Difference between revisions of "Vascular malformations"

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#Venous angioma.
#Venous angioma.
#*Many small veins.
#*Many small veins.
#Caverous malformation.
#Cavernous hemangioma (Cavernoma).
#*Vessels are back-to-back (no intervening parenchyma).
#*Vessels are back-to-back (no intervening parenchyma).
#Capillary teleangiectasia
#*Small capillaries


Also see: ''[[Sturge-Weber syndrome]]''.
Also see: ''[[Sturge-Weber syndrome]]''.


==Arteriovenous malformation==
==Arteriovenous malformation==
*Abbreviated ''AVM''.
===General===
===General===
*High risk for bleeding vis-a-vis other vascular malformations.
*High risk for bleeding vis-a-vis other vascular malformations.
*May be seen in the context of [[hereditary hemorrhagic telangiectasia]].<ref name=pmid12668602>{{Cite journal  | last1 = Marchuk | first1 = DA. | last2 = Srinivasan | first2 = S. | last3 = Squire | first3 = TL. | last4 = Zawistowski | first4 = JS. | title = Vascular morphogenesis: tales of two syndromes. | journal = Hum Mol Genet | volume = 12 Spec No 1 | issue =  | pages = R97-112 | month = Apr | year = 2003 | doi =  | PMID = 12668602 }}</ref>


===Gross===
===Gross===
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*Classically wedge-shaped - with base toward superficial aspect and apex toward deep aspect (like pulmonary infarcts).
*Classically wedge-shaped - with base toward superficial aspect and apex toward deep aspect (like pulmonary infarcts).
*Usually middle cerebral artery distribution.
*Usually middle cerebral artery distribution.
Image:
*[http://www.flickr.com/photos/11462589@N05/1125883661/in/photostream/ AVM (flickr.com)].
Clinical DDx:
*Melanocytic lesion.
*Other vascular lesions.


===Microscopic===
===Microscopic===
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**"Large" = ~ 0.5 mm (0.25-1.0 mm).
**"Large" = ~ 0.5 mm (0.25-1.0 mm).
***0.25 mm = ~ 31 RBC diameters across.
***0.25 mm = ~ 31 RBC diameters across.
Image: [http://commons.wikimedia.org/wiki/File:Arteriovenous_malformation_-_brain_-_low_mag.jpg Cerebral AVM (WC)].


Notes:
Notes:
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**[[Vein]]s do not have an external elastic lamina and have a poorly developed/thin internal elastic lamina.
**[[Vein]]s do not have an external elastic lamina and have a poorly developed/thin internal elastic lamina.


==Cavernous angioma==
DDx:
*[[Angioleiomyoma]].
*Other vascular lesions.
 
====Images====
<gallery>
Image:Arteriovenous_malformation_-_brain_-_low_mag.jpg  | Cerebral AVM. (WC)
</gallery>
www:
*[http://path.upmc.edu/cases/case123.html AVM - several images (upmc.edu)].
 
===Sign out===
<pre>
ANUS, BIOPSY:
- ARTERIOVENOUS MALFORMATION (PROMINENT SUPERFICIAL DERMAL ARTERIES AND VEINS).
- SKIN WITH PARAKERATOSIS.
- NEGATIVE FOR MELANOCYTIC LESION.
- NEGATIVE FOR MALIGNANCY.
</pre>
 
<pre>
ANUS, BIOPSY:
- SKIN WITH PARAKERATOSIS.
- PROMINENT SUPERFICIAL DERMAL ARTERIES AND VEINS -- COMPATIBLE WITH
  ARTERIOVENOUS MALFORMATION.
- NEGATIVE FOR MELANOCYTIC LESION.
- NEGATIVE FOR MALIGNANCY.
</pre>
 
 
==Cavernous hemangioma==
===General===
===General===
*Usually diagnosed by radiology.
*Usually diagnosed by radiology.
*Clinicians call it cavernoma.


===Microscopic===
===Microscopic===
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*Vessels back-to-back/little intervening parenchyma.
*Vessels back-to-back/little intervening parenchyma.
**Muscle is absent in the vessel walls - '''key feature'''.<ref>MUN. 23 November 2010.</ref>
**Muscle is absent in the vessel walls - '''key feature'''.<ref>MUN. 23 November 2010.</ref>
Images:
<gallery>
File:Cavernous hemangioma.jpg | Cavernous hemangioma (WC/Patho82).
File:Cavernous liver hemangioma - intermed mag.jpg | Cavernous hemangioma of the liver (WC).
</gallery>
==Venous angioma==
===General===
*Subcortical white matter.
*Most common vascular malformation found at autopsy.
===Gross===
*May look like petechial hemorrhages.
===Microscopy===
*Thin walled, dilated vascular channels.
*Lesions larger than capillary teleangiectasia.
==Cherry angioma==
*[[AKA]] ''Campbell De Morgan spots''.
*[[AKA]] ''senile angioma''.
*[[AKA]] ''cherry hemangioma''.
===General===
*Benign.
*Common in the elderly.
Clincal:
*Red spot.
*Polypoid.
===Gross===
*Red spot - well demarcated.
Image:
*[http://missinglink.ucsf.edu/lm/DermatologyGlossary/img/Dermatology%20Glossary/Glossary%20Clinical%20Images/CherryAngioma.jpg Cherry angioma (ucsf.edu)].<ref name=ucsf_ca>URL:: [http://missinglink.ucsf.edu/lm/DermatologyGlossary/cherry_angioma.html http://missinglink.ucsf.edu/lm/DermatologyGlossary/cherry_angioma.html]. Accessed on: 13 August 2012.</ref>
===Microscopic===
Features:<ref>{{Ref Derm|546}}</ref>
*Superficial polypoid lesion that is well-circumscribed.
*Abundant capillaries - '''key feature'''.
DDx:
*[[Venous lake]] - single vessel.<ref name=Ref_Derm551>{{Ref Derm|551}}</ref>
*[[Hemangioma]].
Images:
*[http://www.dermpathexpert.com/id30.html Cherry hemangioma (dermpathexpert.com)].
*[http://missinglink.ucsf.edu/lm/DermatologyGlossary/img/Dermatology%20Glossary/Glossary%20Histo%20Images/cherry_angioma_mid_power.jpg Cherry angioma (ucsf.edu)].<ref name=ucsf_ca>URL:: [http://missinglink.ucsf.edu/lm/DermatologyGlossary/cherry_angioma.html http://missinglink.ucsf.edu/lm/DermatologyGlossary/cherry_angioma.html]. Accessed on: 13 August 2012.</ref>
==Capillary teleangiectasia==
*Usually incidental finding at autopsy.
*Pons as predilection site.
===Microscopy===
*Many small, thin walled capillaries surrounded by normal brain.
*No hemorrhage.
Images:
<gallery>
File:Teleangiectasia brain.jpg | CNS teleangiectasia
</gallery>


==See also==
==See also==
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{{Reflist|2}}
{{Reflist|2}}


[[Category:Malformation]]
[[Category:Cardiovascular pathology]]
[[Category:Cardiovascular pathology]]
[[Category:Neuropathology]]
[[Category:Neuropathology]]

Latest revision as of 14:39, 30 August 2021

Vascular malformations come in different flavours.

Types:[1]

  1. Arteriovenous malformation.
    • Most important clinically - highest risk of bleeding.
  2. Varix.
    • One large (dilated) vein.
  3. Venous angioma.
    • Many small veins.
  4. Cavernous hemangioma (Cavernoma).
    • Vessels are back-to-back (no intervening parenchyma).
  5. Capillary teleangiectasia
    • Small capillaries

Also see: Sturge-Weber syndrome.

Arteriovenous malformation

  • Abbreviated AVM.

General

Gross

Features:[1]

  • Classically wedge-shaped - with base toward superficial aspect and apex toward deep aspect (like pulmonary infarcts).
  • Usually middle cerebral artery distribution.

Image:

Clinical DDx:

  • Melanocytic lesion.
  • Other vascular lesions.

Microscopic

Features:

  • Large vessels with eccentric wall thickening.
    • "Large" = ~ 0.5 mm (0.25-1.0 mm).
      • 0.25 mm = ~ 31 RBC diameters across.

Notes:

  • There is usually one feeding artery.
  • Arteries have a well-defined internal elastic lamina and an external elastic lamina (best seen on elastic trichrome).
    • Veins do not have an external elastic lamina and have a poorly developed/thin internal elastic lamina.

DDx:

Images

  • Cerebral AVM. (WC)

www:

Sign out

ANUS, BIOPSY:
- ARTERIOVENOUS MALFORMATION (PROMINENT SUPERFICIAL DERMAL ARTERIES AND VEINS).
- SKIN WITH PARAKERATOSIS.
- NEGATIVE FOR MELANOCYTIC LESION.
- NEGATIVE FOR MALIGNANCY.

ANUS, BIOPSY:
- SKIN WITH PARAKERATOSIS.
- PROMINENT SUPERFICIAL DERMAL ARTERIES AND VEINS -- COMPATIBLE WITH
  ARTERIOVENOUS MALFORMATION.
- NEGATIVE FOR MELANOCYTIC LESION.
- NEGATIVE FOR MALIGNANCY.


Cavernous hemangioma

General

  • Usually diagnosed by radiology.
  • Clinicians call it cavernoma.

Microscopic

Features:

  • Vessels back-to-back/little intervening parenchyma.
    • Muscle is absent in the vessel walls - key feature.[3]

Images:

  • Cavernous hemangioma (WC/Patho82).

  • Cavernous hemangioma of the liver (WC).


Venous angioma

General

  • Subcortical white matter.
  • Most common vascular malformation found at autopsy.

Gross

  • May look like petechial hemorrhages.

Microscopy

  • Thin walled, dilated vascular channels.
  • Lesions larger than capillary teleangiectasia.


Cherry angioma

  • AKA Campbell De Morgan spots.
  • AKA senile angioma.
  • AKA cherry hemangioma.

General

  • Benign.
  • Common in the elderly.

Clincal:

  • Red spot.
  • Polypoid.

Gross

  • Red spot - well demarcated.

Image:

Microscopic

Features:[5]

  • Superficial polypoid lesion that is well-circumscribed.
  • Abundant capillaries - key feature.

DDx:

Images:


Capillary teleangiectasia

  • Usually incidental finding at autopsy.
  • Pons as predilection site.

Microscopy

  • Many small, thin walled capillaries surrounded by normal brain.
  • No hemorrhage.

Images:

  • CNS teleangiectasia

See also

References

  1. ↑ 1.0 1.1 Prayson RA, Kleinschmidt-DeMasters BK (November 2006). "An algorithmic approach to the brain biopsy--part II". Arch. Pathol. Lab. Med. 130 (11): 1639–48. PMID 17076525.
  2. ↑ Marchuk, DA.; Srinivasan, S.; Squire, TL.; Zawistowski, JS. (Apr 2003). "Vascular morphogenesis: tales of two syndromes.". Hum Mol Genet 12 Spec No 1: R97-112. PMID 12668602.
  3. ↑ MUN. 23 November 2010.
  4. ↑ 4.0 4.1 URL:: http://missinglink.ucsf.edu/lm/DermatologyGlossary/cherry_angioma.html. Accessed on: 13 August 2012.
  5. ↑ Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 546. ISBN 978-0443066542.
  6. ↑ Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 551. ISBN 978-0443066542.
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