Page 417 - Textbook of Pathology, 6th Edition

 TABLE 15.3: Classification of Vasculitis. 401
I. INFECTIOUS ARTERITIS
1. Endarteritis obliterans
2. Non-syphilitic infective arteritis
3. Syphilitic arteritis
II. NON-INFECTIOUS ARTERITIS
1. Polyarteritis nodosa (PAN)
2. Hypersensitivity (allergic, leucocytoclastic) vasculitis
3. Wegener’s granulomatosis
4. Temporal (giant cell) arteritis
5. Takayasu’s arteritis (pulseless disease)
6. Kawasaki’s disease
7. Buerger’s disease (thromboangiitis obliterans)
8. Miscellaneous vasculitis

attached to it, there is minimal or no inflammatory cell
infiltrate.
Figure 15.12 Syphilitic aortitis. There is endarteritis and periarteritis
Non-syphilitic Infective Arteritis
of the vasa vasorum in the media and adventitia. There is perivascular
Various forms of invasions of the artery by bacteria, fungi, infiltrate of plasma cells, lymphocytes and macrophages.
parasites or viruses, either directly or by haematogenous
route, cause non-syphilitic infective arteritis. Microscopically, the conspicuous features are as under

Microscopically, the inflammatory infiltrate is present in (Fig. 15.12):
the vessel wall. The vascular lumen may get occluded by Endarteritis and periarteritis of the vasa vasorum CHAPTER 15
thrombi and result in ischaemic necrosis of the affected located in the media and adventitia.
tissue. Perivascular accumulation of plasma cells, lympho-
cytes and macrophages that may form miliary gummas
Syphilitic Arteritis which undergo necrosis and are replaced by scar tissue.
Intimal thickenings consist of dense avascular collagen
Syphilitic or luetic vascular involvement occurs in all stages
of syphilis but is more prominent in the tertiary stage. The that may undergo hyalinisation and calcification.
changes that are found in the syphilitic arteritis are seen The effects of syphilitic aortitis may vary from trivial to
within the arterial tissue (syphilitic endarteritis) and in the catastrophic. These are as follows:
periarterial tissues (syphilitic periarteritis). Manifestations of a) Aortic aneurysm may result from damage to the aortic wall
the disease are particularly prominent at two sites—the aorta (page 406).
and the cerebral arteries.
b) Aortic valvular incompetence used to be considered an
SYPHILITIC AORTITIS. Syphilitic involvement of the important sequela of syphilis but now-a-days rheumatic The Blood Vessels and Lymphatics
ascending aorta and the aortic arch is the commonest disease is considered more important cause for this. The
manifestation of cardiovascular syphilis. It occurs in about aortic incompetence results from spread of the syphilitic
80% cases of tertiary syphilis. Preferential involvement of process to the aortic valve ring.
the arch of aorta may be due to involvement of mediastinal c) Stenosis of coronary ostia is seen in about 20% cases of
lymph nodes in secondary syphilis through which the syphilitic aortitis and may lead to progressive myocardial
treponemes spread to the lymphatics around the aortic arch. fibrosis, angina pectoris and sudden death.
The lesions diminish in severity in descending thoracic aorta The features distinguishing syphilitic aortitis from aortic
and disappear completely at the level of the diaphragm. atheroma are given in Table 15.4.
Grossly, the affected part of the aorta may be dilated, and CEREBRAL SYPHILITIC ARTERITIS (HEUBNER’S
its wall somewhat thickened and adherent to the ARTERITIS). Syphilitic involvement of small and medium-
neighbouring mediastinal structures. Longitudinally sized cerebral arteries occurs during the tertiary syphilis. The
opened vessels show intimal surface studded with pearly- changes may accompany syphilitic meningitis.
white thickenings, varying from a few millimeters to a
centimeter in diameter. These lesions are separated by Grossly, the cerebral vessels are white, rigid and thick-
wrinkled normal intima, giving it characteristic tree-bark walled.
appearance. Cut section of the lesion shows more firm and Microscopically, changes of endarteritis and periarteritis
fibrous appearance than the atheromatous plaques. similar to those seen in syphilitic aortitis are found. There
However, superimposed atherosclerotic lesions may be is atrophy of muscle in the media and replacement by
present. fibrosis. This results in ischaemic atrophy of the brain.