Colon

Other nonneoplastic

Vascular ectasia



Topic Completed: 16 February 2021

Minor changes: 17 February 2021

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PubMed search: Vascular ectasia [title] colon

Raul S. Gonzalez, M.D.
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Cite this page: Gonzalez RS. Vascular ectasia. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/colonvascularectasia.html. Accessed October 23rd, 2021.
Definition / general
Essential features
  • Cause of lower GI tract bleeding
  • More common in right colon and in older patients
  • Can be subtle and focal on histology
Terminology
  • Also called angiodysplasia, arteriovenous malformation
Epidemiology
  • < 1% prevalence but accounts for 20% of patients with lower GI bleeding (#2 most common cause, after diverticulitis)
  • Incidence increases with age (J Clin Pathol 1982;35:824)
Sites
Etiology
  • Acquired changes in colonic extracellular matrix which distort veins and capillaries, disposing them to bleed
  • Changes may be secondary to chronic vascular obstruction
Clinical features
  • Rectal bleeding, often in elderly
  • Bleeding episodes typically cease spontaneously but recur
  • May be associated with aortic stenosis or von Willebrand disease
Diagnosis
  • Colonoscopy, angiography
Case reports
Treatment
Clinical images

Images hosted on other servers:

Friable telangiectatic mucosal lesions

Gross description
  • Tortuous dilation of multiple small submucosal and mucosal blood vessels
  • Easier to identify by angiography than in a surgical specimen unless injected with silicone rubber and cleared with methyl salicylate
Microscopic (histologic) description
  • Dilated and thin walled vessels (arteries, veins and capillaries) in mucosa and submucosa, often clustered
  • Overlying mucosa may be eroded
  • Changes can be subtle and focal
Microscopic (histologic) images

Contributed by Raul S. Gonzalez, M.D.

Vascular ectasia

Sample pathology report
  • Ascending colon, resection:
    • Segment of colon with submucosal angiodysplasia and focal overlying mucosal erosions
    • Margins of resection unremarkable.
    • Two benign lymph nodes.
Differential diagnosis
  • Colonic or anal varices:
    • Due to portal hypertension
  • Hemangioma:
    • Discrete lesion
Board review style question #1

    Which of the following is true about vascular ectasia (angiodysplasia) of the colon?

  1. Can be found in roughly 20% of resected colons
  2. Indistinguishable from hemangioma
  3. More prevalent in younger patients
  4. Usually found in the right colon
Board review style answer #1
D. Usually found in the right colon

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