Fibrous necrosis of small vessels

Introduction Small vessel fibrotic necrosis is common in Fibrinous inflammation. Celluloid inflammation, which is dominated by fibrinogen exudation, which in turn forms fibrin, or cellulose. In HE sections, cellulose is red-dyed interlaced in a network, strip or granule, often mixed with fragments of neutrophils and necrotic cells. Necrosis is the death of local tissue cells in vivo characterized by changes in enzyme solubility. Necrosis can be directly caused by strong pathogenic factors, but most of them are developed from reversible damage. The basic manifestations are cell swelling, organelle disintegration and protein denaturation.

Cause

There are many causes of small vasculitis, but about 70% of the causes are primary, and 30% are secondary vasculitis.

Changes in the nucleus are the main markers of cell necrosis, and there are three main forms:

(1) Nuclear pyknosis: The nuclear DNA of the nucleus is concentrated and shrunk, which reduces the nuclear volume and increases basophilicity, suggesting that DNA transcription stops.

(2) nuclear fragmentation: the nucleus ruptures due to nuclear chromatin disintegration and nuclear membrane rupture, which can be lysed by nuclear pyknosis into shredded skin.

(3) Nuclear lysis: caused by the activation of non-specific DNase and protease to decompose nuclear DNA and nuclear protein, the nuclear chromatin tropism decreases, and the dead cell nucleus will completely disappear within 1-2 days.

an examination

Related inspection

Blood routine angiography

The supply of peripheral vascular lesions can cause neuropathy and neurological sensation and dyskinesia.

Nasopharyngeal: In Wegener's granulomatosis (one of vasculitis), there may be granulomatous lesions of the nasopharynx, nasal congestion, nosebleeds and other symptoms.

Skin: Many vasculitis can cause rash, skin vascular changes, and sometimes rash is the only clinical manifestation. In allergic purpura, there may be skin bleeding spots and bleeding spots. Some manifest as nodular lesions, which appear after mosquito bites, and are found in allergic vasculitis and Behcet's disease. In addition, there are joint pains, gastrointestinal symptoms and the like.

Differential diagnosis

Differential diagnosis of small vessel fibrous necrosis:

Cellulose degeneration of small vessel wall: a denaturation of interstitial collagen fibers and small vessel walls. The local tissue structure of the lesion disappeared, forming a pile of granular, small or small block-like unstructured material with a clear boundary. It was strongly eosinophilic red dyed, and its morphology and dyeing characteristics were very similar to cellulose, also known as cellulose. Necrosis. Common in allergic diseases such as rheumatism, lupus erythematosus, nodular arteritis. It can also be seen in non-allergic diseases such as the wall of the arteriolar artery in the case of malignant hypertension and the wall of the artery at the bottom of the gastric ulcer.

Primary vasculitis: Primary vasculitis is a part of systemic vasculitis. It refers to a group of autoimmune diseases based on small vessel wall inflammation and/or fibrinoid necrosis. It mainly refers to the microscope. Lower polyangiitis (MPA) Wegener's granulomatosis (WG) and focal segmental necrotizing glomerulonephritis (FSNGN) and allergic granulomatous vasculitis (CSS). The so-called primary small Vasculitis is named after secondary vasculitis, such as systemic lupus erythematosus, allergic purpura, rheumatoid arthritis, etc. are secondary vasculitis.

Supply of peripheral vascular lesions, can cause neuropathy and neurological sensation, dyskinesia; nasopharynx: in Wegener's granulomatosis (one of vasculitis), may have nasopharynx granulomatous lesions, nasal congestion , nose bleeding and other symptoms; skin: many vasculitis will have rash, skin vascular changes, and sometimes rash is the only clinical manifestation. In allergic purpura, there may be skin bleeding spots and bleeding spots. Some manifest as nodular lesions, which appear after mosquito bites, and are found in allergic vasculitis and Behcet's disease. In addition, there are joint pains, gastrointestinal symptoms and the like.

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