Pathology CVS Labs Flashcards

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Aschoff Bodies

pathognomonic heart lesions in RF

Rheumatic Valvulitis

- thick valves
- warty vegetations
- along the line of closure of leaflets and cusps
- great mechanical stress on the valves of the left heart

Rhuematic Endocarditis: Rheumatic valvulitis

Acute RF

- edema of the valvue leaflet
- aschoff nodule

Rheumatic valvulitis
chronic healed mitral valve is

'fish mouth' or 'button hole' stenosis
permanent deformity

Rheumatic valvulitis
chronic stage of RHD
Calcified aortic stenosis GROSS

Rheumatic valvulitis
chronic stage of RHD
Calcified aortic stenosis MICROSCOPIC

Rheumatic Mural Endocarditis

Gross appearance of heart showing dilated left atrium with MacCallum plaque and vegetations

lesions are commonly seen in the region of endocardial surface in the posterior wall of left atrium

Rheumatic Myocarditis

Aschoff bodies are seen between myocardial bundles as paravascular fusiform collection of mononuclear cells around fibrinoid necrosis

Rheumatic Pericarditis

'bread and butter appearance'.

[surfaces are shaggy due to thick fibrin covering them].

Rhematic Vegetations

on mitral alone, or mitral and aortic combined.
occur along the line of closure.
small, multiple, warty, grey brown, translucent firmly attached produce permanent valvular deformity

Libman Sack Vegetations

occur on both surfaces of the valve leaflet
Medium sized, multiple, DO NOT produce permanent valvular deformity

NON-Bacterial Thrombotic Vegetations

occur on along the line of closure
larger than of that in RHD, More friable than RHD

Bacterial INFECTIVE Vegetations

SABE = on diseased valves
ABE = on normal valves

LARGE, green tawny, irregular, single/multiple, TYPICALLY FRIABLE

SABE Non RH Endocarditis: Infective Bacterial

- valve thickened and fibrotic
- firm, gray vegetations
- organized
- sometimes may show calcification
- chronic inflammatory granulation
- healing scars

ABE Non RH Endocarditis: Infective Bacterial

- valve ulcerated and destroyed
- soft, bulky, easily detached (sometimes causes emboli)
- grey yellow vegetations
- typically friable
- underlying valves shows necrosis, suppuration and abscess

Non RH Endocarditis: Infective Bacterial

The vegetations of BE consist of 3 zones:

i) Outer cap consists of eosinophilic material composed of fibrin and platelets.

ii) Middle basophilic zone containing colonies of bacteria.

iii) Deeper zone consists of non-specific inflammatory reaction in the cusp itself

Idiopathic (Fiedler’s) Myocarditis
Diffuse idiopathic myocarditis

Idiopathic (Fiedler’s) Myocarditis
Giant Cell idiopathic granulomatous

Dilated Cardiomyopathy

four chamber dilation and hypertrophy

Dilated Cardiomyopathy

Myocyte hypertrophy and interstitial fibrosis (Blue with masson trichrome stain)

Hypertrophic Cardiomyopathy

asymmetric septal hypertrophy, septal muscle bulges into the left ventricular outflow tract, "banana-shaped" ventricular lumen

Hypertrophic Cardiomyopathy

Myocyte disarray, extreme hypertrophy, and characteristic branching, & interstitial fibrosis.

Arrhythmogenic right ventricular cardiomyopathy

Morphologically, the right ventricular wall is severely thinned owing to myocyte replacement by fatty infiltration and lesser amounts of fibrosis. (Gross)

Arrhythmogenic right ventricular cardiomyopathy

Morphologically, the right ventricular wall is severely thinned owing to myocyte replacement by fatty infiltration and lesser amounts of fibrosis. (Microscopy)

Fibrinous pericarditis

most common form of pericarditis.
In RF & Uraemia
The pericardial cavity contains a mixture of fibrinous exudate with serous fluid.
When two layers of pericardium are pulled apart, 'bread and butter' appearance

(GROSS APPEARANCE)

Fibrinous pericarditis

i. Pericardial surface contains pink fibrinous exudate.

ii. pericardium shows congestion and an acute inflammatory infiltrate composed predominantly of neutrophils.

(MICROSCOPIC APPEARANCE)

Suppurative/Purulent pericarditis

Acute Bacterial

. Exudate: Fibrinopurulent

. Pericardial cavity may contain pus.

Tuberculous pericarditis

Caseating granulomatous inflammation.

Thickened pericardium with yellow plaques of caseous necrosis.

Outcome: Healing by fibrosis, sometimes causing constrictive pericarditis.

Chronic pericarditis

Dense fibrotic scars that may obliterate the pericardial space, leading to constrictive pericarditis.

Dissecting aneurysm

begins in the arch of aorta. most often located in the ascending aorta.
The dissection is seen most characteristically separates the intima and inner two third of the media on one side from the outer one-third of the media and the adventitia on the other.

Dissecting aneurysm

begins in the arch of aorta. most often located in the ascending aorta.
The dissection is seen most characteristically separates the intima and inner two third of the media on one side from the outer one-third of the media and the adventitia on the other.

Dissecting aneurysm

begins in the arch of aorta. most often located in the ascending aorta.
The dissection is seen most characteristically separates the intima and inner two third of the media on one side from the outer one-third of the media and the adventitia on the other.

Cardiac neoplasm: Myxoma

- most common in adults
- left atrium (attached to fossa ovalis by stalk)
- gelatinous, lobulated mass
- may obstruct mitral valve → syncope/sudden death

Cardiac neoplasm: Myxoma

- Scattered polygonal or stellate myxoma cells in myxoid (mucoid) stroma.
- May form cords, rings, or gland-like structures.
- May show hemorrhage and inflammation.

Cardiac neoplasm: Rhabdomyoma

- Mostly in children
- associated with tuberous sclerosis
- Grey white nodular mass

Cardiac neoplasm: Rhabdomyoma

- Mostly in children
- associated with tuberous sclerosis
- Grey white nodular mass

Cardiac neoplasm: Rhabdomyoma

- Large spider Cells
- Abundant cytoplasm, radial cytoplasmic strands extending to cell membrane
- May regress spontaneously

Cardiac neoplasm: Rhabdomyoma

- Large spider Cells
- Abundant cytoplasm, radial cytoplasmic strands extending to cell membrane
- May regress spontaneously

Vascular neoplasm: Benign

Cystic Hygroma cavernous lymphangioma GROSS

Vascular neoplasm: Benign

Cystic Hygroma cavernous lymphangioma MICROSCOPY

Vascular neoplasm: Benign

Pyogenic Granuloma, Lobular capillary hemangioma GROSS

Vascular neoplasm: Benign

Pyogenic Granuloma, Lobular capillary hemangioma MICROSCOPY

Vascular neoplasm: Benign

Capillary hemangioma MICROSCOPY

Vascular neoplasm: Benign

Cavernous hemangioma MICROSCOPY

Vascular neoplasm: Intermediate
KAPOSI SARCOMA

Reddish macules that become raised plaques and nodules over time; begins in skin GROSS

Vascular neoplasm: Intermediate
KAPOSI SARCOMA

Reddish macules that become raised plaques and nodules over time; begins in skin GROSS

Vascular neoplasm: Intermediate
KAPOSI SARCOMA

Reddish macules that become raised plaques and nodules over time; begins in skin GROSS

Vascular neoplasm: Intermediate
KAPOSI SARCOMA

Dilated blood vessels with an endothelial mononuclear infiltrate; will progress to see spindle cells with hyaline globules, mitotic figures, and hemosiderin pigment MICROSCOPY

Vascular neoplasm: Malignant
Angiosarcoma

.Highly malignant tumor of endothelial origin.
.Site: liver
.Gross: Large, hemorrhagic, necrotic mass.

Vascular neoplasm: Malignant
Angiosarcoma

.Malignant endothelial cells forming irregular, anastomosing vascular channels.
.Atypia, mitotic activity, and multilayering of endothelial cells.

Arteriosclerosis
Hypertensive vascular disease: Benign Hypertension

Hyaline arteriolosclerosis.
The arteriolar wall is thickened with the deposition of amorphous proteinaceous material (hyalinized), and the lumen is markedly narrowed.

Arteriosclerosis
Hypertensive vascular disease: Benign Hypertension

Elastosis
Splitting of internal elastic lamina into multiple layer

Arteriosclerosis
Hypertensive vascular disease: Malignant Hypertension

Hyperplastic ("onion-skinning") obliteration arteriolosclerosis causing luminal

Arteriosclerosis
Hypertensive vascular disease: Malignant Hypertension

Necrotizing arteriolosclerosis
Fibrinoid necrosis showing fragmented collagen & inflammation

Atherosclerosis
Atheromatous lesions

Aorta with mild atherosclerosis composed of fibrous plaques, one denoted by the arrow.

Atherosclerosis
Atheromatous lesions

Aorta with severe diffuse complicated lesions, including an ulcerated plaque (open arrow), and a lesion with overlying thrombus (closed arrow).

Atherosclerosis
Atheromatous plaque

· FIBROUS CAP
· CELLULAR ZONE (smooth muscle cells, macrophages, foam cells, lymphocytes, collagen, elastin, proteoglycans, neovascularization)
· NECROTIC CENTER (cell debris, cholesterol crystals, foam cells, calcium)

IHD: Myocardial infarction

40-50%
left anterior descending artery obstruction

IHD: Myocardial infarction

30-40%
Right coronary artery obstruction

IHD: Myocardial infarction

15-20%
Left circumflex artery obstruction

IHD: Myocardial infarction
Acute Myocardial Infarction

1d: Beginning of coagulative necrosis with few neutrophils, wavy fibers with elongation, and narrowing, compared with adjacent normal fibers (lower right).

IHD: Myocardial infarction
Acute Myocardial Infarction

2-3 ds: Coagulative necrosis, Dense neutrophilic infiltrate in an area of acute myocardial infarction

IHD: Myocardial infarction
Acute Myocardial Infarction

7-10 ds: Nearly complete removal of necrotic myocytes by phagocytosis

IHD: Myocardial infarction
Acute Myocardial Infarction

7-10 ds: the posterior wall of the left ventricle.
The yellow area (arrow) of necrosis is surrounded by a rim of dark, red granulation tissue.

IHD: Myocardial infarction
Acute Myocardial Infarction

10-14 ds: Granulation tissue

IHD: Myocardial infarction
Acute Myocardial Infarction

After 8 wks: Healed MI with replacement of the necrotic fibers by dense collagenous scar. Residual cardiac muscle cells are present

IHD: Myocardial infarction
Acute Myocardial Infarction

Yellow area = necrosis
arrow head = anterior scar (remote infarction)
star = myocardial haemorrhage due to ventricular rupture (was the acute cause of death

IHD: Myocardial infarction
Acute Myocardial Infarction
Reperfused myocardial infarction

Reperfused myocardial infarction. The transverse heart slice exhibits a large anterior wall myocardial infarction that is hemorrhagic because of bleeding from damaged vessels. The posterior wall is at the top.

IHD: Myocardial infarction
Acute Myocardial Infarction
Reperfused myocardial infarction

Hemorrhage and contraction bands, visible as prominent hyper eosinophilic cross-striations spanning myofibers (arrow), are seen microscopically.

IHD: Myocardial infarction
Acute Myocardial Infarction

Mural thrombus

IHD: Myocardial infarction
Acute Myocardial Infarction

Left Ventricular aneurysm

IHD: Myocardial infarction
Acute Myocardial Infarction

Hemopericardium (caused by rupture of infarcts
P= Pericardial sac
B= Filled with blood
H= Surrounding the heart