PA - Vascular Pathology 2013

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Budiana Tanurahardja/ Rahmiati/Lisnawati DEPARTMENT of ANATOMIC PATHOLOGY DEPARTMENT of ANATOMIC PATHOLOGY FACULTY OF MEDICINE UNIVERSITY of INDONESIA FACULTY OF MEDICINE UNIVERSITY of INDONESIA 2013 2013 Vascular pathology

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kuliah PATOLOGI ANATOMI-KARDIOVASKULAR

Transcript of PA - Vascular Pathology 2013

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Budiana Tanurahardja/ Rahmiati/Lisnawati

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

20132013

Vascular pathology

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Vascular Pathology

Normal blood vessels.

Aneurysms.

Hypertension.

Vasculitis.

Varices.

Neoplasms.

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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

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Normal blood vessels

Veins :Smallmediumlarge.

Lymphatic.

The main components : endothelial cells.smooth musclesTunica intima, tn. media, tn.adventitia

Normal blood vessel

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Normal blood vessels Normal blood vessel

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Normal blood vessels Normal blood vessel

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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

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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

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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

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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

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Berry aneurysm Berry aneurys

m

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Berry aneurysm Berry aneurys

m

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Aneurysm Aneurysm

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Dissecting aneurysm Dissecting Aneurysm

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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

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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

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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.

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ArteriolosclerosisElderly patient:

normal/hypertensive.

Diabetes.

Leakage plasma component ,matrix production by smooth muscle cells hyaline deposition.

benign nephrosclerosis.

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Arteriolosclerosis

Acute /severe hypertension.

Onion skin

often : accompanied by deposits of fibrinoid and acute necrosis necrotizing arteriolitis(kidney)

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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

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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

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Vasculitis Vasculitis

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Thromboangiitis obliterans

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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.

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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).

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Varices

Statis dermatitis.

Varicose ulcers.

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Neoplasm

Benign : hemangioma: Capillary,cavernous.

lymphangioma: capillary,cavernous.

pyogenic granuloma(lobular capillary)glomus tumor.

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Neoplasm

Intermediate grade neoplasms.Kaposi sarcoma.HemangioendotheliomaHemangiopericytoma.

Malignant neoplasm.angiosarcoma.

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Congenital cavernous hemangioma

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Haemangioma

cavernous capillary

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Angiosarcoma

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Thank you