Pathology Flashcards
(32 cards)
Transmural inflammation of arteries with fibrinoid necrosis?
Polyarteritis nodosa
Findings on arteriole biopsy in pt with malignant HTN?
onion-like concentric thickening
due to laminated smooth muscle cells and reduplicated BMs
Is polyarteritis nodosa (PAN) segmental or nonsegmental? What infection is PAN associated with?
Segmental: bead-like aneurysm formation
associated with Hepatitis B infection in 30% of pts!!
What disease results from abnormally low lipoprotein lipase activity? What is the most common presentation?
Hyperchylomicronemia
(Type I familial dyslipidemia)
Most common presentation is abdominal pain due to acute pancreatitis.
Skin xanthomas may be present, but tendon xanthomas and xanthelasmas (medial eyelids) are NOT (seen in familial hypercholesterolemia)
Are patients with familial hyperchylomicronemia at risk for premature coronary artery disease?
NO increased risk for atherosclerosis
Small bluish lesion under nailbed of finger that is painful to touch? Origin and function?
Glomus tumor/glomangioma
(could also be a melanoma)
Arises from the modified smooth muscle cells of a glomus body, which have a thermoregulatory function.
Bright red slightly elevated lesion on buttocks of an infant? Will it grow or regress?
Strawberry hemangioma
unencapsulated aggregates of closely packed, thin-walled capillaries
will initially grow in proportion to the child, but then regresses spontaneously at 5-8 years old
Heaviness in legs with cashier job and dilated, tortuous superficial veins in lower legs? Mechanism? Complications?
varicose veins
due to prolonged increases in intraluminal pressure or loss of vessel-wall tensile strength – leads to venous dilation which stretches venous valves and causes them to fail
Complications: painful thromboses, skin ulcerations, poor wound healing, superficial infections
Homogenously thickened arteriolar walls that stain pink on H&E? Mechanism?
Hyaline arteriolosclerosis
from long-standing nonmalignant HTN and/or diabetes
hyaline material derived from leakage of plasma constituents across the vascular endothelium and from excessive ECM production by smooth muscle cells
Myxomatous changes in arteries? Predisposes to? Associations?
pathological weakening of connective tissue
found in cystic medial degeneration
medial degeneration:
- fragmentation of elastic tissue (“basket weave” pattern of separated elastic fibers)
- separation of elastic and fibromuscular components of the tunica media by small cleft-like spaces that become filled with amorphous ECM
Predisoposes to the development of aortic dissections and aortic aneurysms.
Seen in younger individuals with Marfan syndrome (fibrillin-1 defect) and can also be induced by a chemical found in certain kinds of sweet peas.
40yo man with red skin lesions near axilla - small bright-red, papular lesions? Composed of? Do they regress?
Cherry angioma
proliferation of capillaries and post-capillary venules in papillary dermis
do not regress, increased frequency with age
appears in 30s/40s
Bright red central papule surrounded by outwardly radiating vessels that blanch when pressed and refill? Dependent on?
Spider angioma
dilation of central arteriole and its superficial capillary network
estrogen-dependent
What is a cystic hygroma? Found where? Associations?
cavernous lymphangioma
lymphatic cyst lined by endothelium
found on neck and lateral chest wall
associated with Turner syndrome (and Down syndrome)
Child with vascular lesions of IgA and C3 deposition on skin biopsy? Associated with? Presentation?
Henoch-Schonlein purpura (HSP)
vasculitis due to IgA deposition
often follows a URI (due to excess IgA production)
Classic triad:
- skin: palpable purpura on buttocks/legs
- arthralgias
- GI: abdominal pain, melena
A significant mismatched defect on ventilation-perfusion scan indicates? Ventilation defect anatomically matched by a perfusion defect (matched defect)?
indicates blood flow has been occluded to that segment of lung
is a specific finding for a pulmonary embolism
matched defect usually indicates lung collapse or consolidation
Pt with decrescendo-type diastolic murmur over left sternal border? Positive FTA-ABS antibodies – how does this pathological process start?
aortic regurgitation murmur: decrescendo blowing diastolic
Tertiary syphilis leading to aneurysmal dilatation of thoracic aorta (dilated aortic valve ring = aortic regurg. murmur)
Begins with vasa vasorum endarteritis and obliteration, resulting in inflammation, ischemia, and weakening of adventitia – leads to dilatation of the thoracic aorta.
Radial mastectomy pt ten years later comes in with persistent right arm swelling – increased risk of?
Lymphangiosarcoma
malignancy of endothelial lining of lymphatic channels
persistent lymphedema with chronic dilatation of lymphatic channels predisposes to lymphangiosarcoma
(classic presentation: post-radial mastectomy)
40yo pt with oliguria and intranasal ulcer? Marker?
granulomatosis with polyangiitis (Wegener’s)
c-ANCA positive
pathognomic for Wegener’s
Abdominal pain with rare vascular tumor associated with past arsenic, radiation, thorotrast (formerly used contrast), or polyvinyl chloride (plastics) exposure? What marker exists on tumor cells?
Hepatic angiosarcoma
Tumor cells express CD31
What is angiosarcoma? Associations?
rare blood vessel malignancy typically in head, neck, breast
usually in elderly on sun-exposed areas
associated with radiation therapy and arsenic (pesticides)
60yo pt with episodes of thrombophlebitis in various sites in arms and legs? May indicate? Mechanism?
migratory thrombophlebitis / Trousseau’s syndrome
should always make you think CANCER
(could also be a small vessel hypersensitivity type vasculitis)
Hypercoagulability is a common paraneoplastic syndrome
often seen in adenocarcinomas of pancreas (also lung, colon)
leads to chronic intravascular coagulations that are both disseminated and tend to migrate
What is aortic dissection? What is the most important risk factor?
intimal tear through the tunica intima of the aorta leading to formation of a false lumen
Hypertension is the most important risk factor for intimal tear development leading to aortic dissection. Other risk factors:
- bicuspid aortic valve
- connective tissue disorders (Marfan’s)
Does atherosclerosis and related factors (diabetes, smoking, etc.) predispose to aortic dissection?
NO.
Atherosclerosis predisposes more to aortic aneurysm than aortic dissection.
Foot ulcers and hypersensitivity to intradermally injected tobacco extract? What is the pathologic process?
Buerger disease (thromboangiitis obliterans)
segmental thrombosing vasculitis extending into contiguous veins and nerves
Acute and chronic inflammation of arterial walls, often with thrombosis of lumen (which can undergo organization and recanalization)
Can extend into contiguous veins and nerves to encase all structures in fibrous tissue
