3.2.3. Vascular Pathology 3 of 3

Question 1

What is and where do we find simple or capillary lymphangiomas?

Answer 1

Simple (capillary) lymphangioma

pedunculated lesions up to 1-2 cm in diameter

predominantly on the head, neck, and axilla

Question 2

When do we see, how do they present and what are cavernous lymphangiomas (cystic hygromas)?

Answer 2

massively dilated lymphatic spaces lined by endothelial cells & separated by intervening connective tissue stroma containing lymphoid aggregates

margins are indistinct and unencapsulated; resection is difficult

CL of the neck are common in Turner syndrome

Question 3

How do they present and what are Glomus Tumors?

Answer 3

benign but exquisitely painful tumors

arise from modified SM cells of the glomus bodies (involved in thermoregulation)

Question 4

Morphology of Bacillary Angiomatosis

Answer 4

skin lesions are red papules and nodules or rounded subcutaneous masses

Question 5

Histology of Bacillary Angiomatosis

Answer 5

Histologically: capillary proliferation with prominent epithelioid endothelial cells exhibiting nuclear atypia and mitoses. Lesions contain stromal neutrophils, nuclear dust, and the causal bacteria.

Question 6

What cat bacteria is linked to Bacillary Angiomatosis? What conditions are associated with it?

Answer 6

Bartonella henselae: principal reservoir is the domestic cat; causes cat-scratch disease

necrotizing granulomatous disorder of lymph nodes

Question 7

What causes Kaposi sarcoma?

Answer 7

Kaposi Sarcoma caused by human herpes virus 8 (HHV8) highly associated with AIDS

Question 8

Who gets Kaposi Sarcoma?

Answer 8

Classic KS: disorder of mediterranean, middle eastern, or eastern european descent (esp. ashkenazic Jews)

Question 9

How does Kaposi Sarcoma present, and where is it on the body?

Answer 9

multiple red-purple skin plaques or nodules

usually distal, lower extremities

Question 10

Progress and Treatment for Kaposi?

Answer 10

persistent, but usually asymptomatic and remain localized to skin and subq

treatment: surgical removal

Question 11

Most common tumor in central Africa

Answer 11

Endemic African Kaposi Sarcoma

Question 12

How is Endemic African Kaposi Sarcoma different from clasic Kaposi Sarcoma?

Answer 12

usually HIV-seronegative individuals than classic KS

Question 13

How do we treat Transplant associated Kaposi Sarcoma?

Answer 13

treatment: decrease immunosuppression

Question 14

How do we treat AIDS associated Kaposi Sarcoma?

Answer 14

treatment: antiretroviral agents to boost immune system

Question 15

How common of a malignancy is AIDS Associated Kaposi Sarcoma in HIV patients?

Answer 15

most common HIV-related malignancy

Question 16

What is Hemangioendothelioma?

Answer 16

spectrum of vascular neoplasms with clinical behaviors intermediate between benign, well-differentiated hemangiomas and frankly anaplastic angiosarcomas

Question 17

How are malignant tumor vasculature conditions different from benign?

Answer 17

Benign tumors typically form obvious vascular channels lined by normal-appearing endothelial cells. Malignant tumors are more often solid and cellular, exhibit cytologic atypia, and lack well-defined vessels

Question 18

What are angiosarcomas?

Answer 18

Angiosarcoma: malignant endothelial neoplasm that primarily affects older adults
mostly involves skin, soft tissue, breast, and liver

Question 19

What are Hepatic angiosarcomas? What are they associated with? How mobile are they?

Answer 19

associated with carcinogenic exposures

arsenic, PVC, Thorotrast

locally invasive and can readily metastasize

Question 20

Morphology of Hepatic Angiosarcomas

Answer 20

cutaneous: deceptively small and asymptomatic red papules or nodules; eventually become large, fleshy masses of red-tan to gray-white tissue with margins blurring imperceptibly into surrounding structures

Question 21

What do we use to best see Hepatic Angiosarcomas microscopically?

Answer 21

endothelial origin of these tumors can be demonstrated by immunohistochemical staining for CD31 or von Willebrand factor

Question 22

What are Hemangiopericytomas?

Answer 22

tumors of ACTUAL pericytes are very rare and the vast majority of those previously assigned to this group are derived from other cells (e.g. fibroblasts)

Question 23

Describe a balloon angio

Answer 23

transiently inflating a balloon catheter to pressures sufficient to rupture an occluding plaque

Question 24

What are coronary stents?

Answer 24

expandable tubes of metallic mesh to make a larger and more regular lumen. Useful to tack down intimal flaps and dissections and mechanically limits vascular spasm

Question 25

2 complications of stents

Answer 25

thrombosis

proliferative in-stent restenosis (lumina closes up again); significant number within 6-12 months of stenting

Question 26

How do drug eluting stents work?

Answer 26

leach antiproliferative drugs into the adjacent walls to prevent SM cell activation

Question 27

What are vascular grafts?

Answer 27

synthetic or autologous vascular grafts used increasingly to replace damaged vessels or bypass diseased arteries

Question 28

When do we use large-bore (12-18 mm) synthetic conduits?

Answer 28

function well in high-flow locations (e.g. aorta)

Question 29

Problem with small-diameter artificial grafts (</= 8 mm dia)

Answer 29

generally fail b/c:

thrombosis

late intimal hyperplasia

Question 30

Better alternatives to small diameter artificial grafts and how effective are they?

Answer 30

saphenous vein grafts
long-term patency: only 50% at 10 years

internal mammary artery
long-term patency: 90% at 10 years