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Currently filtering by tag: Vasculitis

Vascular Changes On Thick Sections

Low power image: The small arteriole (large arrow) shows thickening and hypercellularity of its wall.  The hypercellularity is in part due to the presence of chronic cells. Note the marked loss of myelinated axons in the two nerve fascicles (small arrows)   This 50-year-old patient presented with microscopic hematuria, weight loss, and difficulty with gait. Electrodiagnostic studies are reported to have demonstrated features of a multifocal sensorimotor neuropathy. Laboratory studies showed positive cANCA, elevated ESR and CRP, and normal CPK. The patient was treated with steroid and azathioprine prior to nerve biopsy.   Which of the following morphologic features in...


ANCA-Associated Vasculitis, anti-neutrophil-cytoplasmic antibodies (ANCA) testing
Hematoxylin and eosin; 200x and 400x original magnifications   This 60-year-old patient presented with fevers and bilateral leg myalgias of one month’s duration. Laboratory studies demonstrate elevated ESR (120) and normal CPK. On physical examination, the patient had pain upon palpation of both calf muscles. Muscle biopsy was performed. Given the clinical history and features seen in the image, what additional laboratory test results would be best to request? A. ANCA B. Stool ova and parasites C. C-reactive protein D. RPR   Answer: ANCA The image shows the circumferential presence of mononuclear histiocytes within the wall of a small artery...

Digging Deeper – Here, There, and Everywhere

ANCA Disease, LECT2 Amyloid, IgG4-Related Disease, AL amyloidosis, ANCA, digging deeper, Dr. Messias, Arkana Laboratories, pathology diseases
This biopsy came from an elderly gentleman in his 80s, who presented with acute renal failure.  His serum creatinine had increased from a baseline of 1.3 mg/dL up to 6.6 mg/dL.  And in addition to that, urinalysis was positive for proteinuria and blood.  His medical history included pulmonary embolism, BPH, gastrointestinal hemorrhage and GERD.  Multiple serologies were ordered upon presentation, and among these, pANCA and MPO were markedly positive.  A biopsy was performed to investigate the possibility of an ANCA-mediated crescentic glomerulonephritis. Unfortunately, the material obtained for biopsy was small in size, and the longest core, submitted to light microscopy,...

Diagnose This (August 20, 2018)

ANCA-Mediated Vasculitis
What is your presumed diagnosis in the absence of immunofluorescence and electron microscopy?   ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​...