnormal dilation of blood vessel or the heart.<br />
Types of Aneurysms based on Morphological pathology<br />True – If it involves all three layers of arterial wall or the wa...
Types of Aortic Aneurysms<br />Aortic route<br />     aneurysm<br />B) Thoracic aortic <br />aneurysm<br />C) Abdominal ao...
Other Aneurysms<br />Brain Aneurysms<br />Peripheral Aneurysms<br />
Site of vessel<br />Wall thinning<br />Representing <br />Aneurysm <br />LPO<br />
Thrombus attached to <br />The vascular wall<br />
Thrombus<br />LPO<br />
LPO<br />
LPO<br />
LPO<br />
Atheromatous aorta<br />Components of Atherosclerotic plaque<br />Fibrous cap – Smooth muscle cells, macrophages, lymphocy...
What will be the effect of this Clinically ?<br />Ans. Most common is Hypertension and patient might have angina along wit...
Plaque formation<br />Involving<br />Intima & <br />subintima<br />F- Fibrous cap<br />C-Necrotic center<br />L- Lumen <br...
F- Fibrous cap<br />C-Necrotic center<br />C<br />F<br />LPO<br />
Plaque component identification<br />LPO<br />
Cholesterol clefts<br />LPO<br />
Cholesterol clefts in HPO<br />
Foam cells<br />HPO<br />
Foam cells <br />HPO<br />
Gross specimen of Atheromatous Aorta<br />
Tumour emboli in Lung<br />Thrombus:- <br />	Thrombi can develop anywhere in the cardiovascular system. A thrombus is foca...
What abnormal cellular features are seen ?<br />Ans. Pleiomorphism<br />What will be the effect of this lesion on lungs ?<...
HPO<br />
HPO<br />
LPO<br />
Alveoli surrounding <br />The tumour<br />LPO<br />
Monkeberg’s Sclerosis/Medial calcification<br />It is characterized by calcific deposits in muscular arteries(Medium sized...
Grossly it is rigid , there is loss of distensibility and there are palpable calcification.<br />How does it differ from P...
LPO<br />
LPO<br />
HPO<br />
Thanking to the entire Universe<br />
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Blood Vessel Diseases

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Blood Vessel Diseases

  1. 1. Blood Vessel Diseases<br />Pathology-B Lab<br />Ravi A Patel<br />
  2. 2. M++<br />Hemangioma-Liver<br />Coronary Artery Atherosclerosis<br />Atherosclerosis with thrombus- Aortic aneurysm<br />Atheromatous aorta<br />Tumour emboli in Lung<br />Monckeberg’s Sclerosis<br />
  3. 3. Hemangioma-Liver<br />***Hemangiomas are very common tumours characterized by increased number of Normal or abnormal blood vessels filled with blood.<br />There are 2 types<br />Capillary Hemangioma- occurs in skin, subcutaneous tissue and mucous membranes of lips as well as liver,spleen and kidneys. <br />Cavernous Hemangioma (shown in lab for liver) - Characterized by large dilated vascular channels. Compared to capillary type, these are less well circumscribed and mostly involve deep structures.<br />Gross:- Red-Blue soft spongy mass<br />Microscopic:- Well defined but not encapsulated large cavernous blood filled vascular spaces.<br />
  4. 4. What is the cell of origin of this tumour ?<br />Ans- Endothelial cells<br />Cavernous hemangiomas arise from the endothelial cells that line the blood vessels and consist of multiple, large vascular channels lined by a single layer of endothelial cells and supported by collagenous walls.<br />How will the tumour give rise to clinical manifestations ?<br />Ans- Abdominal pain & vomiting<br />Presentation<br /> The vast majority of hemangiomas (as many as 85%) are asymptomatic; however, hemangiomas may cause symptoms because of the compression of adjacent structures, rupture, acute thrombosis, or consumptive coagulopathy (ie,KasabachMeritt syndrome).Pressure on the stomach and duodenum caused by large pedunculatedhemangioma lesions may cause vague abdominal pain, early satiety, nausea, and vomiting. Pedunculatedhemangiomas may twist and cause acute abdominal pain.Compression of the inferior vena cava may result in Budd chiarisyndrome.Acute thrombosis may result in acute inflammatory changes that cause fever, abdominal pain, and abnormal results in liver function tests.Spontaneous or posttraumatic rupture is a catastrophic complication that occurs in about 1-4% of hemangiomas; this condition has a considerable mortality rate, as high as 60%.<br />
  5. 5. Why is it called cavernous(hollow) ?<br />Ans- Because there are large blood filled spaces found compared to capillary type where in there are no spaces found.<br />Is it capable of spreading ?<br />Ans- No (Malignant transformation occurs rarely)<br />What examination would you request to show this tumour ?<br />Ans- MRI, CT and US<br /> Most hemangiomas are incidentally detected on imaging studies. Ultrasonography is a cost-effective imaging modality for the diagnosis of a hemangioma. However, computed tomography (CT) scanning and/or MRI may be required to specifically diagnose a hemangioma<br />
  6. 6. <ul><li>Identification of organ involved in low power </li></ul>Less circumscribed mass <br />Fat vacuoles in liver <br />LPO<br />
  7. 7. Description of the mass at the pointer* well defined* Less circumscribed * Not encapsulated * Large blood filled vascular spaces<br />LPO<br />
  8. 8. Description of the mass at the pointer<br />* well defined* Less circumscribed * Not encapsulated * Large blood filled vascular spaces<br />LPO<br />
  9. 9. If it is a cirrhotic liver then the tumour will ultimately shrink as the fibroblast <br />Wont allow the tumour to grow<br />Lots of<br />Neutrophils<br />At the <br />pointer<br />Significant <br />Amount<br />Of fibroblast<br />In this slide<br />HPO<br />
  10. 10. Blood filled<br />Vascular <br />Space at <br />The pointer<br />HPO<br />
  11. 11. Mild to moderate <br />Amount of <br />Connective <br />Tissue in<br />Stroma<br />Between <br />The vascular<br />spaces<br />HPO<br />
  12. 12. Mild to moderate <br />Amount of <br />Connective <br />Tissue in<br />Stroma<br />Between <br />The vascular<br />spaces<br />HPO<br />
  13. 13. Intravascular thrombosis<br />HPO<br />
  14. 14. Neutrophils<br />At the pointer<br />In HPO<br />HPO<br />
  15. 15. Magnified <br />Hepatocytes<br />With some <br />Fat vacuoles<br />In Hemangioma<br />slide<br />HPO<br />
  16. 16. Coronary Artery Atherosclerosis<br />Components of Atherosclerotic plaque<br />Fibrous cap – Smooth muscle cells, macrophages, lymphocytes, collagen, elastin<br />proteoglycans.<br />Necrotic center- cell debris, foam cells,Cholesterolclefts,calcium.<br />Intact media<br />
  17. 17. Complication expected with progression of Coronary artery atherosclerosis<br />Rupture/Ulceration/erosion of luminal surface of the plaque exposes the blood stream to highly thrombogenic substances and induces thrombus formation. <br />Such thrombi partially or completely occludes the lumen of the artery<br />This will lead to Ischemic heart disease(IHD)<br />And indeed Myocardial infarction(MI)<br />
  18. 18. Examination request for CAA<br />Primary Angioplasty<br />2) Echocardiogram<br />
  19. 19. F – Fibrous cap<br />C – Necrotic center region<br />L – Lumen <br />Plaque rupture<br />site<br />LPO<br />F<br />L<br />C<br />C<br />F<br />
  20. 20. Identification of Plaque components at the pointer<br />LPO<br />
  21. 21. Magnified<br />Rupture site<br />HPO<br />
  22. 22. Scattered<br />Inflammatory<br />Cells in<br />The fibrous<br />cap<br />HPO<br />
  23. 23. Aortic aneurysm with thrombus & Atherosclerosis<br />Thrombus:- <br />Thrombi can develop anywhere in the cardiovascular system. A thrombus is focally attached to the underlying vascular surface. Propagating portion of the thrombus tends to be poorly attached and there for is prone to fragmentation generating an Embolus<br />Emboli:-<br /> Embolus is a detached intravascular solid, liquid or gaseous mass that is carried by the blood to a site distant from the site of its origin.<br />
  24. 24. Aneurysm<br />It is a localized abnormal dilation of blood vessel or the heart.<br />
  25. 25. Types of Aneurysms based on Morphological pathology<br />True – If it involves all three layers of arterial wall or the wall of the heart.<br />----- True(Saccular)- spherical pouching involving only a portion of the vessel wall.. Varying from 5-20 cm in diameter often containing thrombi.<br />----- True(Fusiform)- Involves diffuse, circumferential dilation of a long vascular segment. Diameter (&lt;/= 20cm) and in length can involve extensive portions of the aortic arch, abdominal aorta, or even the iliacs.<br />False(Pseudoaneurysm) –A Breach in the vascular wall leading to the extravascular hematoma.(Usually involves the endothelial layer)<br />
  26. 26. Types of Aortic Aneurysms<br />Aortic route<br /> aneurysm<br />B) Thoracic aortic <br />aneurysm<br />C) Abdominal aortic<br />aneurysm <br />
  27. 27. Other Aneurysms<br />Brain Aneurysms<br />Peripheral Aneurysms<br />
  28. 28. Site of vessel<br />Wall thinning<br />Representing <br />Aneurysm <br />LPO<br />
  29. 29. Thrombus attached to <br />The vascular wall<br />
  30. 30. Thrombus<br />LPO<br />
  31. 31. LPO<br />
  32. 32. LPO<br />
  33. 33. LPO<br />
  34. 34. Atheromatous aorta<br />Components of Atherosclerotic plaque<br />Fibrous cap – Smooth muscle cells, macrophages, lymphocytes, collagen, elastin<br />proteoglycans.<br />Necrotic center- cell debris, foam cells, Cholesterol clefts, calcium deposits.<br />Intact media<br />
  35. 35. What will be the effect of this Clinically ?<br />Ans. Most common is Hypertension and patient might have angina along with HPN<br />What laboratory tests would be associated ?<br />Ans. Lipid profile, CBC ,Coagulation studies, serum electrolytes, Glucose & liver function tests.<br />What are the acute plaque changes ?<br />Ans. Rupture,ulceration or erosion<br />
  36. 36. Plaque formation<br />Involving<br />Intima & <br />subintima<br />F- Fibrous cap<br />C-Necrotic center<br />L- Lumen <br />Tunica<br /> adventitia<br />Tunica Media<br />LPO<br />C<br />F<br />L<br />
  37. 37. F- Fibrous cap<br />C-Necrotic center<br />C<br />F<br />LPO<br />
  38. 38. Plaque component identification<br />LPO<br />
  39. 39. Cholesterol clefts<br />LPO<br />
  40. 40. Cholesterol clefts in HPO<br />
  41. 41. Foam cells<br />HPO<br />
  42. 42. Foam cells <br />HPO<br />
  43. 43. Gross specimen of Atheromatous Aorta<br />
  44. 44. Tumour emboli in Lung<br />Thrombus:- <br /> Thrombi can develop anywhere in the cardiovascular system. A thrombus is focally attached to the underlying vascular surface. Propagating portion of the thrombus tends to be poorly attached and there for is prone to fragmentation generating an Embolus<br />Emboli:-<br /> Embolus is a detached intravascular solid, liquid or gaseous mass that is carried by the blood to a site distant from the site of its origin.<br />
  45. 45. What abnormal cellular features are seen ?<br />Ans. Pleiomorphism<br />What will be the effect of this lesion on lungs ?<br />Ans. Pulmonary hypertension as common one due to the tumour compressing the surrounding alveolar region.<br />How will this manifest clinically ?<br />Ans. Dyspnea<br />Where do emboli like this usually arise ?<br />Ans. There emboli are mostly intra cardial mural thrombi<br />
  46. 46. HPO<br />
  47. 47. HPO<br />
  48. 48. LPO<br />
  49. 49. Alveoli surrounding <br />The tumour<br />LPO<br />
  50. 50. Monkeberg’s Sclerosis/Medial calcification<br />It is characterized by calcific deposits in muscular arteries(Medium sized) in Tunica media.<br />More frequent in patients over 50 yrs of age and Diabetics.<br />
  51. 51. Grossly it is rigid , there is loss of distensibility and there are palpable calcification.<br />How does it differ from Psammoma bodies ?<br />Ans. Psammoma bodies are characterized by concentrically laminated calcified concretions , most commonly found in malignant conditions(Meningioma,Pappilary carcinoma)<br /> and not necessarily found in Blood vessel wall..<br />Will it give rise to systemic hypertension ?<br />Ans. Yes <br />This lesion usually occur in Medium sized arteries..<br />
  52. 52. LPO<br />
  53. 53. LPO<br />
  54. 54. HPO<br />
  55. 55. Thanking to the entire Universe<br />
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