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PATHOLOGY > Vascular > Flashcards

Flashcards in Vascular Deck (142):
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Berry aneurysm congenital defect of the

tunica intima and tunica media are congenitally absent allowing an outpocketing of the tunica adventitia

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Average age of berry aneurysm

20-40

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Berry aneurysm location

Circle of Willis

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Arteriovenous fistulas congenital defect

abnormal communications between arterial and venous blood vessels

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Arteriovenous fistulas may be secondary to

to infection, trauma, blood vessel rupture or previous surgical intervention.

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Arteriovenous fistulas may contribute to

right-sided congestive heart failure by increasing venous return to the heart

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Temporal Arteritis definition

granulomatous inflammation and breakdown if the internal elastic membrane of branches of carotid artery

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Temporal Arteritis Treatment

corticosteroids

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Takayasu Arteritis definition

granulomatous inflammation of aortic arch, young asian female

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Takayasu Arteritis symptoms

ocular disturbances, weak/absent pulses in UE

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Polyarteritis Nodosa

young, adult males w/ nodular inflammation of vessels

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Polyarteritis Nodosa affects which organs

all organs except the LUNG

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Polyarteritis Nodosa acute pathology

fibrinoid necrosis w/ neutrophils, eosinophils, monocytes

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Polyarteritis Nodosa healing lesion pathology

fibroblastic proliferation w/ macrophages and plasma cells

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Kawasaki Disease symptoms

fever, conjunctivitis, erythematous rash of palms and soles, enlarged cervical lymph nodes

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Complication of Kawasaki Disease

coronary aneurysm

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Kawasaki Disease patient population

young asian children/infants

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Buerger Disease patient population

male, heavy smokers,

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Buerger Disease Symptoms

gangrene, pain mostly in fingers and toes, Raynaud Phenomenon

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Treatment for Kawasaki Disease

ASA

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Treatment for Buerger Disease

smoking cessation

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Wegener Granulomatosis definition

necrotizing granulomatosis of the nasopharynx, lung, kidney

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Wegener Granulomatosis Symptoms

chronic sinusitis, nasopharynx ulcerations, hemoptysis, pneumonitis, necrotizing glomerulitis

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Test for Wegener Granulomatosis

C-ANCA

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Wegener Granulomatosis patient pop

male, 50+

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Microscopic Polyangitis definition

arterioles, venules, capillaries of the skin, mucus membranes, lung, heart, GIT, kidney, etc

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Test for Microscopic Polyangitis

P-ANCA

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Churg-Strauss Syndrome is associated w/

asthma and eosinophilia

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Test for Churg-Strauss Syndrome

P-ANCA

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Infectious vasculitis

direct extension of organism into wall or hematogenous embolization

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vaso vasora

found in the tunica adventitia

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Atherosclerosis commonly occurs in the

abdominal aorta, coronary arteries, elastic arteries, muscular arteries and cerebral arteries

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atherosclerotic plaque is composed what cells

smooth muscle cells, macrophages and leukocytes

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atherosclerotic plaque is composed what CT

collagen, elastic fibers, proteoglycans

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Simple atheromatous plaque is composed of

composed of a fibrous cap and central lipid core

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The fibrous cap is composed of

macrophages, foam cells, lymphocytes, collagen, elastin, and proteoglycans

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The inner core is a necrotic center composed of

lipid, cholesterol, cellular debris, foam cells, and calcium

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Simple atheromatous plaques occur b/w

tunica intima and tunica media

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Complicated atheromatous plaque is associated w/

Either: 1.) calcification 2) surface ulceration 3) thrombosis 4) hemorrhage into the plaque causing hematoma. 5) aneurysmal dilation

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fatty streaks

earliest sign of atherosclerotic plaque

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Fatty streaks are characterized by

proliferation of smooth muscle with intracytoplasmic lipid accumulation

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fatty streaks tend to occur as

intimal cushion pads occurring at the bifurcation of arteries

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intimal cushion pads HOWEVER are

smooth muscle cells with collagen however, they usually lack lipid

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atheroma formation is initiated by

damage to endothelium lining arterial blood vessels

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Damage causes

adherence of platelets and monocytes, attraction of SM cells and collagen production, w/ monocyte/macrophage phagocytosis of lipids deposited in the injury site

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Monckeberg

ring-like calcifications of the tunica media arranged in a concentric fashion throughout the length of an artery - give rise to bone

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Monckeberg sites most commonly affected

femoral, tibial, radial, ulnar, and arterial supplies of the genital tracts in both sexes

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Arteriolosclerosis

thickening of arterial walls due to HTN

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Hyaline arteriolosclerosis occurs in

hypertensive and diabetics

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Hyaline arteriolosclerosis appears as

accumulation of pink homogenous hyaline material within the blood vessel wall -> narrowing of intima

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Benign nephrosclerosis and/or ischemic necrosis and gangrene in the lower extremities of diabetics is due to

Hyaline arteriolosclerosis

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Hyperplastic arteriolosclerosis

malignant hypertensive

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Hyperplastic arteriolosclerosis characteristic finding

onionskin layering due to an increase of smooth muscle cells within the tunica media

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Hyperplastic arteriolosclerosis most commonly affects

abdominal and thoracic viscera are very commonly affected

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headache, temporal tenderness, visual loss or facial pain.

Temporal arteritis

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Polyarteritis Nodosa most commonly affects

arterial bifurcations

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Polyarteritis Nodosa Sx

fever of unknown origin, weight loss, hematuria, albuminuria, renal failure, hypertension, abdominal pain, melena myalgia and neuritis

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acute form of Polyarteritis Nodosa

fibrinoid necrosis of the blood vessel wall with infiltrates of neutrophils, eosinophils and monocytes

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Healing form of Polyarteritis Nodosa

fibroblastic proliferation with an infiltrate of macrophages and plasma cells

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Healed form of Polyarteritis Nodosa

fibrotic thickening of the blood vessel wall with a loss of the internal elastic membrane.

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Churg-Strauss Syndrome

allergic granulomatosis of Polyarteritis Nodosa

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Churg-Strauss Syndrome key findings

bronchial asthma, marked eosinophilia

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Wegener granulomatosis

necrotizing granulomas, upper airway and lungs, glomerulitis

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Wegener granulomatosis occurs at age

50+

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Treatment of Wegener granulomatosis

if not fatal in 5 mo

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Buerger Disease patients

heavy smokers under the age of 35

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Buerger Disease Sx

Raynaud phenomenon, instep claudication, pain with gangrene

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mycotic aneurysm

weakening of the vessel wall due to infectious vasculitis

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Raynaud Disease definition

intense vasospasm of small arteries and arterioles of

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Raynaud Disease pathology

no identifiable changes in the arterial walls except in the late form in which there may be intimal proliferation

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Raynaud phenomenon definition

arterial insufficiency from a direct underlying cause

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Underlying causes of Raynaud phenomenon

SLE, scleroderma, atherosclerosis, Buerger

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The most common cause of aortic aneurysms is

atherosclerosis

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Aneurysm pathogenesis

cystic medial necrosis with degeneration of the tunica media and subsequent weakening of the wall

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Atherosclerotic aneurysms pt pop

hypertensive males, abdominal aorta, may rupture

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Complications of Atherosclerotic aneurysms

mural thrombi/emboli, rupture into peritoneum

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Syphilitic (luetic) aneurysms common site

ascending thoracic aorta and arch

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Syphilitic (luetic) aneurysms characteristic shape

fusiform

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Syphilitic (luetic) aneurysms appearance of vessel

endothelium undergoes “tree-barking”, caused by linear destruction and inflammation of the tunica intima

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Syphilitic (luetic) aneurysms pathology

lymphocytes and plasma cells, medial necrosis and destruction

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Aortic Dissection

tear of the tunica intima into the tunica media with separation and dissection along the tunica media

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Aortic Dissection fate

spontaneously reenter the aortic lumen or may end as a blind pouch

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Aortic Dissection pathology

cystic medial necrosis with fragmentation of the elastic membrane

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Aortic Dissection Type A1

begins in the ascending aorta and extends over the arch and down along the entire descending aorta

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Aortic Dissection Type A2

begins at and involves only ascending aorta

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Aortic Dissection Type B

distal to the aortic arch and involves the entire descending aorta

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Venous varicosities are caused by

destruction of venous valves with subsequent venous insufficiency

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Venous varicosities Sx

progression of marked dilation and tortuosity of veins

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Venous varicosities pt pop

genetic predisposition, non-mobile upright occupations

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Venous varicosities of the Lower extremities

superficial veins, dilated tortuousities, prone to thrombi

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Venous varicosities - Hemorrhoids caused by

increased abdominal pressure (obesity, tumor, scarring secondary to previous surgery or trauma, pregnancy)

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Venous varicosities - Esophageal varices

lower plexus of the esophagus, cirrhosis, chronic alcoholics and prone to rupture

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Venous varicosities - Varicocele

pampiniform plexus of the spermatic cord, “bag of worms"

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Phlebothrombosis and Thrombophlebitis

inflammation with thrombosis - inflammatory processes of the veins associated with the formation of venous thrombi

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Causes for Phlebothrombosis

cardiac failure, neoplasia, pregnancy, obesity, post operative state, infection, prolonged bed rest or immobilization and hypercoagulable states

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Trousseau sign

paraneoplastic syndrome of malignany is migratory thrombophlebitis

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Phlebothrombosis locations

DVT, periprostatic venous plexus, large veins of the skull

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first manifestation of Phlebothrombosis may be

PE

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Lymphangitis causes

bacterial - group A beta hemolytic streptococci

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Lymphangitis pathogenesis

dilated and filled with acute inflammatory exudate -> break through causing cellulitis and abscess

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Clinically lymphangitis is diagnosed by

development of streaks along extremities spreading towards the trunk from the distal area proximally

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The most common causes of lymph edema include

1. metastasis + obstruction in the lymphatic vessels 2) surgery 3) radiation 4) filariasis 5) post inflammatory thrombosis with scarring of lymphatic channels.

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chylous ascites, chylothorax or chylopericardium

Lymph edema in the abdominal and thoracic cavities

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Capillary hemangioma

small, benign, neoplasm of capillaries in the skin, mucus membrane, viscera

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strawberry hemangioma

large capillary hemangioma on the skin of infants

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strawberry hemangioma fate

usually fade at approximately 3 years of, regress by 5

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Cavernous hemangiomas

small, benign, neoplasm of dilated vascular spaces of the head and neck, mucus membranes, viscera, brain

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von Hippel-Lindau

condition in which cavernous hemangiomas occur in the cerebellum or brain stem and eye grounds, pancreas, liver, etc

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Granuloma Pyogenicum

polypoid form of hemangioma, with surface inflammation and ulceration or the skin, gingiva, and oral mucosa

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Granuloma Pyogenicum pathology

distinct collarette at base w/ granulation-looking stroma

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33% of Granuloma Pyogenicum are due to

trauma

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granuloma gravidarum

tumor on the gingiva and spontaneously regresses after delivery

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Glomus Tumor definition

benign, painful tumor of the nerve receptor sensitive to temperature variation and regulating arterial flow

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Glomus Tumor commonly found

distal extremities, especially beneath the nails

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Pathology of Glomus Tumor

Vascular channels split by CT Aggregated nests of gloms cells

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Vascular Ectasias

Nevus flammeus, Spider telangiectasis, Hereditary hemorrhagic telangiectasia

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Hemangioendothelioma

endothelial cells growing in vascular lumina

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Hemangioendothelioma is intermediate b/w

hemangioma and angiosarcoma

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Hemangioendothelioma is most common in the

skin but also the spleen and liver

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Hemangioendothelioma pathology

spindle shaped cells with occasional mitotic figures and pleomorphism

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Angiosarcoma

anaplastic endothelial cells with frequent mitotic figures

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Angiosarcoma is most common in the

skin, breast, soft tissue and liver

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Angiosarcoma symptoms

small red well-demarcated masses -> bulky and fleshy with central areas of hemorrhage and poorly defined borders

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Hepativ variants of Angiosarcoma involve exposure to

arsenic, Thorotrast and PVC

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Hemangiopericytoma

lower extremities and retroperitoneum, these rare tumors arise from pericytes

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Hemangiopericytoma pahtology

spindle-shaped cells

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Hemangiopericytoma risk of metastatsis

50% may metastasize to the lungs, bone and liver.

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Classic Kaposi Sarcoma pt pop

older men of Eastern European and Mediterranean,

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Classic Kaposi Sarcoma Sx

multiple purple red skin plaques or nodules usually arising on the lower extremities and spreading proximally

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African Kaposi Sarcoma pt pop

children and younger men

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African Kaposi Sarcoma accounts for 10% of

All tumors in Africa, regional lymph node involvement

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Transplant Associated Kaposi pt pop

transplant recipients + immunosuppressants

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Transplant Associated Kaposi Sx

localized or metastasized, regresses w/ discontinuation of immunosuppressants

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AIDS-associated Kaposi pt pop

33% of all AIDS pts

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AIDS-associated Kaposi Sx

wide dissemination, skin, membranes, viscera and typically develop another malignancy

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Appearance of all kaposi lesions

red to blue coalescing plaques and nodules composed of spindle cells around angulated blood filled vascular spaces with occasional mitoses

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Lymphangioma

benign, subcutaneous tissues of the head, neck and axilla

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Lymphangioma pathology

identical to capillary hemangioma but absence of blood from the vascular spaces

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Lymphangiosarcoma

malignant, after prolonged lymph obstruction w/ lymphedema

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Lymphangiosarcoma is most common in

mastectomy pt

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Lymphangiosarcoma Sx

small subcutaneous nodules, which later coalesce to form a large mass