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Name Congenital Anomalies Anomalous Vessels

位置/定義

Cause

Result/ Patho Trait

血管局部性 異常突出

True: Atherosclerosis, Cystic Medial degeneration, 感染, 創傷 False: Pseudoaneurym, Hematoma

True: Attenuated Wall,鼓出/管壁脆弱 False: Extravasation, 管壁沒變

Berry Aneurysm

Circle of Willis

True

Spherical 球狀擴張,先天性,<1.5cm

Saccular aneurysm

True, Atherosclerosis

Spherical

Fusiform aneurysm

True, Atherosclerosis

Spindle shape, Lumen Dilation

Dissecting Aneurysm

Aorta

Intimal Tear Type A: Ascending Aorta / B: distal to Ascending aorta

Media 中間至外 1/3

Aneurysm

Arteriovenous fistula

動脈

動脈和靜脈異常相接,LR Shunt

Fibromuscular dysplasia

血管

Medial, Intimal hyperplasia/ Fibrosis

Endothelial Cells

血管管壁

Smooth Muscle Cells

血管管壁

SMC growth, 管壁增厚

Endothelial Injury

管壁增厚、失去彈性 Essential (95%): 不明(Genetic + 環境) Hypertensive vascular disease 小動脈 Secondary: 腎臟、內分泌、CV 異常 (arteriolosclerosis) Arteriosclerosis

Hyaline (Benign)

Hyperplastic (malignant)

Atherosclerosis

中大型血管

內皮受損;多重因子(腎、基因、壓力) 老年/慢性高血壓/腎硬化/糖尿病

Homogeneous, Pink hyaline thickening,管道狹窄

突然升高(200,120)

Concentric 增厚(Onion),Basement membrane/SMC↑ 出血、滲出增加,Papilledema→Necrotizing arterioitis

主因:四大因子+1(Modifiable)- Hyperlipidemia (LDL↑), Hypertension, Smoking, Diabetes, CRP 次因:(Non-modifiable)- Age, Male, 基因缺陷 [Add.]: Inflammation, Hyperhomocysteinemia (low B12)

Atheroma: 黃白色= Cell + ECM (Fibrous Cap) + Lipid Fatty Streak (Intimal): Fibro-fatty plaque/Necrotic Lipid Core Plaques: Thrombosis, atheroembolism, aneurysm

Pathology Monckerberg’s arteriosclerosis

小中型血管 Muscular A.

舒>90;收 >140

Unknown

Vessels (Artery and Vein) Pathology [2014.01] NYMU 10001085

Endothelial Injury→Lipoproteins→Monocyte (Foam Cells)→Platelet→Factors→SMC ↑→Lipid accumulation 中層鈣化: Medial calcific sclerosis→鵝頸、Ring-Like, Plate-Like Intima 和 Adventitia 不可見


Name Inflammatory Diseases

Cause 位置/定義 Vasculitis Infectious / Immunologic / Physical and Chemical

Result/ Patho Trait

Immune-mediated vasculitis 多為老人 T-Cell Mediated Granulomatous

Clinic: flu-like, 肌肉血管痛, blind, fever (polymyalgia rheumatica) Patho: 分節, 管腔狹窄/ 可用 Steroid granulomatous inflammation-Mononuclear infiltrate/ Giant Cell nonspecific pan-arteritis-無 Granuloma/ 多種細胞 Infiltrate/ fibrinoid necrosis Healed Stage-管壁有 Collagen

Takayasu Arteritis (Pulseless disease)

<50yr, 年紀輕的東方女性 Granulomatous

Clinic: 視力模糊、上肢脈搏低 Patho: 動脈弓 Fibrous thickening(阻斷分支) Early-Vasa Vasorum 單核球浸潤 Later-Medial Fibrosis, granuloma thickening (intima, 無細胞)

Polyarteritis nodosa

Immune complex Segmental Transmural Necrotizing inflammation

30% Hepatitis B HBs-Ag-HbsAb complex→腎臟衰竭為主要死因 Focal fibrinoid necrosis/ PMN, eosin, monocyte

Mucocutaneous lymph node syndrome =coronary A. aneurysm Antibody attack

Delayed type hypersensitivity T cell = auto Ab to endo & SMC 類似 Polyarteritis nodosa (PAN)

Antibody attack

Anti-Basement membrane

Hypersensitivity vasculitis (leukocytoclastic)

p-ANCA (與 Microscopic polyangiitis (Polyarteritis) 相同)

Necrotizing glomerulonephritis/ 中性的發炎反應

Churg-Strauss syndrome

p-ANCA Allergic granulomatosis

Eosinophil Rich

Giant Cell Arteritis (Temporal) 大血管

中血管 Kawasaki’s disease Goodpasture’s syndrome

小血管

c-ANCA T-Cell mediated hypersensitivity

Wegner’s granulomatosis

Heavy smoker/ 年輕 Thromboangiits obliterans (Buerger’s disease)

Essential cryoglobulinemic

Segmental/ Thrombosing Reynaud-like cold sensitivity: 血管收縮不再擴張/ nodular phlebitis ※Proximal: Pollar, Cyanosis/ Prox:dilation; Mid: constriction; distal: cyanosis

四肢 中小靜脈

Henoch-Schonlein purpura 小血管

Immune complex

RA, SLE, Malignancy

Vessels (Artery and Vein) Pathology [2014.01] NYMU 10001085

Acute necrotizing granulomas of respiratory tract Necrotizing or granulomatous vasculitis Necrotizing glomerulitis

IgA

Arthralgia/ arthritis

Cryoglobulin

vasculitis


Name Venous and Lymphatics

位置

Cause 靜脈屈張

Varicose Vein Phlebothrombosis Thrombophlebitis

Result/ Patho Trait

Vein

靜脈內的血栓:HF, neoplasia, postoperative, 長 血栓性的靜脈發炎:Inflammation 久不動, Local infection Hypercoagulability Cancer (Visceral Cancer)

Migratory thrombophlebitis (Trousseau’s sign) SVC/ IVC Syndrome Lymphedema

淋巴管阻塞

Lymphangitis

Beta-hemolytic Strep.

過多累積的體液(peau d’orange)

Vascular Tumor Capillary/ Cavernous hemangioma/ Pregnancy tumor (granuloma gravidarum):牙齦 Pyogenic granuloma (lobular capillary)

Hemangioma 良性

Glomus Tumor (glomangioma)

Modified SMC of glomus body. (溫度調控血流受器)

Capillary Cavernous lymphagioma (cystic hygroma): 無 Capsule, cyst 有 endothelium

Lymphagioma Hemangioendothelioma Kaposi’s Sarcoma Angiosarcoma

會痛/ Branching Vascular channel Aggregate glomus Cells

中大靜脈

Plump cuboid Cell (Epitheloid); 20% meta 中度 HHV-8 (patch-plaque-nodule) Transplant: immunosuppression 惡性

Lymphagiosarcoma

Vessels (Artery and Vein) Pathology [2014.01] NYMU 10001085

As, PVC Lymedema-associated angiosarcoma

Classic: 老人,下肢,死亡率低 / African Type: 年輕人 Transplant/ AIDS: 侵犯到內臟, Spindle Cells 老人/ anaplastic endothelial cell

Pathology vessels  
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