Current nomenclature and histopathological criteria for assessment of the noninflammatory degenerative diseases of the aorta

Czech version

Authors: Ondřej Fabián
Authors‘ workplace: Ústav patologie a molekulární medicíny 2. LF UK a FN Motol, Praha
Published in: Čes.-slov. Patol., 56, 2020, No. 1, p. 26-31
Category: Reviews Article

Overview

A histopathological examination of the surgical specimen of the aorta usually follows a surgical reconstruction of the aortic aneurysm or dissection. Among the adults, the frequent cause of the aneurysm development is a severe atherosclerosis, while in children the aneurysm or dissection usually come as a complication of genetic syndromes. The common microscopical denominator of those diseases is a medial degeneration of variable degree. For a long time, a terminology of microscopical structural alterations used to be subjective and unsettled. In 2016, the first international guidelines for the histopathological assessment of the non-inflammatory degenerative diseases of the aorta were established. They introduced unified nomenclature, defined individual microscopic alterations and implemented a three-tier grading system. This work aims at practical aspects of the microscopical assessment and interpretation of the degenerative processes in the aorta with regards to the aforementioned consensus.

Keywords:

Aorta – histopathology – Marfan syndrome

Sources

1. Halushka MK, Angelini A, Bartoloni G et al. Consensus statement on surgical pathology of the aorta from the Society for Cardiovascular Pathology and the Association For European Cardiovascular Pathology: II. Noninflammatory degenerative diseases - nomenclature and diagnostic criteria. Cardiovasc Pathol 2016; 25(3): 247-257.

2. Jain D, Dietz HC, Oswald GL, Maleszewski JJ, Halushka MK. Causes and histopathology of ascending aortic disease in children and young adults. Cardiovasc Pathol 2011; 20(1): 15-25.

3. Lindsay ME, Dietz HC. Lessons on the pathogenesis of aneurysm from heritable conditions. Nature 2011; 473(7347): 308-316.

4. Halushka MK. Single gene disorders of the aortic wall. Cardiovasc Pathol 2012; 21(4): 240-244.

5. Erdheim J.Medionecrosis aortae idiopathica cystica. Virchovs Arch Pat Anat 1930; 276(1): 187-229.

6. Stone JR, Bruneval P, Angelini A et al. Consensus statement on surgical pathology of the aorta from the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology: I. Inflammatory diseases. Cardiovasc Pathol 2015; 24(5): 267-278.

7. Wolinsky H, Glagov S. A lamellar unit of aortic medial structure and function in mammals. Circ Res 1967; 20(1): 99-111.

8. Stone JR, Basso C, Baandrup UT et al. Recommendations for processing cardiovascular surgical pathology specimens: a consensus statement from the Standards and Definitions Committee of the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology. Cardiovasc Pathol 2012; 21(1): 2-16.

9. Schlatmann TJ, Becker AE. Histologic changes in the normal aging aorta: implications for dissecting aortic aneurysm. Am J Cardiol 1977; 39(1): 13-20.

10. Paterick TE, Humphries JA, Ammar KA et al.Aortopathies: etiologies, genetics, differential diagnosis, prognosis and management. Am J Med 2013; 126(8): 670-678.

11. Waters KM, Rooper LM, Guajardo A, Halushka MK. Histopathologic differences partially distinguish syndromic aortic diseases. Cardiovasc Pathol 2017; 30: 6-11.

12. Chowdhury UK, Mishra AK, Ray R, Kalaivani M, Reddy SM, Venugopal P. Histopathologic changes in ascending aorta and risk factors related to histopathologic conditions and aortic dilatation in patients with tetralogy of Fallot. J Thorac Cardiovasc Surg 2008; 135(1): 69-77.

13. Fabian O, Gebauer R, Koblizek M, Hornofova L, Janousek J. Histopathological evidence of aortopathy in newborns and infants with Tetralogy of Fallot at the time of the surgical repair. Cardiovasc Pathol 2019; 40: 59-64.