Pathomorph lab #13: Cardiovascular Part 2

1) Atheromatous plaque of the aorta (H&E 273),

(Sudan 274)

Disease of large and medium sized arteries that result in the

progressive accumulation within the intima of smooth muscle
cells and lipids.
Cells in the intima can transform into phagocytes
Tunica intima of elastic and muscular arteries
o The proliferation of intimal smooth muscle cells and the
accumulation of lipids
o Endothelium breaks down and platelets are deposited
Neovascularization of plaque (vasa plaquorum)
Grossly- fibrofatty plaque
o The fibrous cap- layer of connective tissue
o Thick intima with fat-filled macrophages (foam cells)
and smooth muscle cells
o Early stage- fatty streak
o The atheroma- necrotic mass of lipid atherosclerotic
lesion
o Especially seen in bifurcation of aorta, abdominal aorta,
or arch of aorta
Complications:
o Ischemic heart disease (Most commonly causes this)
o MI by 2 mechanisms 1) rupture of plaque and bleeding into plaque
causes the lumen to close (main reason is caused
by atherosclerosis)
2) thrombosis blocks distal part of artery
Stroke
Gangrene of the extremities
Thrombosis, emboli

2) Hyaline arteriolosclerosis of the kidney (263)

Chronic hypertension leads to reactive changes in the smaller

arteries and arterioles throughout the body. These changes
are collectively referred to as arteriosclerosis. In the
arterioles, the alterations are also known as
arteriolosclerosis.
Benign arteriosclerosis- variable increase in thickness of
vessel walls

Pathomorph lab #13: Cardiovascular Part 2

o in smallest arteries and arterioles= hyaline

arteriosclerosis
o Hyaline- glassy, scarred appearance of blood vessel
walls seen by light microscopy
Walls are thickened by deposition of basement membrane
material and by accumulation of plasma proteins
The small muscular arteries display new layers of elastin,
presenting a reduplication of intimal elastic lamina and an
increase in connective tissue
Benign arteriosclerosis- kidney pathology, results in loss of
renal parenchyma
o Sclerosis of renal arterioles and small arteries
o Aging, genetic disorders, hemodynamic disorders, injury
of endothelium
o Diabetes, hypertension
Micro:
o Thickening and hyalinization of the wall
o Smooth muscle cell proliferation onion-skin
o Narrowing of the lumen, regional scars in kidney
parenchyma

3) Malignant nephrosclerosis (H&E) (353), (azan)

(354)

Form of renal disease associated with malignant phase of

hypertension
Small muscular arteries- segmental dilatation as a result of
necrosis of smooth muscle cells.
Fibrin and the entry of plasma proteins into the vessel wall.
The combination of cells necrosis and deposition of plasma
proteins is termed fibriniod necrosis. Azan staining is
needed for this.
The period of acute injury is rapidly followed
o Smooth muscle proliferation
o Striking concentric increase in the number of layers of
smooth muscle cells.
Result- onion skin appearance.
Complications- increased intracranial pressure, renal failure,
and 50% of mortality within 3 months of onset.

4) Polyarteritis nodosa (the kidney) (355)

Small and medium sized muscular arteries

Children and young adults

Pathomorph lab #13: Cardiovascular Part 2

Kidney, mesenteric artery, heart, skeletal muscle

Clinical manifestation- malaise, fever, weight loss,
hypertension, abdominal pain, melena (bloody stool),
infarction- can be of all ages
Grossly- thick wall of arteryartery (rosary), narrow lumen.
Micro:
o Fibriniod necrosis- eosinophilic mass that stains for
fibrin.
o Inflammation (neutrophils, lymphocytes, plasma cells
and macrophages) is present in the arterial wall and
often is associated with disruption of the vessel wall
o Aneurysm formation (can rupture) because fibrosis will
make wall weaker (smooth muscle is stronger); pressure
of blood can cause dilatation aneurysm

5) Hemorrhoidal varices (266)

Pregnancy, the dilatations of the veins of the rectum and anal

canal, may occur inside or outside the anal sphincter.
Although there maybe a hereditary predisposition, the
condition is aggravated by constipation and pregnancy or it
may result from venous obstruction by rectal tumors. They
often bleed and the thrombosed hemorrhoids are exquisitely
painful.
Symptoms similar to neoplastic tumors that are ulcerative

6) Capillary hemangioma (the skin) (132)

Common congenital vacuolar lesions

Skin, subcutaneous tissue, mucous membrane of the lips and
mouth, and internal viscera (spleen, kidney, liver)
Composed of vascular channels that have the size and
structure of normal capillaries.
Located below the epidermis.
They vary from few milliliters to several centimeters in
diameter
Color is bright red to blue
Strawberry hemangioma of the spleen- h&e staining
When tumor is cut, theres pressure against vascular channels
which causes empty spaces to be seen in the slide where
blood used to be

7) Kaposis sarcoma (the skin) (141)

Malignant tumor derived from endothelial cells

Pathomorph lab #13: Cardiovascular Part 2

Common in parts of Central Africa, AIDs related and immunecompromised patients.

Tumor in the 6-7 decades of life (men x10 than women)
Widespread, multifocal lesion (related to the loss of immunity)
Transplant- Ks occurs typically several month or few years
after the operation. This type of Ks tends to be aggressive.
Some cases- infections with HHV-8 (also known as KSassociated herpes virus KSHV).
Micro:
o Is highly variable
o Can resemble hemangioma- tightly packed clusters of
capillaries
o Tumor can be highly cellular and the vascular spaces
are less prominent- (difficult to distinguish from
fibrosarcomas).