Thrombophlebitis

The findings are diagnostic of a superficial thrombophlebitis. Thrombophlebitis manifesting this particular morphology being of striking thrombotic vascular occlusion can be indicative of an underlying procoagulant state including the procoagulant state that would be reflective of a syndrome such as Behcet's disease, antiphospholipid antibody syndrome, acquired protein S deficiency or Factor-V Leiden. In addition certain tumors can evoke a prothrombotic tendency due to the elaboration of certain cytokine such as thromboplastin perhaps best exemplified by pancreatic cancer.

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Slide 1: 70 year old woman with a forearm lesion. The tissue sections show a very striking inflammatory reaction involving a medium sized vein several millimeters in caliber. The vein is clearly situated in the subcutaneous fat.

Slide 2: The vascular lumen in occluded by fibrin and permeated by disintegrating neutrophils.

Slide 3: In addition, there is an infiltrate of neutrophils along with histiocytes and small lymphocytes permeating the wall of the vein. In examining the occluded vascular lumen there are a number of admixed histiocytic forms including a few binucleated elements.

Slide 4: An Elastic tissue stain confirms the venous nature of the thrombosed and inflamed vessels. In particular while there is some highlighting of an internal elastic lamina very key in establishing the fact that it is a vein and not an artery is the presence throughout the wall of Elastic tissue. In particular, in between the smooth muscle cell there are elastic fibers.

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