8 - Blood Vessels: Classification of Vascular Tumors and Tumor-Like Conditions

Question 1

Benign Neoplasms: Developmental and Acquired (4)

Answer 1

1. Hemangioma (Capillary/Cavernous)
2. Pyogenic Granuloma (Lobular Capillary Hemangioma)
3. . Glomus Tumor
4. . Spider telangiectasia (arterial spider)
5. Hereditary hemorrhagic telangiectasis (Osler-Weber-Redu disease) –> associated with Fe deficiency anemia

Question 2

Intermediate-Grade Neoplasms: 2 Types

Answer 2

1. Kaposi Sarcoma

2. Hemangio-endothelioma

Question 3

Malignant Neoplasms:

Answer 3

1. Angiosarcoma

2. Hemangiopericytoma

Question 4

Benign Neoplasms: Hemangiomas - Incidence (2)

Answer 4

Extremely common, benign vascular tumors

Infancy and childhood

Question 5

Benign Neoplasms: Hemangiomas - Clinical Features (3)

Answer 5

1. Skin (face and neck)
   Mucous membranes OR
   Internal organs
2. May spontaneously regress
3. Malignant transformation occurs rarely, if at all

Question 6

Benign Neoplasms: Hemangiomas - Major Types (2)

Answer 6

1. Capillary hemiangioma - small and little thick

2. Cavernous hemiangioma - big and are thin, venous channels

Question 7

Benign Neoplasms: Hemangiomas - Capillary Hemangioma

Answer 7

Most Common

“Strawberry type” of capillary hemiangioma
- Skin of newborns

***GROWS RAPIDLY FIRST FEW MONTHS
FADES DURING 1-3 YEARS
REGRESSES BY AGE 7 (usually)

*Gross: Bright red-blue; flat/elevated

Question 8

Benign Neoplasms: Hemangiomas - Capillary Hemiangioma Microscopy

Answer 8

**Lobulated aggregates of closely packed, thin walled capillaires lined by a flattened endothelium

(slide 87)

Question 9

Benign Neoplasms: Hemangiomas - Cavernous Hemiangioma (5)

Answer 9

Less common

Usually larger

**More frequently involve deep structures (liver, spleen, skin)

May be locally dectructive

*No tendency to regress and many require removal by surgery

Slide 88

Question 10

Benign Neoplasms: Hemangiomas - Cavernous Hemiangioma - Histology (3)

Answer 10

1. *LARGE CAVERNOUS vascular spaces
2. Partly or completely filled with blood
3. Separated by a scant connective tissue stroma

Question 11

Benign Neoplasms: Pyogenic Granuloma (Lobular Capillary Hemangioma)

Answer 11

Seen in skin and GINGIVAL/ORAL mucosa

Usually after H/O Trauma

Gingiva found in PREGNANCY, REGRESSES POST delivery

Question 12

Benign Neoplasms: Hereditary hemorrhagic telangiectasis (Osler-Weber-Redu disease)

Answer 12

Associated with Fe deficiency

Malformations composed of dilated caps and veins

Present from birth

Site: Skin, oral mucosal membrane, GIT, Respiratory tract and urinary tract

C/F: Epistaxis, GI bleeds, Hematuria

Question 13

Bacillary Angiomatosis

Answer 13

Vascular proliferation due to oppurtunistic infection in immunocompromised individuals

• *Bartonella henselae - modified silver (Warthin-Starry) stain of clusters of tangled bacilli (black)
  
  • Cat scratch fever

Question 14

Other Tumors: Hemangioblastomas

Answer 14

Associated with von Hippel-Landau disease

Multiple tumors involving cerebellum, brain stem, spinal cord, and retina

Question 15

Benign Neoplasms: Globus Tumor

Answer 15

Benign BUT EXTREMELY PAINFUL

Question 16

Benign Neoplasms: Globus Tumor - Origin

Answer 16

Modified smooth muscle cells (pericytes) of glomus body (thermoregulation

Question 17

Benign Neoplasms: Globus Tumor - Site

Answer 17

Distal portion of fingers, especially UNDER FINGERNAILS

Question 18

Intermediate-Grade Neoplasms: Kaposi Sarcoma

Answer 18

Seen in HIV patients, but the virus that gives rise to it is HHV -8

Chronic (Classic or European) KS

Question 19

Intermediate-Grade Neoplasms: Kaposi Sarcoma: Chronic (Classic or European) Type (4)

Answer 19

Red purple skin plaques lower extremities

Slow spread to viscera

Asymptomatic, localized to skin and SC tissue

Locally persistent with remissions

Question 20

Intermediate-Grade Neoplasms: Kaposi Sarcoma: Transplant-Associated Type (3)

Answer 20

Aggressive

Site: LN, mucosa, and viscera (50%)

Skin lesions may be absent

May regress

Question 21

Intermediate-Grade Neoplasms: Kaposi Sarcoma: Lymphadenopathic (African or endemic KS) (3)

Answer 21

1. African children (Bantu tribe) and young men
2. Localized or generalized lymphadenopathy
3. Skin lesions are sparse

Question 22

Intermediate-Grade Neoplasms: Kaposi Sarcoma: AIDS Associated - Epidemiology (2)

Answer 22

1. Most common AIDS-associated cancer in US

2. Most common in homosexual males in HIV patients

Question 23

Intermediate-Grade Neoplasms: Kaposi Sarcoma: AIDS Associated - Clinical Features

Answer 23

1. Aggressive form with widespread visceral dissemination (can involved all organs)

Question 24

Intermediate-Grade Neoplasms: Kaposi Sarcoma: AIDS Associated - Clinical Course

Answer 24

Usually responsive to treatment; rarely causes death

Question 25

Intermediate-Grade Neoplasms: Kaposi Sarcoma: AIDS Associated - Gross

Answer 25

Red-purple patches, plaques, or nodules

Slide 97

Question 26

Intermediate-Grade Neoplasms: Kaposi Sarcoma: AIDS Associated - Microscopy (2)

Answer 26

1. Spindle-shaped endothelial cells
2. Slit-like vascular spaces

Slide 97

Question 27

Hemangioendothelioma

Answer 27

Vascular neoplasms

Behavior intermediate b/w hemangiomas and angiosarcaoms

Question 28

Hemangiopericytoma

Answer 28

“Staghorn” vascular pattern

Question 29

Angiosarcomas (Hemangiosarcoma)

Answer 29

HIGHLY malignant

Liver angiosarcomas associated with carcinogens –> polyvinyl chloride, arsenic

Radiation, foreign material inside the body