Vascular

Question 1

how are varicose veins produced

Answer 1

prolonged increased intraluminal pressure leading to vessel dilation and venous incompetence

Question 2

complications of varicose veins

Answer 2

stasis/ brawny induration

congestion

edema

pain

thrombosis

ulceration

poor wound healing

superimposed infection

esophageal varices

hemorrhoids

Question 3

most common locations of varicose veins

Answer 3

superficial veins of the leg due to dependent pressure

Question 4

risk factors of DVT

Answer 4

h/o prior emboli

stasis

malignancy

hypercoagulable states

pregnancy/ estrogen use

obesity

smoking

Question 5

clinical presentation of SVC vs IVC syndrome

Answer 5

SVC: marked dilation od veins in the upper body with cyanosis and respiratory distress

IVC: lower extremity edema with distension of superficial collateral veins of the lower abs; proteinuria

Question 6

neoplasms that could cause SVC syndrome

Answer 6

bronchogenic carcinoma

mediastinal lymphoma

aortic aneurysm

Question 7

neoplasms that could cause IVC syndrome

Answer 7

hepatocellular carcinoma

renal cell carcinoma

Question 8

Define ectasia

Answer 8

expansion of a hollow or tubular organ

Question 9

define hemangioma

Answer 9

tumor characterized by increased numbers of normal or abnormal vessels filled with blood

Question 10

define lymphangioma

Answer 10

benign lymphatic counterpart of a hemangioma

Question 11

most common type of hemangioma

location and morphology

Answer 11

Capillary hemangiomas= most common

found in the skin, subQ tissues, mucosal surfaces, liver, spleen, and kidneys

Morphology: tin walled capillaries with scant stroma

Question 12

most common hemangioma in newborns

Location

Answer 12

Juvenile/ Strawberry hemangioma

found on the kin of newborns and typically regresses by age 7

Question 13

significance of cavernous hemangiomas

Answer 13

can compress adjacent structures, bleed, and be cosmetically troublesome

associated with VHL

Morphology: large dilated infiltrative vascular channels separated by connective tissue stroma

Question 14

what kinds of hemangiomas typically occur after trauma

what do they look like

where are tey found

Answer 14

pyogenic granulomas

Morphology: rapidly growing capillary hemangiomas that appear as red pedunculated lesions

Location: skin, gingival and mucosal surfaces

Question 15

which lymphangioma is associated with Turner syndrome

Answer 15

Cavernous lymphangioma/ cystic hygroma

Question 16

Describe glomus tumors

Answer 16

Painful, but benign tumors arising from modified smooth muscle cells of the glomus bodies

Mostly located in the distal portions of the digits and under fingernails

Question 17

Describe bacilliary angiomatosis

Answer 17

vascular proliferation caused by Bartonella infections. Bacteria induces host hypoxia-inducible factor 1 (HIF-1) which drives VEGF production

grossly appears as red papules/ nodules/ rounded subQ masses

Microscopically, cells exhibit nuclear atypia and mitosis with stroma neutrophils

Question 18

Describe Kaposi Sarcoma

Answer 18

vascular neoplasm caused by HHV8, associated with AIDS

mostly asymptomatic with red patches confined to lower extremities; patches later spread to become raised nodular plaques

Question 19

Morphology of Kaposi sarcoma

Answer 19

Patches: irregularly dilated endothelial lined vascular spaces with interspaced lymphocytes, plasma cells, and macrophages

Plaques: dermal accumulations of jagged vascular channels lined and surrounded by plump spindle cells; RBCs, hemosiderin-laden macrophages and mononuclear inflammatory cells scattered between vascular channels

Nodules: sheets of plump proliferating spindle cells around small vessels and slitlike spaces, with marked hemorrhage, hemosiderin pigment and mononuclear inflammation

Question 20

Demographics of Kaposi Sarcoma

Classic type

Endemic African Type

Answer 20

Classic type: older men of Mediterranean, middle eastern and eastern European descent

Endemic African Type: HIV seronegative individuals (wearing no shoes)

Question 21

Describe angiosarcoma

Answer 21

Malignant endothelial neoplasms appearing as small red papules/ nodules that eventually grow and blend into surrounding structures

Morphology: varying degrees of differentiation with central areas of hemorrhage and necrosis

solid spindled appearance without discernable blood vessels

Question 22

Risk factors for angiosarcoma

Answer 22

PVC

thorotrast

arsenic

radiation

carcinogenic exposure to the liver in the setting of lymphedema in the BUE after radical mastectomy