Origuchi N, Shigematsu H, Nunokawa M, Muto T, Esaki Y
Department of Clinical Pathology, Tokyo Metropolitan Institute of Gerontology, Japan.
Int Angiol. 1997 Sep;16(3):180-4.
Aneurysms are morphologically classified as true or false based on the nature of their walls. True aneurysms are composed of all or parts of layers of the vessel. False aneurysms are the result of rupture and their walls have only fibrous tissues. The orifice of false aneurysms is narrow relative to the aneurysmal diameter and thus they are grossly or angiographically referred to as punched-out lesions. Hence false aneurysms present with punched-out lesions, but in reverse, are all of punched-out lesions false aneurysms? We experienced some cases of punched-out lesions which histologically contained traces of elastin, and the purpose of this report was to histologically investigate grossly punched-out lesions. We examined 671 elderly autopsy cases, and a total of 21 grossly punched-out lesions in the aorto-iliac region were selected. They were histologically classified as false, "pseudo-false", or "disguised" aneurysm. False aneurysms were found in 3 patients (0.45%), and were histologically mycotic. A total of 5 "pseudo-false" aneurysms were found in 3 patients (0.45%). They histologically contained traces of elastin, and thus they were categorised in true aneurysms. A total of 13 "disguised" aneurysms were found in 6 patients (0.89%). They were true fusiform aneurysms with an eccentric thrombus, on which a fibrin-cap formed a narrow orifice. Partial sections are insufficient for diagnosis; cross-sections are necessary. To the best of our knowledge, there have been no reports of "pseudo-false" or "disguised" aneurysms in the aorto-iliac region.
动脉瘤根据其壁的性质在形态学上分为真性或假性。真性动脉瘤由血管壁的全部或部分层组成。假性动脉瘤是破裂的结果，其壁仅含有纤维组织。假性动脉瘤的开口相对于瘤体直径较窄，因此在大体或血管造影上被称为“穿凿样病变”。因此，假性动脉瘤表现为穿凿样病变，但反之，所有穿凿样病变都是假性动脉瘤吗？我们遇到了一些组织学上含有弹性蛋白痕迹的穿凿样病变病例，本报告的目的是对大体穿凿样病变进行组织学研究。我们检查了671例老年尸检病例，共选择了21例主动脉-髂动脉区域的大体穿凿样病变。它们在组织学上被分类为假性、“假-假性”或“伪装性”动脉瘤。3例患者（0.45%）发现假性动脉瘤，组织学上为霉菌性。3例患者（0.45%）共发现5个“假-假性”动脉瘤。它们在组织学上含有弹性蛋白痕迹，因此被归类为真性动脉瘤。6例患者（0.89%）共发现13个“伪装性”动脉瘤。它们是真性梭形动脉瘤，伴有偏心血栓，其上有纤维蛋白帽形成狭窄开口。部分切片不足以诊断，需要横断面切片。据我们所知，此前尚无关于主动脉-髂动脉区域“假-假性”或“伪装性”动脉瘤的报道。
