Arteries

Author: Mikael Häggström

Presentations

• Aneurysm
  Aneurysm

• Thrombus

Gross processing

A minimal gross processing of arteries includes a longitudinal dissection and inspection of tunica intima.

Consecutive cross-sections allows for a detection and estimation of atherosclerotic stenosis.

File:Plaque at different degrees of atherosclerotic stenosis.jpg

Plaque at different degrees of atherosclerotic stenosis.

Microscopic examination

• Confirm that it is actually an artery (may be a vein, and a neuron may look grossly like a small artery).
• Look for atherosclerosis and thrombosis.
• Classify atherosclerosis as mild, moderate or severe.
• If cross-sections were made, estimate the maximum percentage of occlusion for each artery.

• Histopathology of pre-atherosclerotic intimal lesions: Intimal thickening (A) consists mainly of smooth muscle cells in a proteoglycan-rich matrix. Intimal xanthoma (B) displays intimal thickening with isolated foam cells (arrows).[1]
  Histopathology of pre-atherosclerotic intimal lesions: Intimal thickening (A) consists mainly of smooth muscle cells in a proteoglycan-rich matrix. Intimal xanthoma (B) displays intimal thickening with isolated foam cells (arrows).
• A progressive atherosclerotic lesion: Pathological intima thickening (A) has some extracellular lipid (EL) present deep in the lesion without true necrosis.[1]
  A progressive atherosclerotic lesion: Pathological intima thickening (A) has some extracellular lipid (EL) present deep in the lesion without true necrosis.
• Progressive lesion: A fibrous cap atheroma has a well-formed necrotic core (NC) containing lipids with an overlying thick fibrous cap (FC).[1]
  Progressive lesion: A fibrous cap atheroma has a well-formed necrotic core (NC) containing lipids with an overlying thick fibrous cap (FC).
• Progressive lesion: Fibrocalcific plaques are heavily calcified lesions with or without a necrotic core.[1]
  Progressive lesion: Fibrocalcific plaques are heavily calcified lesions with or without a necrotic core.
• Histopathology of plaque components in atherosclerosis: (A) Intraplaque neovasculature (arrows); (B) intraplaque hemorrhage; (C) large areas of calcification seen as purple morula; (D) lumen thrombus (arrowhead); stained with hematoxylin and eosin (H&E); (E) macrophage infiltration; stained with CD68 antibodies.[1]
  Histopathology of plaque components in atherosclerosis: (A) Intraplaque neovasculature (arrows); (B) intraplaque hemorrhage; (C) large areas of calcification seen as purple morula; (D) lumen thrombus (arrowhead); stained with hematoxylin and eosin (H&E); (E) macrophage infiltration; stained with CD68 antibodies.
• Cross-sections collapse more or less after cutting, and estimations of the maximum percentage of stenosis should be made as imagined on an expanded blood vessel, as: 1-(lumen area)/(atherosclerosis area). In this case, there is 45-50% stenosis.
  Cross-sections collapse more or less after cutting, and estimations of the maximum percentage of stenosis should be made as imagined on an expanded blood vessel, as: 1-(lumen area)/(atherosclerosis area). In this case, there is 45-50% stenosis.

File:Histopathology of giant cell arteritis.png

Evaluate for giant cell arteritis at least upon request. It is characterized by a granulomatous inflammation of arteries with discontinuous and fragmented internal elastic lamina.

Microscopy report

• Classify any atherosclerosis as mild, moderate or severe.
• If cross-sections were made, state the maximum percentage of stenosis for each artery.

Example:

Sections of the three main coronary arteries reveal << mild / moderate / severe>> atherosclerosis, with approximately __%, __% and __% stenosis of the left anterior descending, left circumflex coronary artery and right coronary artery, respectively.

Main page

• Main page of Patholines