Tratamiento quirúrgico de aneurisma micótico con preservación de injerto renal / Surgical treatment of mycotic aneurysm with conservation of renal graft

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Possible involvement of myofibroblast in the development of inflammatory aortic aneurysm.

To clarify the role of myofibroblasts in the development of inflammatory aortic aneurysm (IAA), 11 cases of IAA (69.2+/-8.59 years) were investigated immunohistochemically and were morphometrically compared with 12 age-matched cases of atherosclerotic abdominal aneurysm (AAA, 69.6+/-5.94 years). The positivity of mantle sign and CRP was significantly higher in the IAA group than in the AAA group. The wall of IAA (5.41+/-1.47 mm) was significantly thicker than that of AAA (2.68+/-0.71 mm). A significant increase in the expression of alpha-smooth muscle actin was found in adventitial fibroblasts of IAA compared to those of AAA. The cell density and MIB-1 index of adventitial myofibroblasts were significantly higher in IAA than in AAA (cell density: 1.69+/-0.51 vs. 1.09+/-0.4 x 10(3) cells/mm(2); MIB-1 index: 5.25+/-2.97% vs. 1.55+/-0.71%). IAA showed a significantly lower area ratio (MAR) of adventitial microvessels than did AAA (2.92+/-1.49% vs. 7.51+/-2.64%). However, there was no significant difference in microvessel density (MVD) between IAA and AAA (84.62+/-50.5 vs. 65.1+/-32.6 vessels/mm(2)). In some cases of IAA, adventitial myofibroblasts expressed hypoxia-inducible factor 1alpha in their cytoplasm or nuclei while it was not detected in AAA. These findings suggest that the development of IAA may be partly mediated by the proliferation of adventitial myofibroblasts, which might be related to tissue hypoxia.

Grossly punched-out lesions in the aorto-iliac region can be histologically classified as false, pseudo-false, or disguised aneurysm.

Aneurysms are morphologically classified as true or false based on the nature of their walls. True aneurysms are composed of all or parts of layers of the vessel. False aneurysms are the result of rupture and their walls have only fibrous tissues. The orifice of false aneurysms is narrow relative to the aneurysmal diameter and thus they are grossly or angiographically referred to as punched-out lesions. Hence false aneurysms present with punched-out lesions, but in reverse, are all of punched-out lesions false aneurysms? We experienced some cases of punched-out lesions which histologically contained traces of elastin, and the purpose of this report was to histologically investigate grossly punched-out lesions. We examined 671 elderly autopsy cases, and a total of 21 grossly punched-out lesions in the aorto-iliac region were selected. They were histologically classified as false, "pseudo-false", or "disguised" aneurysm. False aneurysms were found in 3 patients (0.45%), and were histologically mycotic. A total of 5 "pseudo-false" aneurysms were found in 3 patients (0.45%). They histologically contained traces of elastin, and thus they were categorised in true aneurysms. A total of 13 "disguised" aneurysms were found in 6 patients (0.89%). They were true fusiform aneurysms with an eccentric thrombus, on which a fibrin-cap formed a narrow orifice. Partial sections are insufficient for diagnosis; cross-sections are necessary. To the best of our knowledge, there have been no reports of "pseudo-false" or "disguised" aneurysms in the aorto-iliac region.