Objective: Plaque morphology plays an important prognostic role in the occurrence of cerebrovascular events. Echolucent and heterogeneous plaques, in particular, carry an increased risk of subsequent stroke. Depending on the quality of the plaque echogenicity based on B-mode ultrasound examination, carotid plaques divide into a soft lipid-rich plaque and a hard plaque with calcification. The aim of this study was to investigate structural changes in the basement membrane of different carotid artery plaque types. Patients and methods: Biopsies were taken from 10 male patients (average age; 75 + 1 years) and 7 females (68 + 3 years). The study population included patients suffering from a filiform stenosis of the carotid artery, 8 patients with acute cerebrovascular events and 9 with asymptomatic stenosis. Scanning electron and polarised light microscopic investigations were carried out on explanted plaques to determine the morphology of calcified areas in vascular lesions. Results: By means of scanning electron microscopy, multiple foci of local calcification were identified. The endothelial layer was partially desquamated from the basement membrane and showed island-like formations. Polarised light microscopy allows us to distinguish between soft plaques with transparent structure and hard plaques with woven bone formation. Conclusion: The major finding of our study is the presence of woven bone tissue in hard plaques of carotid arteries, which may result from pathological strains or mechanical overloading of the collagen fibers. These data suggest a certain parallel with sclerosis of human aortic valves due to their similar morphological characteristics.

In vascular calcification, as a physiological process, intimal arterial calcification (IAC) associated with increased cardiovascular risk is distinguished from medial arterial calcification (MAC) localized mainly in the lamina elatica interna, which are not only based on different pathophysiological mechanisms. They also lead to different cardiovascular diseases. While intimal arterial calcification involves inflammation and lipid accumulation, a calcification process similar to desmal ossification plays the main role in medial arterial calcification. In this context, the phenotype change of smooth muscle cells from muscular type to synthesizing form in the tunica media is considered to be of great importance, which puts the matrix GLA protein, mainly involved in bone metabolism, in the center of interest. The present review work elucidates the molecular biological basis of interaction of matrix GLA protein subunits in the pathogenesis of vascular calcifications and the influence of diet on the consequences of underactivation of matrix GLA protein.

Rhabdomyosarcomas, being the most common sarcomas of childhood, have an extremely poor prognosis, and pleomorphic rhabdomyosarcomas occur very rarely in adults. Despite advanced diagnostics, it is not uncommon for such tumours to be misinterpreted. The 73-year-old patient was diagnosed with a swelling on the inner side of the left thigh 3 years previously after a minor trauma, which was interpreted as a small well-revascularised haemangioma in original CT angiography. While this mass showed little change over the last 2.5 years, a sudden progression of growth occurred 6 months ago. With the working diagnosis of a haemangioma, differential diagnosis of a schwanoma, the vessels supplying the tumour from profunda femoral artery were visualised preoperatively in a selective angiography and embolised. Shortly before the operation, dupex sonography revealed a renewed hypervasculariasis of the tumour. The supplied vessels from the superficial femoral artery and from the main left profunda trunc were embolised with Embosphere Microspheres 500-700 (Merit). Complete devascularisation of the tumour was achieved, so that the tumour could be resected very effectively in accordance with the compartment. The histological work-up of the tumour resulted in the diagnosis of a pleomorphic rhabdomyosarcoma grade II with tumor-free margins. Preoperative embolisation could be an effective method for preoperative conditioning of such rhabdomyosarcoma. Using this example, this study discusses the current diagnostic and therapeutic options for adult rhabdomyosarcomas.

No abstract