- Hemangioma is a benign tumor of blood vessels characterized by increased and abnormal blood vessels. Cavernous hemangioma involves large, dilated vascular channels in the liver. It arises from endothelial cells and can cause abdominal pain from compression. - Coronary artery atherosclerosis involves plaques with necrotic cores, cholesterol, and inflammatory cells that can rupture and cause thrombosis, potentially leading to myocardial infarction. - Aortic aneurysm is an abnormal dilation of the aorta that can contain thrombi and cause emboli in the lungs through fragmentation. Medial calcification or Monckeberg's sclerosis involves calcification of medium arteries and can cause hypertension.

1. Blood Vessel DiseasesPathology-B LabRavi A Patel

2. M++Hemangioma-LiverCoronary Artery AtherosclerosisAtherosclerosis with thrombus- Aortic aneurysmAtheromatous aortaTumour emboli in LungMonckeberg’s Sclerosis

3. Hemangioma-Liver***Hemangiomas are very common tumours characterized by increased number of Normal or abnormal blood vessels filled with blood.There are 2 typesCapillary Hemangioma- occurs in skin, subcutaneous tissue and mucous membranes of lips as well as liver,spleen and kidneys. 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.Gross:- Red-Blue soft spongy massMicroscopic:- Well defined but not encapsulated large cavernous blood filled vascular spaces.

4. What is the cell of origin of this tumour ?Ans- Endothelial cellsCavernous 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.How will the tumour give rise to clinical manifestations ?Ans- Abdominal pain & vomitingPresentation 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%.

5. Why is it called cavernous(hollow) ?Ans- Because there are large blood filled spaces found compared to capillary type where in there are no spaces found.Is it capable of spreading ?Ans- No (Malignant transformation occurs rarely)What examination would you request to show this tumour ?Ans- MRI, CT and US 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

6. Identification of organ involved in low power Less circumscribed mass Fat vacuoles in liver LPO

7. Description of the mass at the pointer* well defined* Less circumscribed * Not encapsulated * Large blood filled vascular spacesLPO

8. Description of the mass at the pointer* well defined* Less circumscribed * Not encapsulated * Large blood filled vascular spacesLPO

9. If it is a cirrhotic liver then the tumour will ultimately shrink as the fibroblast Wont allow the tumour to growLots ofNeutrophilsAt the pointerSignificant AmountOf fibroblastIn this slideHPO

10. Blood filledVascular Space at The pointerHPO

11. Mild to moderate Amount of Connective Tissue inStromaBetween The vascularspacesHPO

12. Mild to moderate Amount of Connective Tissue inStromaBetween The vascularspacesHPO

13. Intravascular thrombosisHPO

14. NeutrophilsAt the pointerIn HPOHPO

15. Magnified HepatocytesWith some Fat vacuolesIn HemangiomaslideHPO

16. Coronary Artery AtherosclerosisComponents of Atherosclerotic plaqueFibrous cap – Smooth muscle cells, macrophages, lymphocytes, collagen, elastinproteoglycans.Necrotic center- cell debris, foam cells,Cholesterolclefts,calcium.Intact media

17. Complication expected with progression of Coronary artery atherosclerosisRupture/Ulceration/erosion of luminal surface of the plaque exposes the blood stream to highly thrombogenic substances and induces thrombus formation. Such thrombi partially or completely occludes the lumen of the arteryThis will lead to Ischemic heart disease(IHD)And indeed Myocardial infarction(MI)

18. Examination request for CAAPrimary Angioplasty2) Echocardiogram

19. F – Fibrous capC – Necrotic center regionL – Lumen Plaque rupturesiteLPOFLCCF

20. Identification of Plaque components at the pointerLPO

21. MagnifiedRupture siteHPO

22. ScatteredInflammatoryCells inThe fibrouscapHPO

23. Aortic aneurysm with thrombus & AtherosclerosisThrombus:- 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 EmbolusEmboli:- 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.

24. AneurysmIt is a localized abnormal dilation of blood vessel or the heart.

25. Types of Aneurysms based on Morphological pathologyTrue – If it involves all three layers of arterial wall or the wall of the heart.----- True(Saccular)- spherical pouching involving only a portion of the vessel wall.. Varying from 5-20 cm in diameter often containing thrombi.----- True(Fusiform)- Involves diffuse, circumferential dilation of a long vascular segment. Diameter (</= 20cm) and in length can involve extensive portions of the aortic arch, abdominal aorta, or even the iliacs.False(Pseudoaneurysm) –A Breach in the vascular wall leading to the extravascular hematoma.(Usually involves the endothelial layer)

26. Types of Aortic AneurysmsAortic route aneurysmB) Thoracic aortic aneurysmC) Abdominal aorticaneurysm

27. Other AneurysmsBrain AneurysmsPeripheral Aneurysms

28. Site of vesselWall thinningRepresenting Aneurysm LPO

29. Thrombus attached to The vascular wall

30. ThrombusLPO

31. LPO

32. LPO

33. LPO

34. Atheromatous aortaComponents of Atherosclerotic plaqueFibrous cap – Smooth muscle cells, macrophages, lymphocytes, collagen, elastinproteoglycans.Necrotic center- cell debris, foam cells, Cholesterol clefts, calcium deposits.Intact media

35. What will be the effect of this Clinically ?Ans. Most common is Hypertension and patient might have angina along with HPNWhat laboratory tests would be associated ?Ans. Lipid profile, CBC ,Coagulation studies, serum electrolytes, Glucose & liver function tests.What are the acute plaque changes ?Ans. Rupture,ulceration or erosion

36. Plaque formationInvolvingIntima & subintimaF- Fibrous capC-Necrotic centerL- Lumen Tunica adventitiaTunica MediaLPOCFL

37. F- Fibrous capC-Necrotic centerCFLPO

38. Plaque component identificationLPO

39. Cholesterol cleftsLPO

40. Cholesterol clefts in HPO

41. Foam cellsHPO

42. Foam cells HPO

43. Gross specimen of Atheromatous Aorta

44. Tumour emboli in LungThrombus:- 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 EmbolusEmboli:- 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.

45. What abnormal cellular features are seen ?Ans. PleiomorphismWhat will be the effect of this lesion on lungs ?Ans. Pulmonary hypertension as common one due to the tumour compressing the surrounding alveolar region.How will this manifest clinically ?Ans. DyspneaWhere do emboli like this usually arise ?Ans. There emboli are mostly intra cardial mural thrombi

46. HPO

47. HPO

48. LPO

49. Alveoli surrounding The tumourLPO

50. Monkeberg’s Sclerosis/Medial calcificationIt is characterized by calcific deposits in muscular arteries(Medium sized) in Tunica media.More frequent in patients over 50 yrs of age and Diabetics.

51. Grossly it is rigid , there is loss of distensibility and there are palpable calcification.How does it differ from Psammoma bodies ?Ans. Psammoma bodies are characterized by concentrically laminated calcified concretions , most commonly found in malignant conditions(Meningioma,Pappilary carcinoma) and not necessarily found in Blood vessel wall..Will it give rise to systemic hypertension ?Ans. Yes This lesion usually occur in Medium sized arteries..

52. LPO

53. LPO

54. HPO

55. Thanking to the entire Universe