Colon nontumor
Nonneoplastic, noncongenital lesions
Idiopathic myointimal hyperplasia of mesenteric veins

Author: Raul S. Gonzalez, M.D. (see Authors page)

Revised: 13 July 2018, last major update May 2016

Copyright: (c) 2002-2018, PathologyOutlines.com, Inc.

PubMed Search: Idiopathic myointimal hyperplasia of mesenteric veins

Cite this page: Gonzalez, R.S. Idiopathic myointimal hyperplasia of mesenteric veins. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/colonmyointimalhyperplasia.html. Accessed September 24th, 2018.
Definition / general
  • Unusual thickening of mesenteric veins, resulting in gastrointestinal symptoms and ischemic colitis
Essential features
  • Rare condition that clinically mimics inflammatory bowel disease in young men
  • Thought to result from arteriovenous fistulization
  • Histology: hyperplastic veins mimic arteries (distinguish with elastin stain); thick walled vascular proliferation in mucosa
Epidemiology
Sites
  • Usually (but not always) involves the left colon
Etiology
Clinical features
  • Diarrhea / constipation, abdominal pain, rectal bleeding
Case reports
Treatment
  • Surgery usually required
Clinical images

Images hosted on other servers:

Encircling ulcer on colonoscopy

Microscopic (histologic) description
  • Biopsy findings: ischemic mucosal change accompanied by proliferation of hyperplastic, thick walled, hyalinized blood vessels (Am J Surg Pathol 1996;20:1271)
  • Resection findings: mesenteric and mural veins show myointimal hyperplasia, making them somewhat resemble arteries; no vasculitis present; arteries are unaffected (Gastroenterology 1991;101:533)
Microscopic (histologic) images

Images hosted on PathOut server:

Contributed by Dr. Raul S. Gonzalez:

Biopsy: mucosal
proliferation
of thick walled
vessels

Resection: thickened
mural veins

High power: two
thickened veins
and one
unaffected artery

Elastin stain
highlights
internal elastic
lamina of artery



Images hosted on other servers:

Colonic ulceration
and thickened vein,
confirmed on
elastin stain

Positive stains
  • Elastin stain confirms that blood vessels with myointimal hyperplasia are veins, not arteries
Differential diagnosis
  • Inflammatory bowel disease: similar clinical picture but histology shows a classic chronic colitis, without vascular abnormalities
  • Mesenteric phlebosclerosis: unusual vascular disease seen only in Japanese patients; mesenteric and colonic mucosal vessels are calcified and sclerotic (Dis Colon Rectum 2003;46:209)