Blood vessels,

1. Diseases of Blood Vessels
Dr. Jyoti Priyadarshini Shrivastava
Associate Professor
Department of Pathology
Gajra Raja Medical College

2. Monckeberg’s Arteriosclerosis
 Medial Calcific Sclerosis
 Johann Georg Monckeberg in 1903
Site: Media of Large and medium sized arteries.
Location: Extremities and Genital Tract
Etiology:
1.Age related Degenerative changes
Dystrophic calcification
2. Pseudoxanthoma elasticum
3.Idiopathic arterial calcification of Infancy

3. Pathogenesis
Age related degenerative change
Vasoconstriction

5. Morphology
Incidental x-ray finding
Calcium deposition in media
Pipe stem like rigid tubes

6. Microscopic
 Deposits of Calcium salts in the media
 No inflammatory reaction
 Often coexistent AS

9. ANEURYSM

10. DEFINITION
A localised permanent abnormal dilatation
of a blood vessel occurring due to
congenital or acquired weakening or
destruction of the vessel wall.

11. SITE
Large Elastic Arteries mainly Aorta
Ascending Aorta and Arch
Abdominal Aorta

12. Sites of Aneurysm
 •Major artery from the heart (the aorta)
 •Brain (cerebral aneurysm)
 •Behind the knee in the leg (popliteal artery aneurysm)
 •Intestine (mesenteric artery aneurysm)
 •Artery in the spleen (splenic artery aneurysm)

14. Classification
 Composition of wall:
1.True
2 False

15. Classification contd.
Depending on the shape
1.Saccular
2.Fusiform
3.Cylinderical
4.Serpentine/Varicose
5.Racemose/Circoid

21. Classification contd.
Based on Pathogenetic Mechanism:
1.Atherosclerotic
2.Syphilitic
3.Dissecting
4.Mycotic
5.Berry

22. Atherosclerotic Aneurysm
Commonest
Males
50 years
Site:Abdominal
Thoracic
Iliac
Other Systemic Arteries

24. Pathogenesis
 Atherosclerosis
 Medial Degeneration(Thoracic)

25. Morphology
 Abdominal Aorta
 Infrarenal
 Above bifurcation
 >5-6 cm.
 Fusiform
 Lumen of Aneurysm –Mural thrombus

26. Microscopical

27. Complications
1.RUPTURE
2.COMPRESSION
3.ARTERIAL OCCLUSION

28. Syphilitic(Luetic) Aneurysm
 T.pallidum
 10% cases
 Syphilitic Aortitis (Thoracic)and Cerebral Arteritis
 Tertiary stage of syphilis
 Men
 >50 years

29. Pathogenesis
 Inflammatory infitrate around vasa
vasorum(adventitia)
 Endarteritis obliterans
 Ischemia in media
 Scarring

30. Morphology
 Saccular(fusiform,cylinderical)
 3-5 cm
 Intima wrinkled shows tree bark appearance
 Aortic valve involved-Valvular incompetence
LVH
 cor bovinum

33. Dissecting Aneurysm and Cystic Medial Necrosis
Dissecting Haematoma in which
blood enters the separated
(dissected ) wall of the vessel and
spreads for varying distance
longitudinally
Males
50-70 yrs
Females: Pregnancy

34. TYPES
 DeBakey Classification-3 types
 Stanford Cassification
1.Type A dissection—The tear begins in the ascending aorta
and progresses throughout the vessel, often extending as
far as the arteries in the leg.
2.Stanford Type B dissection—The tear is located only in the
descending aorta, but may extend into the abdomen.

36. Pathogenesis
 Weak Aortic Media
1.Hypertension
2.Non hypertensive cases(Connective tissue disorder)
a.Marfans Syndrome
b.Cystic Medial Necrosis
c.Smoking
d.Iatrogenic trauma
e.Pregnancy

38. Morphology
 No significant dilatation
 k/a Dissecting Haematoma
 Site:Arch of Aorta
 Characteristic: Sharpely incised
Transverse/Oblique
Intimal tear
3-4 cm.
 Extends below Into AA and proximally into valves

39. Wide Aortic Knob

40.  The grade of medial alterations :
cystic medial necrosis,
elastin fragmentation,
fibrosis
medionecrosis

41. Histopathological image of dissecting aneurysm of thoracic aorta in
a patient without evidence of Marfan's trait. The damaged aorta
was surgically removed and replaced by artificial vessel. Victoria
blue & HE stain.

42. COMPLICATIONS
 1.RUPTURE
 2.CARDIAC DISEASE
 3.ISCHAEMIA

43. FIBROMUSCULAR DYSPLASIA
 Non AS and non-inflammatory disease
 Renal artery
 Medial Fibroplasia commonest
 Gross: Segmental involvement, Bead like
pattern
Intervening normal areas
 Complication: Renovascular HTN
Renal Atrophy

44. Renal Artery FMD

45. TUMOURS OF BLOOD VESSELS
Benign Tumours
Hemangioma
Intermediate grade tumours
Haemangioendothelioma
Malignant Tumours
Haemangiopericytoma
Angiosarcoma
Kaposis Sarcoma

46. Hemangioma
 A capillary hemangioma (also known as an Infantile
hemangioma,
 Site:Face
Liver,Spleen,Kidney
 Gross:Few mm to Few cm.
 Histologically:Well defined
UnEncapsulated
Thin walled vessels

49. Cavernous Hemangioma
Cavernous hemangioma, cavernous
angioma, cavernoma, or cerebral
cavernous malformation (CCM)
(when referring to presence in the
brain) is a type of blood vessel
malformation or hemangioma,
where a collection of dilated blood
vessels form a benign tumor.

50. Cavernous Haemangioma
 Single/Multiple
 Discrete /Diffuse
 Red to blue
 Soft
 1-2 cm
 Site: Skin and Internal organs

54. Hemangioendothelioma
 True tumour of Endothelial cells.
 Intermediate b/w Hemangioma and Hemangiosarcoma
 Skin and subcutaneous tissue
 They usually grow slowly and can sometimes spread to
other tissues in the body (metastasize).
 Vasoproliferative lesion
 Gross: well defined, grey red

57. References
 Robbins Textbook of Pathology,10th edn.
 Textbook of Pathology,Harsh Mohan ,6th edn.
 Textbook of Pathology,1st edn.,Vinay Kamal
 Wikipedia

58. THANK YOU