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Pathology of Blood Vessels

Pathology of Blood Vessels. LECTURE - 6 Learning objectives. Vascular tumours Introduction Classification Some types. Wide spectrum: benign hemangioma to intermediate , highly malignant Congenital malformations/tumours

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Pathology of Blood Vessels

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  1. Pathology of Blood Vessels

  2. LECTURE - 6Learning objectives Vascular tumours Introduction Classification Some types

  3. Wide spectrum: benign hemangioma to intermediate , highly malignant • Congenital malformations/tumours • Non - neoplastic reactive vascular proliferation: bacillary angiomatosis • Arise from EC or supporting cells • ECs - IHC by CD31, CD34 and vWF vWF

  4. Classification

  5. BENIGN TUMOURS HAEMANGIOMA • Difficult to distinguish from hamartomas, several types • Localised/large segments of body - entire extremity (angiomatosis) • Superficial in head, neck or deep in liver, malig transformation rare • Most present at birth, expand, may regress spontaneously

  6. CAPILLARY HAEMANGIOMA • Most common tumour - skin, oral cavity, subcutaneous tissue , lip • Deeper organ- liver, spleen, kidney • Strawberry type - newborns, multiple, grow rapidly, fade 1-3 yr • Few mm to cms, bright red to blue • Closely packed vessel, thrombosis, scarring, haemosiderin deposition

  7. CAVERNOUS HAEMANGIOMA • Less common, share age & anatomic distribution, larger, less circumscribed • Deeper, locally destructive, no tendency to regress, may require surgical removal • Cosmetic problem, ulceration, bleeding, Von Hippel – Lindua disease associated • Spongy, 1-2 cm, giant size, large spaces, thrombosis, calcification and bleeding

  8. LYMPHANGIOMA • Capillary: head, neck, axilla, elevated/ pedunculated,1-2cm, lymphatic channel, eosinophilic lymph filled – lymphocytes • Cavernous: children, mostly congenital, neck, axilla, retroperitoneum, produce abnormality; Turner synd; large,dilated, lymphatic channel, lymphoid aggregates

  9. FNA diagnosis • blood / lymph

  10. MotherHood

  11. GLOMUS TUMOUR • Benign, exquisitely painful, arise - SMCs of glomus body – specialised AV anastomosis , thermoregulation • Mostly under nail, excision curative • Grossly – < 1 cm, slightly elevated, rounded, red blue, firm nodule • Micro: branching BV, surrounded by round cells, features of SMCs by EM Glomangioma

  12. INTERMEDIATE GRADEKAPOSI SARCOMA Four variants • Chronic/Classic/European – 90%, East Europe (Ashkenazi Jews), skin plaque, arms /legs, asymptomatic, relapses • Lymphadenopathic/African/Endemic – Bantu children, skin, local/generalised, sparse, lymphadenopathy, aggressive Hungarian dermatologist practicing at  University of Vienna in 1872

  13. KAPOSI SARCOMA • Transplant / immunosuppression associated; after organ transplant, aggressive, lymph nodes, visceral organs, regress ↓ after removal of immunosuppression • AIDS associated – 1/3 of AIDS pts, lymph nodes, gut/ internal organs, HAART (highly active antiretroviral therapy)

  14. PATHOGENESIS • KS associated human herpes 8 (HHV– 8)KSHV (KS associated), identified in 95% • Immunosuppression important cofactor • Latent, immune dysregulation, disrupted cell proliferation, apoptosis, AIDS cofactor • Management – radiation, chemotherapy

  15. MORPHOLOGY Three stages • Patch: pink, solitary/multiple; angulated BV, lymphos, plasma cells, haemosiderin • Plaque: raised, dilated, jagged BV, sheet spindle cell, haemosiderin, pink globules • Nodular:distinctlyneoplastic, sheets of plump, spindle cells, slit like spaces containing RBCs, hyaline droplets, inflammatory cells, mitosis

  16. MALIGNANT TUMOUR ANGIOSARCOMA • Skin, soft tissue, breast, liver, heart • Liver - exposure to arsenic (pesticides), Thorostat (contrast med), PVC industry • In lymphoedema, 10 years after radical mastectomy, radiation / foreign material • Small/large, fleshy masses; BV lined by neoplastic EC, sheets, spindle cell - IHC

  17. Summary

  18. Books are the carrier of civilization. Without books, history is silent, literature dumb, science crippled, thoughts and speculation at a standstill. They are engines of change, windows on the world, light houses erected in a sea of time.

  19. THANK YOU

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