Pulmonary hypertension (PH) is a rare, life-threatening disease characterized by high blood pressure that affects the pulmonary arteries, which are the vessels that transport blood from the right heart ventricle to the lungs. Due to the disease, the pulmonary arteries become narrowed and blocked, which forces the heart to work harder to properly pump the blood. This extra effort can result in heart enlargement and weakening, as well as heart failure.
There is currently no cure for the disease, and the difficulties in understanding the causes behind the disease are among the greatest challenges in the field. Pulmonary hypertension can be a consequence of another disease, or occur due to alterations in the cells.
Histology focuses on the microscopic anatomy of cell tissues through the examination under light or electron microscope. Due to its capacity for identifying microscopic structures, structures and alterations, histology is a key component of medicine, including pulmonary hypertension understanding.
Importance and Evolution of Pulmonary Hypertension Histology
The pathological alterations that cause pulmonary hypertension have been a subject of interest since the late 19th century, and dominated the initial investigations of the disease. Pulmonary hypertension histology is still an important variable in the field, with a particular focus on the present age of cell and molecular investigation of the PH pathogenesis.
In the late 1940s and early 1950s, advancements were made in pulmonary hypertension histology and pathology that revealed the correlation between pulmonary vascular remodeling and the altered pulmonary vascular hemodynamics.
The study “Pathology of Pulmonary Hypertension,” authored by Rubin M. Tuder, MD; John C. Marecki, PhD; Amy Richter, BS; Iwona Fijalkowska, PhD; and Sonia Flores, PhD, is among many on the subject. According to the researchers in the study, “the pathological diagnosis of pulmonary vascular remodeling depends on the histological assessment of the cellular composition of pulmonary vascular walls, which if abnormal, is described as pulmonary vascular ‘lesions’.”
Pulmonary Hypertension Histology Appearance and Pathology
“Despite the advances in the understanding and treatments aimed at the disease, the pathology of PH clearly lags behind the comprehensive approach employed by pathologists in their assessment of other diseases such as cancer,” the authors wrote.
The current approach is based on screening for abnormal expression of the p53 tumor suppressor or adenomatous polyposis coli (APC) genes, abnormal expression of cytokeratins in breast adenocarcinomas, and markers of cell proliferation in sarcomas.
The treatment and prognosis of PH patients is closely related to the functional status of the pulmonary circulation and the levels of pulmonary vascular resistance and pulmonary artery pressures. In addition, the pulmonary hypertension histology and pathology can also help determine if the disease is mild to moderate or severe, and divide it into the four classes that include muscular hypertrophy (grade I), intimal proliferation (grade II), concentric laminar intimal fibrosis (grade III), necrotizing vasculitis (grade IV), plexiform lesions (grade V), and dilatation and angiomatoid lesions (grade VI).
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