Cvs misc-1-csbrp
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Cvs misc-1-csbrp
- 1. CVS - Miscellaneous CSBR.Prasad, MD., DEC-2014-CSBRP
- 2. Raynaud’s phenomenon (RP) • Paroxysmal exaggerated vasoconstriction of digital arteries and arterioles • Results in cyanosis and pallor • Sometimes may affect: Nose, ear and lips • Types: – Primary RP • Response to cold / emotional stress • CF: Atrophic changes may develop in the course of time – Secondary RP • SLE, Scleroderma, Buerger’s disease DEC-2014-CSBRP
- 4. Buerger’s disease Thromboangiitis obliterans - TAO • Def: It’s segmental, thrombosing arteritis affecting small & medium sized vessels of acute or chronic nature • Men <40yrs • Smokers • Arteries: Tibial, femoral, peroneal & popleteal • Upper limb involvement – 70% • More common in Asians than in Western countries DEC-2014-CSBRP
- 5. Buerger’s disease Thromboangiitis obliterans - TAO Morphology: • Thrombosis • Initially: Neutrophil exudate in all the layers – microabscesses • Later: lymphocytes and macrophages, occasionally giant cells • Musculature of the media and elastic laminae are preserved DEC-2014-CSBRP
- 7. Buerger’s disease Thromboangiitis obliterans - TAO DEC-2014-CSBRP
- 8. Buerger’s disease Thromboangiitis obliterans - TAO Clinical features: • Intermittent claudication – In the instep – Less commonly in the calf – Rarely in the upper limbs • Later: pain comes on at night and is relieved by walking / hanging the leg over the side of bed • Pulse may be absent in the small vessels like Dorsalis pedis and Radial • Raynaud’s phenomenon – 50% of patients develop this when the hands are exposed to cold • Migratory superficial thrombophlebitis • Gangrene DEC-2014-CSBRP
- 9. Buerger’s disease Thromboangiitis obliterans - TAO DEC-2014-CSBRP
- 10. Buerger’s disease Thromboangiitis obliterans - TAO DEC-2014-CSBRP
- 11. Varicose veins • Abnormally dilated tortuous veins • Due to: – Prolonged increased pressure within – Loss of vessel wall support • Site: Superficial vessels of lower limbs are affected • Women more commonly affected • Obesity increases the risk • Familial tendencies are seen in some • CF: Edema, Stasis dermatitis, Ulceration, Thombosis NOTE: Embolism is not a feature of thrombosis of superficial veins. It’s commonly associated with DVTDEC-2014-CSBRP
- 12. DEC-2014-CSBRP
- 14. Varicose veins • Other sites for varocosities: – Esophageal varices (due to PHT) – Hemorrhoides (due to PHT, Pregnancy, Constipation) – Varicocele • Complication: Bleeding DEC-2014-CSBRP
- 17. Varococele What is the importance of ACUTE left sided varicocele ? DEC-2014-CSBRP
- 18. Thrombophlebitis & Phlebothrombosis • Interchangeable terms • Components: – Venous thrombosis and – Inflammation • Sites: – Deep veins of legs – Periprostatic plexus in male – Pelvic venous plexus in female – Large veins of skull & dural sinuses DEC-2014-CSBRP
- 19. Thrombophlebitis & Phlebothrombosis Causes: • Peritoneal infections – Appendicitis – Salpingitis • PLT hyperactivity – PCV – Myelofibrosis • Prolonged immobilization • Systemic hypercoagulability – Adenocarcinoma • Complications of DVT – Pulmonary embolism Trousseau’s sign (Migratory thrombophlebitis) DEC-2014-CSBRP
- 20. Known for: Trousseau sign of malignancy Trousseau sign of latent tetany Trousseau-Lallemand bodies "use new drugs quickly, while they still work" During his later years Trousseau developed pancreatic cancer. Coincidentally, he previously described Trousseau sign of malignancy and developed a similar finding in himself. This cancer limited his activities and eventually proved fatal. Armand Trousseau (1801-1867) DEC-2014-CSBRP
- 21. Case: Identify the abnormality. Give your differentials. Marcos Duarte Siosaki, M.D., and Ana Tarsila Souza, M.D. N Engl J Med 2013; 368:e7February 7, 2013 DOI: 10.1056/NEJMicm1204740
- 22. Case: Identify the abnormality. Give your differentials. Marcos Duarte Siosaki, M.D., and Ana Tarsila Souza, M.D. N Engl J Med 2013; 368:e7February 7, 2013 DOI: 10.1056/NEJMicm1204740 Virchow's node or Troisier's node
- 23. Dr.Troisier The French pathologist Charles Emile Troisier noted in 1889 that other abdominal cancers, too, could spread to the Virchow’s node Cf DEC-2014-CSBRP
- 24. Tumors of blood vessels DEC-2014-CSBRP
- 25. Hemangiomas • Very common tumors • Increased number of blood vessels filled with blood • Many of the capillary lesions seen in infancy may regress spontaneously as the child grows (by the age of 7years) • Some hemangiomas involve large portions of the body – Angiomatosis DEC-2014-CSBRP
- 26. Capilalry Hemangioma • Sites: Skin, subcutis, oral cavity, liver, spleen, kidney • Strawberry angioma – new borns Morphology: • Bright red to blue • Closely packed thin walled blood vessels • Lined by flat endothelium • Scant connective tissue • Hemorrhages, thrombosis, hemosiderin laden MØ DEC-2014-CSBRP
- 28. Capillary angioma - Strawberry angioma DEC-2014-CSBRP
- 30. Cavernous angioma • Large dilated vascular channels • Less well circumscribed • Frequently involve deep structures • May be a part of VHL, Muffucci syndromes Morphology: • Red blue soft spongy masses • Large intercommunicating vascular channels • Modest connective tissue stroma • Thrombosis and calcification DEC-2014-CSBRP
- 32. Muffucci syndrome Cavernous angiomas + Enchondromas DEC-2014-CSBRP
- 34. Granuloma pyogenicum (Pregnancy tumor) • A form of capillary angioma • Rapidly growing • Pedunculated red nodule • Skin, gingiva, oral mucosa • “Bleeds on touch” • Capillaries arranged in lobular fashion • Finger like epidermal projections at the margins DEC-2014-CSBRP
- 39. Bacillary Angiomatosis Bacillary angiomatosis is a vascular proliferation in immunocompromised hosts Caused by: • Bartonella henselae • Bartonella quintana Morphology: • Skin lesions are red papules and nodules, or rounded subcutaneous masses • Histologically: – Capillary proliferation with prominent epithelioid endothelial cells – Nuclear atypia and mitoses – Stromal neutrophils, nuclear dust, and the causal bacteria DEC-2014-CSBRP
- 41. Kaposi sarcoma (KS) Forms of KS: • Chronic KS (Classic) • Lymphadenopathic KS • Transplant associated KS • AIDS associated KS Pathogenesis: • HHV8 (KSHV) • Latent infection in endothelial cells > [p53 inhibitors + Cyclin-D equivalent + viral G protein which induces VEGF] > Cellular proliferation DEC-2014-CSBRP
- 42. Kaposi sarcoma (KS) Morphology: • Patches / plaques / nodules • Red / purple / violaceous • Dermal accumulations of spindle cells with slit like spaces with extravasated RBCs • Hemosiderin laden macrophages • Mitotic figures are common in nodular form Nodular forms often heralds LN and visceral involvement IFN-α anti-VEGF are effective DEC-2014-CSBRP
- 44. Kaposi sarcoma – Nodular form DEC-2014-CSBRP
- 48. Angiosarcoma • Malignant endothelial neoplasm • Primarily affects older adults • Tumor may occur at any site – Skin, soft tissue, breast, and liver • Liver: Thorostrat, Vinyl chloride Morphology: • Skin: Asymptomatic red papules or nodules • Plump, atypical endothelial cells forming vascular Channels • Wildly undifferentiated tumors with a solid spindled appearance and no discernible blood vessels • IHC: CD31 or von Willebrand factor DEC-2014-CSBRP