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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
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 ).
• 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 lipidladen 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
encapsulated 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. 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