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Cardiology Exam III > Pathology 9 &10: Peripheral Venous and Lymphatic disease > Flashcards

Pathology 9 &10: Peripheral Venous and Lymphatic disease Flashcards

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1
Q

Vericose Veins

A

Abnormally dilated, tortuous veins

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2
Q

Causes of Vericose Veins (2)

A

Prolonged, increased intraluminal pressure

Loss of vessel wall support (vein walls are much more weak than arterial walls)

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3
Q

Which veins typically become vericose ?

A

Superficial veins

Upper and lower leg

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4
Q

Is there a familial link to Varicose veins ?

A

You know it ! Due to defective development of vein walls

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5
Q

The most troublesome complications from varicose veins are persistent edema in the extremity and Ischemic skin changes. What are some of theses skin changes ?

A

Stasis dermatitis

Cutaneous ulceration

These contribute to poor wound healing , infections –> osteomyelitis if infection gets into bone, This can lead to amputation of the limb

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6
Q

What causes esophageal varices to form ?

A

Portal Vein HTN ( Cirrhotic liver)

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7
Q

With cirrhosis and subsequent portal vein hypternsion, where else might you see varices ?

A 
Rectum (hemorrhoids) 
Periumbilical veins (caput medusae)
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8
Q

What is the most dangerous association with esophageal varicoses ?

A

RUPTURE –> massive upper GI bleeds

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9
Q

What non-cirrhotic conditions can lead to hemorrhoids ?

A

Prolonged pelvic vascular congestion
Pregnancy
Chronic constipation
Increased intra-abdominal pressure

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10
Q

Thrombophelbitis/Phlebothrombitis

A

Venous thrombosis and inflammation

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11
Q

What are some state that can potentiate Venous Thrombosis ?

A

cardiac failure, neoplasia, pregnancy, obesity, post-op state, prolonged bed rest/immobilization

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12
Q

Where do most cases of thrombophlebitis occur in the body ?

A

Deep leg veins

Other sites:

Periprostatic venous plexus (males)
Pelvic venous plexus (females)
Large veins in the skull and the dural sinuses (infection or inflammation)
Portal vein thrombosis
Peritoneal infections, appendicitis, salpingitis
and pelvic abscesses

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13
Q

Explain how carcinoma can lead to thrombophlebitis

A

Elaboration of pro-coagulant factors by the tumor cells

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14
Q

Migratory thrombophlebitis (thrombophlebitis migrans) exhibits will exhibit “trousseaus sign” or clotting in many areas of the body w/o order. What is this indicative of

A

Cancer (adenocarcinoma)

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15
Q

What is the most serious complication of DVT (phlebothrombosis of the deep leg veins) ?

A

Pulmonary embolism

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16
Q

What is often the first sign of Thrombophlebitis ?

A

PE ! Sadly, many don’t realize they have a DVT until it is too late.

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17
Q

Lymphangitis (define)

A

Acute inflammation in lymphatic channels

Dilated and filled with inflammatory infiltrate
Composed of neutrophils and histiocytes
Extends through the vessel wall
Perilymphatic tissues
Cellulitis or focal abscesses (severe cases

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18
Q

Most common agent of lymphangitis ?

A

Group A β-hemolytic streptococci

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19
Q

Clinical features of lymphangitis

A

Painful subcutaneous red streaks
Extend along the course of lymphatics
Painful enlargement of regional lymph nodes
If lymph nodes fail to block bacteria
Drainage into venous circulation
Bacteremia or septicemia

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20
Q

Primary Lymphedema

A

Isolated congenital defect (simple congenital lymphedema)

Often due to agenesis or hypoplasia or lymph tissue

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21
Q

Famililal Milroy disease

A

Heredofamilial congenital lymphedema

Lymphatic agenesis or hypoplasia

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22
Q

Secondary Lymphedema

A

Occlusion of lymphatic vessels
Abnormal accumulation of interstitial fluid

Caused by:
Malignancy (efacement of lymphnode and
destruction of lymph tissue)

 Post surgical
 Post irradiation fibrosis 

 Post inflamm scarring

 Obstruction due to filiarisis
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23
Q

Persistent edema seen in lymphedema leads to subcutaneous interstitial fibrous tissue and induration. Induration is often referred to by its strange appearance, what is it ?

A

Peau d’orange (orange peel)

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24
Q

In lymphedema, lymphatics may rupture leading to milky collections of lymph in potential spaces. What is a major lymph structure that could rupture leading to this ?

A

Thoracic duct

Places where lymph will accumulate by name:
Chylous ascites (peritoneum)
Chylothorax (pleural cavity)
Chylopericardium (pericardium

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25
A common cause of lymph rupture is ....
malignant invasion.
26
What kind of tumors are primarily found in the aorta,plum art and vena cava ?
Connective Tissue Sarcoma's | Extremely rare
27
Endothelium derived neoplasms include
Hemangioma, Lymphangioma and Angiosarcoma
28
Tumors arising from cells that support vessels include
Glomus tumor and hemangiopericytoma
29
Hemangioma
Benign and extremely common tumors compose of increased # of normal or abnormal vessels filled w/ blood. Rare turn malignant
30
Where do you find most hemangiomas
head and neck (superficial)
31
Where can you find internal hemangiomas
The liver (1/3 of all)
32
Capillary hemangioma
Most common Composed of a proliferation of benign capillaries Found in: Skin and subcutaneous tissues Mucous membranes of the oral cavities and lips Liver, spleen, and kidneys
33
Physical description of capillary hemangioma
Bright red to blue Millimeters to several centimeters in diameter Flat or elevated
34
Histologic description of Capillary Hemangioma
Unencapsulated aggregates of closely packed, thin-walled capillaries Blood-filled and lined by flattened endothelium Scant connective tissue stroma separates vessels Lumens may be partially or completely thrombosed
35
Describe "strawberry type" capillary hemangioma
AKA Juvenile hemangioma of the skin of newborns Extremely common May be multiple Grows rapidly in the first few months Fades at 1 to 3 years of age Completely regresses by age 7 (75% to 90% of cases)
36
Carvenous Hemangioma
``` Large(compared to the capillary hemangioma), dilated vascular channels Less well circumscribed Involve deep structures Brain hemangiomas--most problematic Pressure symptoms or rupture ```
37
Cavernous Hemangiomas are a component of what disease
Von Hippel Lindau disease (Cerebellum,brain stem and retina)
38
Physical description of Cavernous Hemangioma
Red-blue, soft, spongy masses 1 to 2 cm in diameter Sharply defined Composed of large, cavernous blood-filled vascular spaces Separated by a modest connective tissue stroma
39
In Cavernous hemangioma, intravascular thrombosis is associated with ...
dystrophic calcification
40
Pyogenic Granuloma
Essentially it is a capillary hemangioma which has ulcerated (acute inflammation ) Rapidly growing pedunculated red nodule Skin, gingival or oral mucosa Bleeds easily; often ulcerated Due to proliferating capillaries --> extensive edema Shows acute and chronic inflammatory infiltrate
41
Lymphangiomas
Benign proliferations of lymph tissue
42
Simple lymphangioma
Small lymphatic channels in the head, ncke and axial sub cue tissues. Elevated or pedunculated (1/2/ cm in diameter) No erythrocytes
43
Cavernous lymphangioma
Neck or axila of children Large (15 cm in diameter) --> gross deformity of the neck Massively dialated, seperated by intervening connective tissue stroma
44
Cavernous lymphangioma is associated with what genetic disease ?
Turner syndrome
45
GLomus tumor
Benign, exquisitely painful tumors Arises from modified smooth muscle cells of the glomus body (Specialized arteriovenous structure involved in thermoregulation). Located anywher eon the skin but often found under the nails on digits
46
Physical description of GLomus tumor
Round, slightly elevated, red-blue Firm nodules (<1 cm in diameter) Aggregates, nests, and masses of specialized glomus cells Branching vascular channels
47
Vascualar ectasias
Group of abnormally prominent capillaries, venules and arterioles Creates a focal red lesion usually in skin or mucous membranes
48
Nevus flammeus
“Birthmark" Most common form of ectasia Head or neck; light pink to deep purple Vascular dilation of blood vessels in dermis
49
Port Wine Stain
Special form of nevus flammeus; grows with child Thickens skin surface Distributed over Trigeminal Nerve
50
What disease is Port Wine Stain often associated with ?
Sturge-Weber syndrome encephalotrigeminal angiomatosis Rare congenital disorder Associations Venous angiomatous masses in cortical leptomeninges Ipsilateral facial port wine nevi Mental retardation, seizures, hemiplegia
51
Spider Telangiectasia
Non neoplastic lesion that blanches when pressure is applied to it Focal network of subcutaneous small arteries or arterioles Arranged in a radial fashion around a central core
52
Who mostly gets Spider Telangiectasia ?
Pregnant women or patients with cirrhosis Increased estrogen levels ! Estrogen not broken down in liver due to cirrhosis
53
Hereditary Hemorrhagic Telangiectasia (Osler-Weber-Rendu Disease)
Dont confuse with Sturge Weber (associated with port wine stain) ``` Autosomal dominant disorder Multiple aneurysmal telangiectasias Skin and oral mucous membranes Respiratory, GI, urinary tracts Present from birth Lesions rupture (occasional) Serious epistaxis, GI bleed, or hematuria ```
54
Bacillary Angiomatis
Vascular proliferation due to opportunistic infections in immunocompromised patients Involve skin bone brain others. Due to gran negative bacilli in the Bartonella family.
55
Physical description of a Bacillary Angiomatosis
Skin lesions Red papules and nodules Rounded subcutaneous masses Capillary proliferation with epithelioid endothelial cells Nuclear atypia and mitoses Lesions contain neutrophils, nuclear dust, and bacteria
56
Diagnosis of Bacillar Angiomatis
PCR !
57
Treatment of Bacillary Angiomatis
Macrolide antibiotics
58
Kaposi Sarcoma (Forms )
Intermediate Grade Neoplasm Common in AIDS patients ``` Chronic KS AKA classic or European KS Lymphadenopathic KS AKA African or endemic KS Transplant-associated KS AIDS-associated (epidemic) KS ```
59
Chronic Kaposi Sarcoma
Can see with underlying malignancy; not HIV Multiple red to purple skin plaques or nodules Distal lower extremities Increase in size and number; spread proximally Locally persistent; asymptomatic Remain localized to skin and subcutaneous tissue
60
Who will you most likely see Chronic Kaposi in ?
Older men of Eastern European (Ashkenazi Jews) or Mediterranean descent
61
Lymphadenopathic KS
Same geographic distribution as Burkitt lymphoma Prevalent among South African Bantu children Not associated with HIV Skin lesions are sparse Lymphadenopathy Extremely aggressive
62
Transplant-associated KS
``` Solid-organ transplantation Long-term immunosuppression Aggressive (even fatal) Nodal, mucosal, and visceral involvement Cutaneous lesions may be absent ``` occasionally these regress, may lower immunosupressives
63
AIDS-associated (epidemic) KS
``` Originally found in 1/3rd of AIDS patients Male homosexuals Regimens of antiretroviral therapy Incidence is less than 1% Lymph nodes or viscera Disseminates widely early in disease ```
64
What cuases Kaposi sarcoma ?
Human herpesvirus-8 (HHV-8) Sexually transmitted or via saliva
65
Kaposi: Patch Stage
Red to purple macules Confined to the distal lower extremities Dilated irregular endothelial cell-lined vascular spaces Interspersed lymphocytes, plasma cells, and macrophages
66
Kaposi: Plaque Stage
Over time, spread proximally Larger, violaceous (more purple), raised Dermal accumulations of dilated, jagged vascular channels Lined and surrounded by plump spindle cells Extravasated red cells, hemosiderin-laden macrophages, and other mononuclear inflammatory cells
67
Kaposi: Nodule Stage
``` Distinctly neoplastic Sheets of plump, proliferating spindle cells Dermis or subcutaneous tissues Small vessels and slit-like spaces Contain red cells More marked hemorrhage, hemosiderin pigment, and mononuclear inflammation Mitotic figures are common Heralds nodal and visceral involvement African and AIDS-associated variants ```
68
Hemangioendothelioma
Intermediate Grade Neoplasm wide spectrum
69
Epithelioid hemangioendothelioma
Vascular tumor of adults Around medium-sized and large veins Plump and cuboidal tumor cells Inconspicuous well-defined vascular channels
70
Angiosarcomas
Group of malignant endothelial neoplasms Anaplastic --> Revert back to stem cell like structure. More often affects older adults Skin soft tissue breast an liver
71
What are angiosarcomas associated with (chemicals) ?
Associated with carcinogen exposures ``` Arsenic (arsenical pesticides) Thorotrast Radioactive contrast agent formerly used for radiologic imaging Polyvinyl chloride (PVC) ```
72
Describe angiosarcoma and association with lymphedema
Several years after radical mastectomy Lymph node resection no lymph drainage. Will be in ipsilateral upper extremity. Ipsilateral upper extremity Tumor arises from lymphatic vessels (lymphangiosarcoma)
73
Physical description of Angiosarcoma
Small, sharply demarcated, asymptomatic, red nodules Large, fleshy masses of red-tan to gray-white tissue Margins blend with surrounding structures Central areas of necrosis and hemorrhage
74
Histologic representation of angiosarcoma
Plump, anaplastic endothelial cells producing vascular channels Wildly undifferentiated tumors Solid spindle cell appearance and without definite blood vessels CD31 or von Willebrand factor Locally Invasive, metastasize readily Aggressive tumors 5 year survival rates approaching 30%
75
Hemangiopericytoma
Rare neoplasm Derived from pericytes-myofibroblast-like cells Arranged around capillaries and venues Slowly enlarging, painless masses
76
Where are hemangiopericytomas most common ?
Most common Lower extremities (thigh) Retroperitoneum
77
Histologic description of Hemangiopericytoma
Numerous branching capillary channels Gaping sinusoidal spaces enclosed within nests of spindle-shaped to round cells Recur after excision About half will metastasize Hematogenously to lungs, bone, or liver

Cardiology Exam III (12 decks)

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