ABSTRACT
There is an extremely high prevalence of Thromboangiitis Obliterans (TAO) or Buerger's disease (BD) in India among people of low socioeconomic class who smoke beedies (homemade cigarettes with raw tobacco). The aim of this study was to study the clinical and histo-morphological aspects of Buerger's disease with relevance to age at presentation in the local population. The study comprised of 25 cases (all were men and were smokers) of clinically diagnosed BD based on Shionoya's criteria. The mean age was 47 years. The specimens consisted of 21 biopsies, 2 end-arterectomies and 2 amputations. Formalin fixed, routinely processed, paraffin embedded tissue sections were stained with Haematoxylin and Eosin (H and E) and Verhoeff's elastic stain. They had claudication pain either in the ankle (5) or in the calf (2) or both (13). 24 had infrapopliteal disease and 9 showed upper limb involvement. 21 showed migratory thrombophlebitis also. Histomorphological presentation included the following features: Luminal thrombosis (14), fresh thrombosis (4), chronic inflammation in the vessel wall (10), within the thrombus (1) and around perivascular channels and nerve bundles (4). Internal elastic lamina showed reduplication in 13, undulation in 9 and fragmentation in 9 cases. Media of the vessel showed the following features: fibrosis (9), hypertrophy (9) and calcification (5) Adventitial haemorrhage, cholesterol clefts and atherosclerotic plaque formation were the other changes seen. In our study the following histopathological features were consistently seen. Thrombus (with or without recanalisation), inflammatory cell infiltrate (within the thrombus wall or periadventitial tissue), subintimal and medial fibrosis and changes in internal elastic lamina. These features were also highlighted in other studies. However in our study, medial hypertrophy and calcification were observed as additional features.
Subject(s)
Adult , Age of Onset , Ankle/blood supply , Elastic Tissue/pathology , Humans , Leg/blood supply , Male , Middle Aged , Thromboangiitis Obliterans/pathology , Thrombosis/pathology , Tibial Arteries/pathologyABSTRACT
Morphologic features and pathogenesis of arterial changes occurring in Buerger's disease (thromboangiitis obliterans) are still controversial. This study describes histopathologic features of medium sized arteries from patients with Buerger's disease, particularly of the internal elastic lamina in relation to the immunologic mechanism of the injury. Seventeen segments of occluded arteries (femoral or popliteal arteries) from 17 patients with Buerger's disease were analyzed by histopathological and immunohistochemical methods. The most characteristic features were total luminal obliteration, together with a varying degree of recanalization and deposition of hemosiderin pigments. Detailed analysis, however, showed marked undulation and multiplication of the internal elastic lamina (100%) associated with basophilic degeneration and delicate linear calcification (47%). Lymphocytic infiltration along the internal elastic lamina was seen in 71% and was associated with localized edema. Lymphocytes along the lamina were consistently positive for T cell marker. Mild to moderate fibrosis was present at the media in 24%. Adventitial changes included mild, nonspecific and irregular fibrosis seen in 53%. Immunologic injury to the internal elastic lamina associated with T-lymphocytic infiltration might be the initial morphogenetic mechanism of the thrombotic occlusion and organization of medium-sized arteries in Buerger's disease.
Subject(s)
Adult , Female , Humans , Male , B-Lymphocytes/pathology , Elastic Tissue/pathology , Elastic Tissue/immunology , Femoral Artery/pathology , Femoral Artery/immunology , Femoral Artery/anatomy & histology , Fibrosis , Middle Aged , Popliteal Artery/pathology , Popliteal Artery/immunology , Popliteal Artery/anatomy & histology , T-Lymphocytes/pathology , Thromboangiitis Obliterans/pathology , Thromboangiitis Obliterans/immunologyABSTRACT
A necrose isquêmica do colo associada à tromboangeíte obliterante é rara e grave, com uma mortalidade elevada. A tromboangeíte abliterante ocorre em pacientes jovens e as manifestaçöes digestivas, raras nesta moléstia, ocorrem posteriormente aos acometimentos dos membros. Relata-se caso de um paciente com necrose segmentar isquêmica de colo com tromboangeite obliterante
Subject(s)
Humans , Male , Adult , Colon, Sigmoid/blood supply , Thromboangiitis Obliterans/complications , Ischemia/complications , Colon, Sigmoid/surgery , Colon, Sigmoid/pathology , Thromboangiitis Obliterans/surgery , Thromboangiitis Obliterans/pathology , Colostomy , Colectomy , Ischemia/surgery , Ischemia/pathology , Laparotomy , NecrosisABSTRACT
La tromboangeítis Obliterante es una enfermedad inflamatoria, oclusiva segmental, no ateroesclerótica de los vasos sanguíneos de pequeño y mediano calibre de las extremidades inferiores, que se observa en hombres y jóvenes fumadores
Subject(s)
Adult , Humans , Male , Thromboangiitis Obliterans/pathology , ThrombophlebitisABSTRACT
La Tromboangeitis Obliterante (TAO) es una panarteritis segmentaria en vasos de mediano y pequeño calibre que afecta fundamentalmente varones, fumadores, menores de 40 años. Su etiología es desconocida, pero se cree que participan mecanismos de autoinmunidad. Se estudiaron 7 pacientes (6 varones y 1 hembra) con TAO de menos de 1 año de evolución. 3 con vasculitis y 10 controles sanos. Se exploró la proliferación de las células mononucleares en presencia de fitohemaglutinina (PHA) y colágeno tipo I y III. Los resultados sugieren: a) Proliferación normal en presencia de PHA tanto en los pacientes con TAO como en aquellos con vasculitis; b) Sólo 2 pacientes con TAO y ninguno con vasculitis mostraron sensibilidad celular al colágeno. Podemos concluir, que la sensibilidad celular al colágeno pudo ponerse de manifiesto en TAO de corto tiempo de evolución