obliterative phlebitis


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obliterative phlebitis

Phlebitis in which the lumen of a vein becomes permanently closed.
See also: phlebitis
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In fact, our patient was diagnosed to have an inflammatory myofibroblastic tumor initially at our hospital, but then the diagnosis was reviewed and changed to IgG4-related disease based on the typical clinical presentation and typical histopathology findings which demonstrate the 3 main features (storiform fibrosis, obliterative phlebitis, and high IgG4/IgG plasma cell ratio of more than 40).
Due to the low specificity of the morphological features in IgG4-related lymphadenopathy, as obliterative phlebitis and storiform fibrosis are often not present, an IgG4/IgG ratio > 40% and more than 100 IgG4-positive cells per HPF are essential for its diagnosis [12].
(c) A vein obliterated by a transmural inflammatory cell infiltration (obliterative phlebitis) (H-E, 20x).
(28) In another study, (29) 1 case of Riedel thyroiditis had an elevated IgG4:IgG ratio (greater than 40) with obliterative phlebitis and infiltrating fibrosis that was not storiform, without elevated serum IgG4 levels.
Typical histopathologic features of IgG4-RD include marked lymphocytic and plasmacyte infiltration with high percentage of IgG4-positive plasma cells, storiform fibrosis, and obliterative phlebitis [13].
Obliterative phlebitis in a case of IgG4-related pancreatitis (type I autoimmune pancreatitis).
(87,97-103) Irrespective of the affected sites in this disease, there are markedly similar histopathologic characteristics of the lesion, which include intense lymphoplasmacytic infiltration, dense fibrosis with storiform or a perivascular onion skin pattern, obliterative phlebitis, and increased numbers of polyclonal IgG4-producing plasma cells.
(22) IgG4-related lesions are characterized histologically by dense storiform fibrosis, lymphoplasmacytic infiltrate, and obliterative phlebitis. They also often have a high number of IgG4-positive plasma cells, a high ratio of IgG4-positive to IgG-positive plasma cells, and elevated serum IgG4, although these findings are not specific to IgG4-related disease.
Histologically, the pancreas demonstrates the characteristic changes seen in IgG4-related disease: a dense, lymphoplasmacytic infiltrate; storiform-type fibrosis; and obliterative phlebitis (Figures 1 and 2).
(5) The 3 major histopathological features are dense lymphoplasmacytic infiltrate, fibrosis arranged in a storiform pattern (at least focally), and obliterative phlebitis. (5) The minor features are phlebitis (without obliteration of the lumen) and increased numbers of eosinophils.
In certain organs, involved veins can show segmental or transmural chronic inflammation and may show luminal occlusion by fibrous tissue (obliterative phlebitis) (3); however, a vasculitic process per se is not seen, since the phlebitis does not show a significant component of neutrophils, fibrinoid necrosis, or karyorrhectic debris.