TUGAS MATA KULIAH HISTOLOGI Nama : Awatif Al Makiyah NPM : 0806315515 Dosen : Drs.

Dadang Kusmana

Kelainan pada Struktur Histologis Pembuluh Darah

Sumber : Rubins Pathology; Clinicopathologic Foundations of Medicine 5 th Edition

1. Hypertension The central lesion in most cases of hypertension is compromised lumens of small muscular arteries and arterioles. These resistance vessels control blood flow through the capillary beds. The lumen may be restricted by active contraction of the vessel wall, increased mass of the vessel wall or both. Structural changes in hypertension have been shown by morphometric analysis of arterial walls. Structurally thicker vessel walls would be expected to narrow vascular lumens more than would normal, thinner walls. The rapid drop in blood pressure after treatment of hypertensive animals or persons with smooth muscle relaxants suggests that active constriction is very important.

Gambar 1. Arteriolosclerosis. in cases of hypertension, the arterioles axhibit smooth muscle cell proliferation and increased amounts of intercellular collagen and glycosaminoglycans. The mass of smooth muscle and associated elements tends to fix the size of the lumen and restrict the arterioles capacity to dilate

2. Arteriosclerosis Chronic hypertension leads to reactive changes in smaller arteries and arterioles throughout the body, collectively termed arteriosclerosis. In the arterioles, the alterations are termed arteriolosclerosis. BENIGN ARTERIOSCLEROSIS: This condition reflects mild chronic hypertension, and the major change is a variable increased arterial wall thickness. In the smallest arteries and arterioles, these lesions are referred to as hyaline arteriosclerosis and arteriolosclerosis. Arteriolar walls are thickened by deposition of basement membrane material and accumulation of plasma proteins. The small muscular arteries display new layers of elastin, manifesting as reduplication of the intimal elastic lamina and increased connective tissue.

Gambar 2. A: a cross-section of a renal intralobular shows irregular thickening of the intima (arrows); B: a renal arteriole exhibits hyaline arteriolosclerosis

3. Polyarteritis Nodosa The characteristic lesions of polyarteritis nodosa are found in small to medium-sized muscular arteries and are distributed in patchily. However, on occasion they extend into larger arteries, such as the renal, splenic, or coronary arteries. Each lesion is no more than a millimeter long and may involve the entire circumference of the vessel or only a part of it. The most prominent morphologic feature of the affected artery is an area of fibrinoid necrosis, in which the medial muscle and adjacent tissues are fused into a structureless eosinophilic mass that stains for fibrin. A vigorous acute inflammatory response envelops the

area of necrosis, usually involving the entire adventitia (periarteritis), and extends through the other coats of the vessel

Gambar 3. Polyarteritis nodosa. The intense inflammatory cell infiltrate in the arterial wall and surrounding connective tissue is associated with fibrinoid necrosis and disruption of the vessel wall.

4. Churg-Strauss Syndrome Widespread necrotizing lesions of the small and medium-sized arteries, arterioles, and veins are found in the lungs, spleen, kidney, heart, liver, CNS, and other organs. These lesions are granulomas and an intense eosinophilic infiltrates in and around blood vessels. The resulting fibrinoid necrosis, thrombosis and aneurysm formation may simulate polyarteritis nodosa, although Churg-Strauss syndrome seems to be a distinct entity.

Gambar 4. Churg-Strauss syndrome. A Medium-Sized artery shows fibrinoid necrosis and a surrounding eosinophilic infiltrate.

5. Takayasu Arteritis Takayasu arteritis is classified according to the extent of aortic involvement: (1) disease restricted to the aortic arch and its branches, (2) arteritis involving only the descending thoracic and abdominal aorta and its branches, and (3) combined involvement of the arch and descending aorta. The pulmonary artery is also occasionally affected and involvement of the retinal vasculature is often a prominent feature.

6. Kawasaki Disease

Gambar 5. Kawasaki Disease. A. The heart of a child who died from Kawasaki disease shows conspicuous coronary artery aneurysms. B. A microscopic section of a coronary artery from the same patient shows two large defects (arrows) in the internal elastic lamina, with two small aneurysms filles with thrombus

7. Buerger Disease

Gambar 6. Buerger disease. A. Section of the upper extremity shows an organized arterial thrombus that has occluded the lumen. Some inflammatory cells are avident in the adventitial fat. In this instance, the vein (arrow) and the adjacent nerve (arrowhead) show foci of chronic inflammation. B. The hand shows necrosis of the tips of the fingers.

8. Kaposi Sarcoma Kaposi sarcoma is a malignant angioproliferative tumor derived from endothelial cells.

Gambar 7. Kaposi sarcoma. A photomicrograph of a vascular lesion from a patient with acquired immune deficiency syndrome shows numerous poorly differentiated, spindle-shape neoplastic cells and a vascular lesion filled with red blood cells.