CARDIOVASCULAR SYSTEM
PATHOLOGY LABORATORY
MICROSCOPY
H – 3 Infective Endocarditis
• A young drug addict who had injection marks on her arms
was admitted to the hospital with high fever, chills, skin and
mucosal petechia, and somnolance.
• Blood culture was positive for S.aureus.
• Despite vigorous treatment with antibiotics the patient died
of sepsis and of acute congestive heart failure.
• At autopsy large, friable, bulky, irregular masses were
hanging from the free margins of mitral and aortic valves.
• The microscopic sections prepared from these
vegetations reveal masses of bacteria ( violet-colored
granular amorpous masses ) covered with fibrin
strands and inflammatory cells-mainly neutrophil
leucocytes.
• You can see the highly edematous leaflet tissue and
myocardium infiltrated by bacteria.
INFECTIVE ENDOCARDITIS
bacteria
inflammatory
cells and fibrin
H-3
myocardium
•
Masses of bacteria
(violet colored,
granular amorphous
masses) in the
vegetations
•
Fibrin strands
•
Inflammatory cells,
mainly neutrophil
leukocytes
INFECTIVE ENDOCARDITIS
bacteria
myocardium
H-3
H – 10 Myxoma
• This section is prepared from a soft, translucent,
irregularly lobulated mass removed from the left atrium
of a 15 year-old girl.
• The tumor had a gelatinous appearance and areas of
hemorrhage on cut section.
• Microscopic sections reveal stellate or elongated cells
with oval nuclei, numerous small blood vessels,
inflammatory cells, macrophages with hemosiderin
pigment embedded in a pale, abundant matrix.
• The tumoral mass is partly covered by intact
endothelium.
• Try to find areas of hemorrhage the fragment of the
leaflet to which the tumor was attached
MYXOMA
blood vessels
H-10
•
Stellate or elongated
cells with oval nuclei
•
Numerous small blood
vessels
•
Inflammatory cells
•
Macrophages with
hemosiderin pigment in
a pale, abundant matrix
MYXOMA
stellate cells
hemorrhage
H-10
G – 7 Aneurysm and Thrombus
• A 52 year-old man, who had recurrent episodes of embolisation of
distal arteries of the lower extremities, was found to have an
aneurysm of the abdominal aorta.
• At operation the dilated segment of aorta between the renal
arteries and iliac bifurcation was removed and replaced by
synthetic graft.
• The wall of this segment was extremely thin, with scattered
atheromatous ulcers and attached mural thrombi.
• In the microscopic slides you see the extreme thinning of the
aortic wall and thrombus composed largely of pale staining
finely granular masses (platelets) and eosinophilic strands
(fibrin).
• The luminal part of the thrombus consists of masses of
erythrocytes. Try to find the area where the thrombus is attached to
the aortic wall.
• There are newly formed small blood vessels, macrophages,
lymphocytes and fibroblasts in this area.
ANEURYSM AND THROMBUS
thrombus
•
Extreme thinning of the
aortic wall
•
Thrombus composed
largely of pale staining
finely granular masses
(platelets) and
eosinophilic strands
(fibrin)
•
Erythrocytes in the
luminal part of thrombus
G-7
aortic wall
erythrocytes
ANEURYSM AND THROMBUS
•
In the area where the
thrombus is attached to the
aortic wall:
you can see;
•
•
•
•
G-7
Inflammatory cells
and fibroblasts
newly formed small blood
vessels
macrophages
Lymphocytes
fibroblasts
G – 10 Medial degeneration and dissecting aneurysm
• A 53 year-old hypertensive man complaining of sudden onset of
severe chest pain was admitted to the emergency room.
• Although the patient had signs of shock and acute left-sided
heart failure, his blood pressure was elevated.
• After angiography, he was immediately operated on dissecting
aneurysm of ascending aorta.
• An intimal tear was found 7 cm above the aortic valve. The blood
filled in, dissecting the media.
• The dissecting hematoma reached proximally to the aortic valve
and distally to the great arteries.
• In the microscopic slides, the media of the aorta shows reduced
cellularity, destruction of its normal lamellar pattern and small
cleft like cystic poorly defined spaces filled with slightly
basophilic material ( cystic medial necrosis ).
G – 10 Medial degeneration and
dissecting aneurysm
• The blood that filled the dissecting aneurism was
lost during tissue processing, but you can see the
tear and seperation between the middle and outer
thirds of media.
• The patient also had atherosclerosis, and you can see
an intimal plaque composed of lipid and lipid-laden
histiocytes, necrotic cells, spindle cells (smooth muscle
cells) capped by a thin fibrous tissue.
MEDIAL DEGENERATION
Reduced
cellularity
G-10
Tear/Seperation
•
Reduced cellularity
and destruction of
normal lamellar
pattern in the media
of aorta
•
Small cleft like
cystic poorly
defined spaces
filled with
basophilic material
(cystic medial
necrosis)
•
Seperation between
the middle and
outer thirds of
media
G – 15 Hemangioma
• This section is prepared from a red elevated nodule
from the skin of a 3-year-old child.
• Beneath a thinned epidermis, in the dermis, you see an
unencapsulated tumor composed of aggregations of
different sized capillaries sepatared by septa of
connective tissue stroma.
• Some capillaries are formed of endothelial cell buds and
have no visible lumina.
• Some capillaries are lined by plump endothelial cells and
have small lumina; others make up larger channels filled
with blood.
• You can see hemosiderin pigment, scattered
inflammatory cells and fibrosis in the stroma.
HEMANGIOMA
epidermis
•
Beneath the thin
epidermis, in the
dermis, you can see
an unencapsulated
tumor
•
Different sized
capillaries
Capillaries are
seperated by septa of
connective tissue
stroma
Some capillaries have
small lumina whereas
larger ones are filled
with blood
•
G-15
•
capillary hemangioma
HEMANGIOMA
•
Some capillaries are
lined by plump
endothelial cells
•
You can see;
•
•
Hemosiderin pigment
Scattered
inflammatory cells
Fibrosis in the stroma
G-15
capillaries
•
Plump endothelial cells
G – 21 Vasculitis
• This slide is prepared from a loop of infarcted small
intestine macroscopically showing dark hemorrhagic
discoloration.
• The patient was a 75-year-old woman with the
clinical diagnosis of acute mesenteric ischemia.
• Histologically there is mucosal edemai inflammatory
infiltration (especially mononuclear cells),
submucosal vascular proliferation, telangiectasis
and intramural necrosis.
G – 21 Vasculitis
• Now try to see pathology in the small caliber
muscular arteries.
• There is fibrinoid necrosis which extents in
some to involve the full thickness of the arterial
wall.
• Besides endothelial cell swelling you can see
numerous leucocytes, including neutrophils,
eosinophils and mononuclear cells that
present in and around the vessel wall.
Submucasal
vascular
proliferation
VASCULITIS
Edema in the
intestinal
mucosa
G-21
•
Mucosal edema
•
Inflammatory
infiltration
(especially
mononuclear cells)
•
Submucosal
vascular
proliferation
•
Telengiectasis
•
Intramural necrosis
VASCULITIS
Intramural
necrosis
Telengiectasia
Inflammatory
cell infiltration
G-21
VASCULITIS
•
In the small caliber
musculary arteries, you
can see “fibrinoid
necrosis” which extents
in some to involve the
full thickness of the
arterial wall.
•
Besides endothelial cell
swelling you can see
Leucocytes(neutrophils,
eosinophils and
mononuclear cells that
present in and around
the vessel wall.
Inflammation
•
G-21
Fibrinoid
necrosis
G – 22 Atherosclerosis
• A 68-year-old male patient who had a history of
uncontrolled diabetes mellitus presented with
gangrene of the lower extremity.
• Amputation was performed.
• This slide is prepared from arteria tibialis posterior, and
stained with EVG, which stains elastic fibers black.
• The microscopic sections reveal a plaque which consists
of dense fibrous tissue (brown), much of it is acellular
and hyaline.
• The internal elastic lamina is wrinkled and reduplicated
to form a second thinner elastic lamina.
• You see areas of thinner elastic lamina and the
thickened intima
ATHEROSCLEROSIS
Fibrous
plaque
G-22
Reduplication
•
This slide is stained
with EVG
•
EVG stains elastic
fibers black
•
This section reveals
a plaque which
consists of dense
fibrous tissue
(brown) much of it is
acellular and hyaline
ATHEROSCLEROSIS
Thickened
intima
G-22
Reduplication
•
The internal elastic
lamina is wrinkled
and reduplicated to
form a second
thinner elastic
lamina
•
You see areas of
thinner elastic
lamina and the
thickened intima