Vascular Tumors & Tumor-Live Lesions PDF

# Vascular Tumors & Tumor-live Lesions ## Nevus Flammeus - most common form of vascular ectasia - flat, light pink to deep purple. - head, neck composed of dilated vessels - regress spontaneously ## Port Wine Stain - grow during childhood - thickened skin surface - do not fade with time ## St...

# Vascular Tumors & Tumor-live Lesions ## Nevus Flammeus - most common form of vascular ectasia - flat, light pink to deep purple. - head, neck composed of dilated vessels - regress spontaneously ## Port Wine Stain - grow during childhood - thickened skin surface - do not fade with time ## Sturge-Weber Syndrome - facial port wine nevus - ipsilateral venous angiomas in the cortical leptomeninges, mental retardation, seizures, hemiplegia & skull radio-opacities. ## Spider Telangiectasias - frequently assc. with hyperestrogenic states: pregnancy or liver cirrhosis ## Hemangiomas - aggregates of closely packed, thin walled capillaries - Strawberry type hemangioma - juvenile capillary hemangioma - spontaneously regress - Cavernous hemangioma - von Hippel Lindau disease - uncapsulated infiltrative mass - difficulty in differential diagnosis - intravascular thrombosis & dystrophic calcifications ## Pyogenic Granuloma - rapidly growing pedunculated lesions. - skin, gingiva, oral mucosa - develop after trauma ## Glomus Tumor - glomangioma - painful. - distal digits, under fingernail - modified smooth muscle cells of glomus bodies in thermoregulation ## Basillary Angiomatosis - gram (-) opportunistic bacillus (Bartonella) cause vascular proliferation in immunosuppressed individuals - can involve skin, bone, brain - Bartonella henselae - domestic cat - cat-scratch disease - Bartonella quintana - human body lice - bacillus - production of VEGF - cause endothelial proliferation - on the skin - red papule/nodule/subcutaneous mass - microscopically: endothelial capillary proliferation including nuclear atypia, neutrophils, & nuclear wastes + purplish granular bacterial communities ## Kaposi Sarcoma - patch /raised plaques / nodules - KSHHV-8 - Classic KS: - assc. w/ malignancy or altered immunity - not assc w/ HIV - asymptomatic - localized to skin & subcutaneous tissue - Endemic African KS: - HIV seronegative <40yr - can be indolent or aggressive - involve lymph nodes more than classic KS - Transplant Assc. KS: - T-cell immunosuppression - involve lymph nodes, mucosa, viscera - often regress w/ ↓ of immunosuppression but at risk of organ rejection - AIDS Assc. (epidemic) KS ## Hemangioendothelioma - no well defined vascular channels - tumor cells often plump with abortive intracytoplasmic lumina ## Angiosarcoma - malignant endothelial neoplasm. - Hepatic angiosarcoma: - assc. with carcinogens - arsenic, thorotrast, PVC - can arise in setting of lymphedema, in ipsilateral upper extremity after radical mastectomy for breast cancer - lymphangiosarcoma ## Hemangiopericytoma - origin from pericyte cell - very rare - pericites, resemble myofibroblast like cells surrounding venules & capillaries. ## Neoplastic Heart Diseases - Primary tumors: - Myxoma - Lipema - rhabdomyosarcoma - Angiosarcoma - Metastatic (more common): - Lung carcinoma - Breast carcinoma - Malignant melanoma - leukemia & lymphomas ## Myxoma - most common in adults - 90% in atrium - 80% left atrium - single mass - from fossa ovalis - 1-10 cm diameter, stalk or sessile - soft, translucent, gelatinous - origin from multipotent mesenchymal cell differentiation - star shaped, hyperchromatic nucleus, endothelial with multiple nuclei ## Rhabdomyoma - spontaneous regression (hamartoma??) - 1-2 cm, ventricular, grey/white mass - nucleus: large round or polygonal w/ spider extensions - cytoplasm with glucose loaded vacuoles - can cause balu-valve obstructions ## Lipoma - usually no symptoms - Papillary Fibroelastoma - usually located on heart valve ## Causes of Pericarditis - Infections: - Viruses - Other parasites - Tuberculosis - Pyogenic bacteria - Fungi - Immune-mediated reactions: - Rheumatic fever - SLE - Scleroderma - Post-cardiotomy - Post-myocardial infarction (Dressler) syndrome - Drug hypersensitivity reaction - Others: - MI - Uremia - After cardiac surgery - Neoplasia - Trauma - Radiation ## According to clinic pathologic findings | | | |---------------------------|---------------------------------------------------| | **Acute pericarditis** | **Healed pericarditis** | | Adhesive mediastinopericarditis | Constrictive pericarditis | ### According to inflammatory change - Serous - Serofibrinous - Fibrinous - Suppurative - Hemorrhagic ## Serous Pericarditis: ### Causes: - Non-bacterial inflamm. (RF, SLE, tumors) - Early stage bacterial inflamm. - Viral infection. ### Inflam. reaction w/ scant PNL, lymphocytes, histiocytes - Fluid accumulation - Avascular permeability, protein rich fluid - Organization rare - heal with resolution ## Fibrinous / Serofibrinous Pericarditis ### Most frequent ### Causes: - MI - Uremia - Radiation - RF, SLE - Trauma - Bacterias or viral infections - Fine granular precipitate of fibrin (bread & butter sign) - Heal with resolution or organization ### When organized: - Plaque-like fibrous thickenings - Large areas of fibrosis - adhesive pericarditis - Loud pericardial friction rub. ## Purulent / Suppurative Pericarditis ### Invasion of pericardial sac by infective organisms: - Direct extension of neighbor infection - Seeding from blood - Lymphatic extension - Direct introduction in cardiac surgery. - Thin, creamy puss - Serosal surface - red, granular, yellow/green exudate - Healing: resolution (rare), organization, constrictive pericarditis due to organization. ## Hemorrhagic Pericarditis: - Exudate mainly composed of blood intermingled with fibrinous/suppurative effusion - Causes: tuberculosis, malignant neoplasia, cardiac surgery ## Caseous pericarditis.