Blood Vessels - The Basics Flashcards
T or F: maintanace of a non-thrombotic state is dependent on laminar flow
True, Laminar Flow is required to prevent thrombosis
What are some basic relaxing and contracting factors secreted from the endothelial lining of vessels?
Relaxing - Nitric Oxide
Contracting - Endothelin
In what conditions might tight junctions become more permeable?
• how are large amounts of solutes moved?
- Vasoactive Agents Secreted or High Blood Pressure will increase the tight junction permeability
- Large Amount of Solute moved by Trancytosis
What are the Two Mechanisms of Vascular Pathology?
- Narrowing or Obstruction
- Weaking (resulting in aneurysm
What vascular pathology has happened here?
Dissecting Aneurysm
• Media has been split in half
What vascular pathology has happened here?
What time frame did it happen in and how do you know?
Acute Narrowing/Obstruction of a vessel
• You can see lines of Zahn indicating that it is a thrombus, clefts of cholesterol indicating that Hypercholesterolemia could be etiology
What vascular pathology has happened here?
• what has caused it, time frame?
Narrowing of Vessel Lumen as a result of intimal thickening can be seen
• More progressive than just acute, resultin from high LDL over a long period of time
What has happened here?
Atherosclerotic aneurysm from Weakening of BVs
What is Glycation?
• Diseases where it is common?
Glycation - non-enzymatic reaction between reducing sugars such as glucose and proteins, lipids, or nucleic acids
**Common in Diabetes, we use Hbg A1C**
What is glycoxidation?
When OXIDATIVE steps are involved ine Glycoxidation
**ROS accelerate this processes
What is a time when you might not want to measure Hbg A1C in a patient?
People who don’t have much Hbg A1 such as Sickle Cell patients or Pts. with alpha thalessemia
In what 3 ways do Advanced Glycation End products (AGEs) contribute to vascular disease?
- Collage Crosslinking promoted
- Glycation of LDL
- Binding to RAGE
How does promotion of collagen cross-linking lead to increased cardiovascular disease?
- Collagen Crosslinking causing Stiffening of Vascular Walls
- Crosslinking also causes entrapment of LDL in the artery walls
How does glycation of LDL promote CV disease?
- Glycation of LDL makes it more prone to get oxidized
- Oxidation of LDL is a MAJOR risk factor of Atherosclerosis
How does binding to RAGE (receptor for advanced glycation end products) lead to CV disease?
- Binding to RAGE promotes Oxidative Stress on the Endothelium
- Also activates Inflammatory Pathways in the endothelial cells
What 3 congenital Anomalies do we need to know for vessels?
- Berry Aneurysms
- Arteriovenous (AV) fistulas
- Fibromuscular Dysplasia
Berry Aneurysms
- What are they?
- Where are they found?
- Why does it happen?
- Dangers?
What/Where:
• Thin-walled arterial outpouching in cerebral vessels specifically at Branch Points
Why:
• Media is CONGENITALLY too thin (attenuated)
Danger:
• Rupture
What is the major complaint of someone experienceing a Berry Aneurysm?
“The worst headache I’ve Ever had”
****What is this?
• What do you think this person complained of when they came to the ED?
Berry Aneurysm - caused by a congenitally thin media
• Probably Said it was the worst headache they’ve ever had
What is an Arteriovenous (AV) fistula?
• Whats a major problem that may result?
• CONGENITAL Abnormal connection between an Artery and a Vein (they don’t go all the way down to capillaries, they just connect)
Major Problem: Susecptible to Hemorrhage and Hypoxia even without Hemorrhage from decreased Surface area of vessel being exposed
*****What has happened here?
AV Fistula - caused by direct connection between an artery and a vein
Fibromuscular Dysplasia
- What is it?
- Type of Vessels Affected?
- Who is it found in?
- Congenital disease causing alternating thickened and thinned arterial walls usually from thickening of the Media
- small to medium sized vessels are affected
- Found in younger women
A young fit woman comes in with hypertension as a result of Fibromuscular Dysplasia.
- What is the most likely cause of the HTN?
- Other risk factors of the disease?
- APPEARANCE?
Cause - hypertension can be caused in patient with Fibromuscular Dysplasia via renal artery constrictions
Other Disease Complications: 10% experience medial dissections
Beads on a String Appearance in affected vessels
****T or F: thickening in this vessel was caused by either an inflammatory or atherosclerotic process.
False, this is from a patient with fibromuscular dysplasia - these patients experience non-inflammatory, non-atherosclerotic thickening of the media
T or F: PRIMARY vascular tumors of large vessels are fairly comon and are often carcinomas
FALSE, they are EXTREMELY RARE and are usually SARCOMAS
What are vascular tumors that arise from the endothelium called?
• what about ones from support cells?
Hemangiomas or Angiosarcomas
Support Cells = Glomus Tumor
Compare Benign and Malignant Tumors with respect to:
- Organization
- Cellularity
Benign:
- Obvious Vascular Channel with Blood
- Lined by monolayer of normal appearing cells
Malignant:
- poor orgnaization of vessels
- more cellular with cytologic atypia
What markers can you use to confirm that the tissue you’re looking at is in fact vascular?
- CD31
- CD34
- D2-40
What is a vascular ectasia?
• Local Dilation of a Blood Vessel
What are the 3 benign vascular ectasias?
- Nevus Flammeus
- Spider Telangectasias
- Hereditary Hemorrhagic Telangectasia
What is a Telangiectasia?
• where is it usually found?
- Telangiectasia - permanent dialation of small BVs
- Typically occurs in mucous membranes and skin
T or F: Vascular ectasias are very benign neoplasms
FALS, these are NOT TRUE NEOPLASMAS
Nevous Fammeus
- Typical Appearance
- Progression
- Life impact
aka port wine
Appearance
• Large Flat patch of purple or dark red skin with well defined borders
Progression
• Starts off flat at birth but become more bumpy and unsighly over time and DOES NOT REGRESS
Life Impact:
• Not any real health impact but the psychosocial element may be huge
****What is this?
• What is the Px?
Nevus Flammus
• No real health impact, BUT they should expect that this will be a long term condition with a high probability of having a psychosocial impact
Salmon Patch
- Typical Appearance and Location
- Progression
- Life Impact
Appearance:
• typically on back of neck (stork bite) or between eyes (angels kiss)
Progression:
• Unlike nevus flammeus will regress over 1st year of life
Life Impact:
• prolly none
****What condition is this?
• What is the Px?
Condition - Naevus Simplex aka salmon patch
• will regress in the 1st year of life
Sturge-Webber Syndrome
- Physical appearance?
- Effects on Brain?
Physical Appearance:
• port wine in the trigeminal distribution
Brain Effects:
- ipsilateral venous angiomas in the leptomeninges
- ^ causes - mental retardation, seizures and hemiplegia
****What condition does this baby likely have?
• What is the Px?
Sturge-Weber Syndrome - because the port wine stain follows the trigeminal distribution
Px: Poor - this often causes Ipsilateral Hemangiomas on the leptomeninges that can result in mental retardation, hemiplagia, and siezures
****What benign Vascular Ectasia may have caused this appearance on CT?
Sturge-Weber Syndrome - hemangiomas in the meninges causes asymmetry and blood on the brain as seen on the right side of the picture (left frontal lobe)
****What is this?
•what are some possible risk factors?
Spider Telangectasias
Risk factors: HYPERestrogen states - Pregnancy, or Cirrhosis (alcoholics)
****What is this condition?
• What is the most likely cause?
Erythemia ab igne (EAI)
caused by Infrared Radiation in the form of heat
*Think about a kid who has been sitting next to a heater or sitting with your laptop on your legs for too long
***What is this?
Classic basal cell carcinoma
Hereditary Hemorrhagic Telangiectasia
- Inheritance?
- Mutation?
- Most common symptom?
Inheritance:
• Autosomal Dominant
Mutation:
• Most commonly in the TGF-beta gene
Symptoms:
• Recurrent nosebleeds, GI bleeds can also be problematic
*****What condition is this?
• Treatment?
Hereditary Hemorrhagic Telangiectasia
• Only treated symptomatically - G.I. bleed etc.
Lymphangitis
• What is it?
Infection uses vasculature (lymph, veins, etc.) to travel into the body
****What condition does this patient have?
lymphangitis
How common is Nevus Flammus compared to Salmon Patch?
Salmon Patch is much more common
Hemangiomas
- How common?
- Composition?
- Benign or Malignant?
- Very Commmon
- Composed of Blood-Filled Vessels
- BENIGN - only a low chance of becoming malignant
****What is this?
Hemangioma
What 4 types of Hemangioma are there?
• Which is most common?
- Capillary Hemangioma
- Juvenile Hemangioma (aka Strawberry Hemangioma)
- Pyogenic Granulomas
- Cavernous Hemangioma
Capillary Hemangioma
- Frequency?
- Location?
- Histological Features?
Most Common Hemangioma
Found in Skin and SubQ, Mucous Membrane, may occasionally be in Liver, spleen, or kidney
Histo: Thin Walled, Scant Stroma
***Note: this is more likely a transformation than a neoplasm
****What condition is this?
• What histological features are you looking for?
capillary hemangioma
Thin walled with Scant Stroma, Endothelial Lining with NO MITOSIS
Juvenile Hemangiomas (strawberry hemangiomas)
- Number typically present?
- Who are they usually seen on?
- Px?
- Can be one or multiple present
- Seen on newborns
- rapid growth for 1 to 3 years followed by regression by age 7
Histological Features of Juvenile Hemangiomas
- Endothelial Cells that line vascular spaces. These have small lumens (hard to see)
- mitotic figures are common (may be multiple)
- Mast Cells are present
****What condition is this?
• Px?
Juvenile (strawberry) Hemangioma
• Tumor will grow years 1-3 then regress by age 7
****What condition is this?
Strawberry Hemangioma
- Endothelial Cells that line vascular spaces. These have small lumens (hard to see)
- mitotic figures are common (may be multiple)
- Mast Cells are present
Pyogenic Granulomas
- Appearance (gross and histological)
- Location/onset
- Pain
Appearance/Location
- Pedunculated appearance often in areas of trauma and common during pregnancy
- Histologically looks like granulation tissue
Pain:
• Often Painless
****What is this?
Pyogenic Granulomas
• Appears like granulation tissue, small slits correspond to capillaries
****What is this?
Pyogenic Granulomas (type of capillary hemangioma)
Cavernous Hemangioma
• ability to infiltrate?
• Regression?
Infiltration:
• More likely to infiltrate than the other capillary hemangiomas
Regression:
• Does not regress
***What is this?
Cavernous Hemangioma
• scant stroma
• Tons of Blood
***What is this?
• Px?
Cavernous Hemangioma
will not regress
What syndrome is associated with Cavernous Hemangiomas?
Von Hippel-Lindau Syndrome
Simple Lymphangioma
• commonly found where?
• Histological Characterisitics
- Found most commonly in head neck and axilla
- NO RBCs in histological section
- Typically 1-2 cm
Cavernous Lymphangioma (cystic hygroma)
- Location
- Disease associations
- Located on Neck or in Axilla
- Presents as more of a cystic mass than simple lymphangiomas
- Associated with Turner syndrome
*****What is this?
Lymphangioma
*must use Hx to determine if its simple capillary lymphangioma or a cavernous lymphangioma
****What is this?
Cavernous Lymphangioma (cystic Hygroma)
- What are some characteristics of Turner Syndrome?
- Genetic defect?
- Webbed Neck
- Far Spread Nipples
**Caused by XO chromosome
Glomus
• Cell type responsible?
- Benign or Malignant?
- Location?
- Pain?
- Cell type = glomus body cells that are needed for thermoregulation (specialized smooth muscle)
- Benign tumor found under the nail
- These are often very painful
****What tumor type is this?
• benign or malignant?
Gloumus - Benign
*looks like endothelial cells are spiralling off the vessel
****what tumor is this likely to be?
Glomus but melanoma should be in your differential
Bacillary Angiomastosis
• what is it?
- organism responsible
- tissue type involved
What is it?
• Vascular Proliferation
Tissue:
• Skin, Bone, Brain, other - Pretty much any type
Organisms Responsible:
- Bartonella henselae - found on cats
- Bartonella quintana - transmitted by body lice
How do bacteria cause Bacillary Angiomatosis?
• They induce HIF-1alpha
***note: these are gram negative bacteria
****What is this?
Bacillary Angiomatosis
Kaposi’s Sarcoma
- How does HHV-8 induce cancer?
- Stages of Kaposi’s
• HHV-8 prevents apoptosis by inhibiting p53
Stages:
- Patches - pink, red or purple typically on distal leg
- Plaque - larger, raised
- Nodular - may involve viscera
***What is this?
Patch phase of Kaposi’s Sarcoma
***What is this?
• Plaque Phase of Kaposi’s Sarcoma
***What is this?
Nodular Phase of Kaposi’s Sarcoma
Angiosarcoma
• Most commonly seen in?
- Seen where?
- Px?
- Most commonly seen in older people, but younger people who get diagnosed have a better px
- Most commonly seen in Skin, Soft Tissue, Breast and Liver but others are possible
- on 30% 5 year survival rate
****What is this?
Lymphangiosarcoma
****What is this?
Angiosarcoma
****what is this?
Angiosarcoma of the breast
What causes angiosarcomas of the liver?
PVC (polyvinyl chloride)
Thorotrast (radioactive contrast dye)
Arsenic Pesticides
What type of women often present with angiosarcoma of the breast?
• Women who undergo radiation chemo treatment
• If long term indwelling foreign bodies are in the breast
***What is this?
Stasis Dermatitis
