Blood Vessels VI

Question 1

spider telangiectasia

Answer 1

dilated subQ arteries/arterioles around centrla core
-blanches when press center

face, neck, upper chest

pregnant women with cirrhosis

Question 2

pregnant women with cirrhosis with red spider looking thing that you can press on to get rid of redness

Answer 2

spider telangiectasia

Question 3

hereditary hemorrhagic telangiectasia

Answer 3

osler-weber-rendu disease

• rare antosomal dominant
• multiple small aneurysmal telangiectasias on skin and mucous membranes

-pt present with epistaxis, hemoptysis, GI/GU bleeds

Question 4

osler-weber-rendu disease

Answer 4

hereditary hemorrhagic telangiectasia

• congenital malformation - present at borth
• oral cavity, lipis, resp, GI, GU tracts - has dilated capillaries and veins

autosomal dominant - mutation in TGF-beta signaling

Question 5

bacillary angiomatosis

Answer 5

in immunocompromised
-gram negative bacillus - bartonella

• lesions skin, bone, brain, other organs
• organism secretes HIF-1alpha leads to VEGF vascularity induction

Question 6

bartonella

Answer 6

opportunistic infection in immunocompromised

-leads to bacillary angiomatosis

Question 7

AIDs patient, lesions on skin, positive for bartonella infection

Answer 7

NOT neoplasm
-bacillary angiomatosis

Tx - antibiotics

Question 8

B. henselae

Answer 8

cat flea - cat scratch disease

associated with bacillary angiomatosis

Question 9

B. quintana

Answer 9

trench fever - human body louse

associated with bacillary angiomatosis

Question 10

Tx for bacillary angiomatosis

Answer 10

erithromycin - antibiotic

Question 11

human herpes virus 8

Answer 11

associated with kaposi sarcoma

Question 12

KSVH

Answer 12

kaposi sarcoma associated herpes virus - HHV8

Question 13

mechanism of kaposi sarcoma

Answer 13

KSVH infection

• infects endo cells
• viral induction of VEGF production
• immunosuppression and AIDS make it worse

reactive, polyclonal lesion with only few cells infected

Question 14

red-purple macules and plaques on skin

Answer 14

kaposi sarcoma

Question 15

early lesion kaposi

Answer 15

polyclonal

Question 16

late lesion kaposi

Answer 16

monoclonal

Question 17

stages of kaposi sarcoma

Answer 17

1 - patch - flat discoloration
2 - plaque - elevated
3 - nodular - raised

diagnosis during stage 2

Question 18

patch stage of KS

Answer 18

first

dilated angulated blood vessels and chronic inflammatory cells (look like granulation tissue)

Question 19

plaque stage of KS

Answer 19

second

larger, jagged vascular channels lined by spindle cells with occasional mitosis

RBC extravasation

MAKE DIAGNOSIS THIS STAGE

Question 20

nodular stage of KS

Answer 20

third

raised nodular lesions - involvement of lymph nodes or viscera
-seets of spindle cells with mitotic figures and slit-like spaces that often contain rows of red cells

Question 21

nodule

Answer 21

raised and rounded

Question 22

plaque

Answer 22

raised and flat

Question 23

classic KS

Answer 23

chronic / euro

• elderly men - euro jews or mediterranean
• red-purple cutaneous plaques and nodules on lower extremities
• rare visceral involvement

Question 24

Tx of classic KS

Answer 24

resection
radiation
chemo

Question 25

lymphadenopathic KS

Answer 25

bantu children of south africa

-extremely aggresive - kills everyone by 3 years

generalized lymphadenopathy

skin lesions sparce

Question 26

Tx of lymphadenopathic KS

Answer 26

chemo and radiotherapy

Question 27

transplant associated KS

Answer 27

after organ transplant

• immunosuppression drugs
• aggressive

involves nodes, mocusa, visceral organs

skin lesions may be absent

Question 28

Tx of transplant associated KS

Answer 28

removal of immunosuppression

Question 29

AIDs-associated KS

Answer 29

most common cancer in US in AIDS patients***

early node, gut, with wide dissemination

-most patients succumb to AIDS complications rather than KS

Question 30

Tx of AIDS KS

Answer 30

antiretrovarval

-HAART

Question 31

angiogenesis inhibitors

Answer 31

useful in limited cases of KS

Question 32

hemangioendothelioma

Answer 32

neoplasms - straddling benign to malignant intermediate**

Question 33

epitheliod hemangioendothelioma

Answer 33

vascular tumor around medium and large veins in soft tissues of adults

well defined vascular channels and tumor cells are plump and often cuboidal

most cured with excision
-40% recur

important to follow*** - don;t know if it will metastasize

Question 34

angiosarcoma

Answer 34

lamignant

• older adults
• skin, soft tissue, breast, liver

radiation or foreign material in body

Question 35

immunohistochem for angiosarcoma

Answer 35

CD31
CD34
factor VIII
vWF

Question 36

vinyl chloride

Answer 36

may cause hepatic angiosarcoma

Question 37

red nodules that become large, fleshy, pale, gray, central soft, hemorrhage

Answer 37

cutaneous angiosarcoma

Question 38

hemangiopericytoma

Answer 38

from pericytes - myofibroblasts

• flesh/spongy
• slow browing - thign of middle aged women

staghorn branching pattern

half malignant

Question 39

staghorn branching tumor

Answer 39

hemangiopericytoma

Question 40

balloon angioplasty

Answer 40

dilation of stenosis

-complications - reclosure and in-stent restenosis

Question 41

vascular stents

Answer 41

expandable wire mesh
-in 90% of angioplasties

limit elastic recoli

Question 42

vascular grafts

Answer 42

synthetic or own tissue

-vein - will remodel to artery

dacron - high flow -a orta
fabric perform less well

can get neointima near anastomosis or pseudointima