Cardiac and Vascular Masses Flashcards
What is thrombosis?
Formation of a blood clot within intact vessels
What are lines of Zahn?
Laminations apparent grossly or microscopically - produced by alternating layers of platelets, fibrin, and RBCs
What is Virchow’s Triad in thrombosis?
- Endothelial Injury
- Abnormal Blood Flow
- Hypercoagulability
What are examples of abnormal blood flow that can lead to cardiac thrombi?
- Arrhythmia
- Dilated Cardiomyopathy
- Myocardial infarction
What is the clinical significance of a thrombus in the left atrium or ventricle?
- Embolization to various organs
- Decreased cardiac output
What is the clinical significance of a thrombus in the right atrium or right ventricle?
- Embolization to lungs
- Decreased cardiac output
Define an Embolus
Detached intravascular mass carried by blood to site distant from origin
What are different types of emboli?
- Thrombus (most common)
- Fat
- Air
- Amniotic fluid
- Tumor
Systemic embolism origins
Heart: Atrium, ventricle, valve (80%)
Atherosclerotic plaque (abdominal aorta, carotid artery)
What are the common destinations of an embolus?
Lower legs (75%)
Brain (10%)
What is a paradoxical embolism?
An embolus that travels through a heart defect into systemic circulation
What are the most common tumors found in the heart?
Metastatic tumors
What is the most common cardiac tumor (originating in the heart)
Myxoma
How do myxomas present?
Sessile or pedunculated (ball valve obstruction)
Myxoma cells embedded in abundant ground substance
What is Carney syndrome
A clinical manifestation found in 10% of myxomas
- Multiple cardiac myxomas, spotty pigmentation, endocrine overactivity
- Familial (Autosomal dominant and recessive)
What is the most common heart tumor in infants/children?
Rhabdomyoma
What complication is rhabdomyoma associated with?
Associated with tuberous sclerosis
What is the morphology of a rhabdomyoma?
Gross:
Histology:
Gross: Usually multiple, firm white nodules
Histology: Spider cells
What are the less common primary neoplasms?
Lipomas - often asymptomatic, may cause ball-valve effect or arrhythmias
Papillary fibroelsatomas - form on valves, can embolize
Angiosarcomas
What are the benign vascular malformations (neoplasms)?
Hemangioma
Lymphangioma
Glomus tumor
Bacillary angiomatosis
What are the intermediate grade vascular malformations?
Kaposi sarcoma
Hemangioendothelioma
What are the malignant vascular malformations?
Angiosarcoma
Hemangiopericytoma
What are the presentations of the capillary hemangiomas?
Juvenile “strawberry” hemangioma - grows for a few months, fade around 2yo and regresses by age 7
Adult “cherry” hemangioma - Does not regress
Pyogenic granulomas - Ulcerate and bleed, seen with pregnancy or trauma
What are cavernous hemangiomas
Larger, dilated channels in deeper tissue that do not regress
Associated with von Hippel Lindau disease
How are hemangiomas classified?
Based on vessel size
Capillary vs cavernous type
What are the different types of lymphangiomas?
Simple lymphangiomas - small, head/neck/axilla
- Cavernous lymphangiomas
- neck/axilla of infants or children
- poorly circumscribed
- Associated with turner syndrome
Describe a glomus tumor (glomangioma)
Composed of clomus cells
Small, on digits, often under nails
Painful, easily cured by exision
What benign vascular lesion is associated with a Bartonella infection (secrete HIF-1) in immunocompromised hosts?
Bacillary angiomatosis
Kaposi Sarcoma Presentations?
- Chronic, classic: indolent
- Lymphadenopathic, African or endemic
- Transplant - associated KS
- AIDS - associated KS
What virus is found in 95% of KS pathogenisis?
Human Herpes Virus type 8
KS disease expression is affected by degree of _________
immunosuppression
What type of cells are seen in later stages of KS morphology?
Spindle cells
Treatment or KS?
- Resection/cryotherapy
- Radiation
- Chemotherapy
What malignant neoplasm of endothelial cells is found in older adults?
Angiosarcoma
What are specific associations with angiosarcoma?
Liver and arsenic, throtrast, polyvinyl choloride
Arm in patient with lymphedema, most commonly , post mastectomy
Post radiation
Lymphangiosarcoma is a malignant variation of _________
lymphangioma
