Blog posts

Benign Vascular Tumours

These are common but remember that a tumour is just a swelling and they are not all neoplastic.
Capillary haemangiomas are composed of small blood vessels with inconspicuous lumina. They occur in all organs but particularly come to notice when they involve the skin. A “port wine stain” and a “strawberry mark” are examples of these. The latter initially grow rapidly, soon after birth, and then may regress completely, usually by 10 years. Whether they should be considered as true neoplasms is not clear.
Angiomas may, also, be seen in the placenta (chorangiomas) and, because of the increased blood flow, cause fetal heart failure.
Following trauma some patients develop pyogenic granulomas. This is sometimes called a lobular haemangiomas because of the lobular arrangement of the blood vessels in them. This is a reactive not and not a neoplastic process and is commoner in pregnancy.
Bacillary angiomatosis is another non-neoplastic vascular proliferation that is most commonly seen in association with AIDS and which is due to infection with Bartonella.
Unlike capillary haemangiomas, cavernous haemangiomas, contain prominent vascular spaces containing blood. They carry a significant risk of rupture and bleeding and hence of intracerebral haemorrhage, when they occur in the brain, or intraperitoneal haemorrhage, when they occur in the liver
Vascular hamartomas (malformed) blood vessels may be seen in a number of syndromes such as the von-Hipple-Lindau Disease and the Sturge-Weber Syndrome.
Glomus tumours, which are derived from glomus bodies (which are in the skin, are composed of an arterio-venous shunt and are involved in temperature regulation )may have a variable amount of angioma mixed in with them; if this is marked they are called glomangiomas. The purer form mostly involves the extremities and are extremely tender.

Eosinophils

This post was stimulated by a case of eosinophilic colitis I reviewed at an MDT this morning. The images are below.

They show sheets of eosinophils in the lamina propria and infiltrating crypts. They are easily recognised by their bilobed nuclei and prominent red granules.

 

 

 

This was an opportunity to review eosinophils.

Eosinophils are conspicuous in inflammatory reactions triggered by IgE, such as asthma, and by parasites and are increased by TH-2 activation.  IL-5 and GM-CSF increase the production of eosinophils by the bone marrow. They are associated are recruited into the tissue by eotaxins which are CC chemokines.

Eosinophils have 2 types of effector function:

  1. they release toxic granule proteins  (e.g. major basic protein which is toxic to parasites) and free radicals.
  2. they synthesise prostaglandins, leukotrienes and cytokines.

In the context of this case, likely causes include gut parasites, such as schistosomiasis, and allergic reactions to drugs.

If you want to read more try the excellent British Society of Immunology Website: https://www.immunology.org/public-information/bitesized-immunology/cells/eosinophils

Not “Everyone Must Get Stoned” *

My first blog is going to be about gallstones. There is no special reason for this other than they are common (and, therefore, I hope this will be of interest to lots of people) and I happen to find gallbladder pathology interesting!

Below is a picture of a case I cut up yesterday:

As a medical student, I remember that the risk factors for gallstones were described as being “fat, fair, female and forty/ fertile ”  (depending on the specific version of the mnemonic).

How does this shape up now?  In this blog my core reference is Robin’s Pathology (in its range of formats) but will use a range of others. I will return to the topic of textbooks another time.

According to Robbins Basic Pathology (page 673):

Age: The prevalence of gallstones increases with age; over a 1/4 of people aged over 80 years have stones.

Sex: At every age, they are twice as common in women.

Ethnicity: They are very common in certain Native American groups.

Hereditary:  Family history and genetic disorders of bile salt metabolism. Although not mentioned in Robbins,  patients with haemolytic anaemias, including genetic ones such as Sickle Cell Anaemia, are at increased risk of pigment stones.

Environment:  Any factor that increases cholesterol excretion will increase the risk of stones. Oestrogens do this  (obviously contributing to the increased risk in women) as does obesity, rapid weight loss and drugs which increase cholesterol excretion, such as clofibrate.

Disorders affecting gallbladder motility: These includes pregnancy which contributes to the female and fertile risk.

So how does the mnemonic stand up? I came  across a paper (Postgrad Med J. 2013 Nov;89(1057):638-41. ) which directly addresses this question and concluded: “Our study found that the validated ‘students’ 5Fs’ mnemonic retains a role in clinical diagnosis of patients suspected of cholelithiasis but the factor ‘familial’ should be substituted for ‘forty’ in recognition of the role of inheritance and the changing demographics of gallstone incidence.”.

* Bob Dylan:  https://www.youtube.com/watch?v=ASQ-yHWKSQk