Vascular And Cardiac Neoplasms Flashcards
Glomus tumor
Benign vascular tumor
PAINFUL
Origin: smooth muscle cell of the glomus body
Distal portion of the digits
Glomus tumor morphology
Usually small
Slightly elevated, rounded, red-blue and firm nodules
Branching vascular channels
Vascular Ectasias- Nevis Flammeus
Benign vascular tumor
Ordinary birthmark
Majority fade
Vascular Ectasias
Port-Wine Stain
May grow, thicken and not fade
Sturgeon-Weber syndrome
- port wine stain in distribution of the trigeminal nerve
- venous angiomatous mass in leptomeninges
- mental retardation, seizures, hemiplegia, radiopacities in the skull
Vascular Ectasias
Spider Telangiectasia
More or less radial; often pulsatile
-central core blanches with pressure
Face, neck, upper chest
Most frequent in hyper-estrogenic states
- pregnancy
- liver cirrhosis
Oiler- Weber-Rendu disease
Autosomal dominant
Dilated capillaries and veins present from birth
Wide distribution
May rupture
Bacillary Angiomatosis
Benign
Seen in AIDS
Vascular proliferation’s in skin, bone, brain
Causes of bacillary angiomatosis
Two bartonella species (gram neg rod)
- B. Henselae
- B. Quintana
Identified with PCR
Bacillary Angiomatosis morphology
One or more numerous red papules and nodules
Prominent epithelioid endothelial cells; lesions also contain:
- numerous storm all neutrophils
- nuclear dust
- granular material with causative organisms
Treatment of bacillary angiomatosis
Macrolides
Kaposi Sarcoma
Malignant
frequent in AIDS
HHV8
Tumor progression requires cofactors provided by HIV
Kaposi sarcoma morphology
- Patch
- lower extremities - Plaque
- dilated vascular channels
- plump spindle cells - Nodules
- sheets of spindle cells
- scattered small vessels and slit’like spaces with rows of red cells and hyaline droplets
- common mitotic figures
- often lymph and visceral involvement
Angiosarcoma
Hepatic angiosarcoma is associated with carcinogen exposure (arsenic, thorotrast, polyvinyl chloride)
May arise in setting of lymphedema (10 yrs after radical mastectomy)
Angiosarcoma morphology
Begin as small, sharply demarcated, multiple red nodules
Eventually, large fleshy masses of pale gray-white soft tissue
Necrosis and hemorrhagic frequent
Angioplasty
May cause localized hemorrhagic dissection
- circumferential or longitudinal dissection may cause abrupt reclosure
- thrombosis may cause reclosure; prevented with anti-coagulation
Proliferation restenosis
- due to intimacy thickening
- Occurs in 30-50% of pts in first 4-6 months
Endovascular stents
Used to preserve luminal patency
Can cause acute thrombosis; require anticoagultaion until re-endothelialized
Late complication- proliferative intimacy thickening causing proliferative restenosis
Vascular Replacement
Autologous grafts used for coronary artery bypass surgery
-reversed saphenous vein
— patency is 50% at ten years
-internal mammary artery
— patency is > 90%
Myxoma
Primary cardiac tumor
Most common primary tumor of heart in adults
Benign
90% arise in atria (L:R is 4:1)
Myxoma morphology
<1 cm to 10cm
If pedunculated
-may cause obstruction of AV valveor wrecking ball effect on AV valve leaflets
composed of Stella the or globular myxoma cells
Myxoma clinical
Ball-valve obstruction, embolization, or syndrome with fever and malaise
Identified by echocardiograph
10% have familial cardiac myxoma syndrome (carney syndrome)
Rhabdomyoma
1 primary heart tumor in infants and children
What neoplasm is most likely to metastasize to heart?
Melanoma
Superior vena cava syndrome
Tumor may invade or compress SVC and obstruct blood flow from head and upper extremities
Renal cell carcinoma
May grow within renal vein to IVC to RA
May block blood return
