HIV: Arteritis
Arteritis during HIV
![](../pics/biopsy/inflammation/hivvasc/hivarttbvlp2.jpg)
Toluidine blue stain
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![](../pics/biopsy/inflammation/hivvasc/hivartcrlp.jpg)
Congo red
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![](../pics/biopsy/inflammation/hivvasc/hivarthelpar.jpg)
H&E stain
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Arteritis
Artery (Above, White arrow): Occluded; Wall damaged; Histiocytic cells (Below; White Arrow)
Endoneurium: Pale regions (Above, Black arrow); Moderately prominent microvessels; Histiocytes, scattered (Below; Black Arrow)
![](../pics/biopsy/inflammation/hivvasc/hivartacplpar.jpg)
Acid phosphatase
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Epineurial Artery
Increased cells in most of wall
Neovascularization
Lumen: Occluded
![](../pics/biopsy/inflammation/hivvasc/hivarthelp2.jpg)
H&E stain
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Hemosiderin
Deposits in epineurium (Arrow)
![](../pics/biopsy/inflammation/hivvasc/hivarthemosidhehp3ar.jpg)
H&E stain
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Neovascularization: Within lumen of Occluded artery
![](../pics/biopsy/inflammation/hivvasc/hivartvvgmp2.jpg)
VvG stain
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Epineurial Artery (Serial sections)
Fibril layer: Irregular (Arrow)
Neovascularization
Lumen: Occluded
Connective tissue around artery: Damaged in some areas (Below)
![](../pics/biopsy/inflammation/hivvasc/hivartvvgmp1ar.jpg)
VvG stain
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![](../pics/biopsy/inflammation/hivvasc/hivarttbmp2.jpg)
Toluidine blue stain
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Epineurial Artery
Neovascularization
Connective tissue around artery: Damaged in some areas; Irregular structure
![](../pics/biopsy/inflammation/hivvasc/hivartalp.jpg)
Alkaline phosphatase stain
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Epineurial Artery
Neovascularization: New vessels within larger vessel stained with alkaline phosphatase
![](../pics/biopsy/inflammation/hivvasc/hivarttbmp.jpg)
Toluidine blue stain
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Epineurial connective tissue: Neovascularization & Fragmentation
![](../pics/biopsy/inflammation/hivvasc/hivarttb4.jpg)
Toluidine blue stain
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![](../pics/biopsy/inflammation/hivvasc/hivarttbmp3.jpg)
Toluidine blue stain
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Epineurial connective tissue: Fragmentation
![](../pics/biopsy/inflammation/hivvasc/hivarteritisgtmp2.jpg)
Gomori trichrome
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![](../pics/biopsy/inflammation/hivvasc/hivartcrmp.jpg)
Congo red
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![](../pics/biopsy/inflammation/hivvasc/hivartcrmp3.jpg)
Congo red
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Occluded Artery
No lumen
Histiocytes within vessel wall: In patchy regions & Scattered
Lymphocytes: Not prominent
![](../pics/biopsy/inflammation/hivvasc/hivartacpmp.jpg)
Acid phosphatase
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![](../pics/biopsy/inflammation/hivvasc/hivartacphp.jpg)
Acid phosphatase
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Artery: Abnormal
Many cells all through wall
![](../pics/biopsy/inflammation/hivvasc/hivart2tbmp.jpg)
Toluidine blue stain
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Wallerian Degeneration: Myelinated Axon loss, Later stages
Myelinated axons: Severe loss
Remaining myelin fragments: Reduced staining (Arrows)
![](../pics/biopsy/inflammation/hivvasc/hivarteritisgthpar.jpg)
Gomori trichrome stain
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![](../pics/biopsy/inflammation/hivvasc/hivarteritisgtmpar.jpg)
Gomori trichrome stain
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Axon loss: Later stages
Myelinated axons: Severe loss
Myelin remnants: Minimal staining on Gomori trichrome & VvG (Arrows)
![](../pics/biopsy/inflammation/hivvasc/hivartwdvvgmpar.jpg)
VvG stain
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Axon loss
Myelinated axons: Severe loss
Perineurium
Normal
![](../pics/biopsy/inflammation/hivvasc/hivartwdtb.jpg)
Toluidine blue stain
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![](../pics/biopsy/inflammation/hivvasc/hivartacpmp2.jpg)
Acid phosphatase stain
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Axon loss: Later stages of Wallerian degeneration
Histiocytic cells scattered in endomysium (Above)
Probable histiocytic cells around an endoneurial microvessel (Below; Arrow)
![](../pics/biopsy/inflammation/hivvasc/hivartcrmp2.jpg)
Congo red stain
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Complement C5b-9 stain
Wallerian degeneration: Present in endomysium
Endomysial microvessels: Mild staining
C5b-9 stain
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HIV: Inflammatory Vasculopathy, Small Epineurial Vessels (Venitis in muscle)
![](../pics/biopsy/inflammation/hivvasc/hivveinhelp.jpg)
H&E stain
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Epineurial Vessels: Inflammatory Vasculopathy
Lymphocytes: Present around & within walls of small epineurial vessels
Epineurial connective tissue:
Neovascularization
Endoneurium
Myelinated axons:
Wallerian Degeneration
![](../pics/biopsy/inflammation/hivvasc/hivveinvvglp2.jpg)
VvG stain
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Epineurial connective tissue: MHC I
Increased staining
Epineurial Perivascular cells: MHC I
Increased staining
![](../pics/biopsy/inflammation/hivvasc/hivveinmhc1lp.jpg)
MHC I stain
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![](../pics/biopsy/inflammation/hivvasc/hivveinhemp3.jpg)
H&E stain
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HIV: Inflammatory vasculopathy
Inflammation: Surrounds small epineurial vessels
MHC I
Stains
Cells around epineurial small vessels
Epineurial connective tissue
Wallerian Degeneration of Myelinated Axons: Common
![](../pics/biopsy/inflammation/hivvasc/hivveinmhc1b.jpg)
MHC I stain
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Small Vessel Inflammatory Vasculopathy: Epineurial Neovascularization
![](../pics/biopsy/inflammation/hivvasc/hivveinatplp.jpg)
ATPase pH 4.3 stain
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Neovascularization
New vessels
Small; Multiple
Stained by:
ATPase;
Alkaline phosphatase
Associated connective tissue:
Pale; Fragmented;
Cellular, including histiocytes
![](../pics/biopsy/inflammation/hivvasc/hivveinvvgmp.jpg)
VvG stain
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![](../pics/biopsy/inflammation/hivvasc/hivveinhemp2.jpg)
H&E stain
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Neovascularization: Epineurial
![](../pics/biopsy/inflammation/hivvasc/hivveinvvgmp2.jpg)
VvG stain
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![](../pics/biopsy/inflammation/hivvasc/hivveingthp2.jpg)
Gomori trichrome stain
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Neovascularization: Epineurial
![](../pics/biopsy/inflammation/hivvasc/hivveingthp.jpg)
Gomori trichrome stain
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![](../pics/biopsy/inflammation/hivvasc/hivveinacpmp.jpg)
Acid phosphatase stain
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Histiocytes
Often present in epineurial connective tissue & around vessels in regions of neovascularization
![](../pics/biopsy/inflammation/hivvasc/hivveinacphp.jpg)
Acid phosphatase stain
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Endothelium in new Epineurial vessels stains with Alkaline phosphatase
![](../pics/biopsy/inflammation/hivvasc/hivveinalp.jpg)
Alkaline phosphatase stain
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![](../pics/biopsy/inflammation/hivvasc/hivveinatphp.jpg)
ATPase pH 4.3 stain
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Endothelium in new Epineurial vessels stains with ATPase
![](../pics/biopsy/inflammation/hivvasc/hivveinatphp3.jpg)
ATPase pH 4.3 stain
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![](../pics/biopsy/inflammation/hivvasc/hivveinatphp2.jpg)
ATPase pH 4.3 stain
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MHC I positive cells & epineurium
![](../pics/biopsy/inflammation/hivvasc/hivveinmhc1.jpg)
MHC I stain
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Wallerian Degeneration: Early, Active & Acute
![](../pics/biopsy/inflammation/hivvasc/hivveingtmp.jpg)
Gomori trichrome stain
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Wallerian Degeneration
Myelin: Irregular structure or Pale stain
![](../pics/biopsy/inflammation/hivvasc/hivveingtmp2.jpg)
Gomori trichrome stain
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![](../pics/biopsy/inflammation/hivvasc/hivveingthp3.jpg)
Gomori trichrome stain
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Wallerian Degeneration
Myelin: Irregular structure
![](../pics/biopsy/inflammation/hivvasc/hivvveinwdvvg.jpg)
VvG stain
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Wallerian Degeneration (Early)
Histiocytes: Scattered in endoneurium
![](../pics/biopsy/inflammation/hivvasc/hivveinacplp.jpg)
Acid phosphatase stain
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Wallerian Degeneration (Early)
NCAM: Mild staining of myelin
![](../pics/biopsy/inflammation/hivvasc/hivveinncam.jpg)
NCAM stain
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Wallerian Degeneration (Early)
Neurofilament staining of myelinated axons: Lost or fragmented
Neurofilament staining of unmyelinaterd axons: Relatively preserved
![](../pics/biopsy/inflammation/hivvasc/hivveinnf.jpg)
Neurofilament stain
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![](../pics/biopsy/inflammation/hivvasc/hivveintbmp2.jpg)
Toluidine blue stain
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Wallerian Degeneration (Early)
Myelin structure: Irregular
Large myelin fragments: Present in cytoplasm of large "Degradative" Schwann cells
![](../pics/biopsy/inflammation/hivvasc/hivveintbhp1.jpg)
Toluidine blue stain
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![](../pics/biopsy/inflammation/hivvasc/hivveintbhp3.jpg)
Toluidine blue stain
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Wallerian Degeneration (Early)
Myelin structure: Irregular
Large myelin fragments: Present in cytoplasm of large "Phagocytic" Schwammm cells
![](../pics/biopsy/inflammation/hivvasc/hivveintbhp4.jpg)
Toluidine blue stain
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![](../pics/biopsy/inflammation/hivvasc/hivveintbhp5.jpg)
Toluidine blue stain
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Wallerian Degeneration (Early)
Myelin structure: Irregular
Large myelin fragments: Present in cytoplasm of large "Phagocytic" Schwammm cells
![](../pics/biopsy/inflammation/hivvasc/hivveintbhp7.jpg)
Toluidine blue stain
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![](../pics/biopsy/inflammation/hivvasc/hivveinnfgmbpr.jpg)
Neurofilament (Green) + MBP (Red)
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Wallerian Degeneration (Early)
Neurofilament staining of myelinated axons
Lost or fragmented
MBP & P0 stained myelin have no associated axons
Neurofilament staining of unmyelinaterd axons: Relatively preserved
![](../pics/biopsy/inflammation/hivvasc/hivveinnfgp0r.jpg)
Neurofilament (Green) + P0 (Red)
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![](../pics/biopsy/inflammation/hivvasc/hivveinnfgncamr.jpg)
Neurofilament (Green) + NCAM (Red)
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Wallerian Degeneration (Early)
Neurofilament staining of myelinated axons
Lost or fragmented
Neurofilament staining of unmyelinaterd axons
Some Loss: Empty (red) non-myeliating Schwann cells
Myelin in Peripheral Nerve: 2 types
Small myelin sheaths (Green): Contain only P0
Large myelin sheaths (Yellow): Contain both P0 & MBP
![](../pics/biopsy/inflammation/hivvasc/hivveinp0gmbpr.jpg)
P0 (Green) + MBP (Red)
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Wallerian Degeneration
Endothelial cells in Endoneurial microvessels: Often large
![](../pics/biopsy/inflammation/hivvasc/hivveinhemp.jpg)
H&E stain
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![](../pics/biopsy/inflammation/hivvasc/hivveinhehp.jpg)
H&E stain
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Wallerian Degeneration
Endothelial cells in Endoneurial microvessels: Often large
![](../pics/biopsy/inflammation/hivvasc/hivveinhehp2.jpg)
H&E stain
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HIV: Inflammatory Veinopathy
Same patient as: Small Vessel Inflammatory Neuropathy
![](../pics/biopsy/inflammation/hivvasc/hivveinmuscvvgmp3.jpg)
VvG stain
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Perimysial Veins
Outer fibril layer: Damaged & Incomplete
Inner layers: Pale & Cellular
![](../pics/biopsy/inflammation/hivvasc/hivveinmuscvvgmp2.jpg)
VvG stain
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![](../pics/biopsy/inflammation/hivvasc/hivveinmuscvvghp2.jpg)
VvG stain
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Perimysial Veins
Outer fibril layer: Damaged & Incomplete
Inflammatory cells: Present around outside of vein
Inner layers: Pale & Cellular
Perimysial Artery: Normal
![](../pics/biopsy/inflammation/hivvasc/hivvmuscveinartvvg.jpg)
VvG stain
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Perimysial Veins
Histiocytic Inflammatory cells: Present around periphery of vein
![](../pics/biopsy/inflammation/hivvasc/hivveinmuscacp.jpg)
Acid phosphatase stain
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Perimysial Veins
Inflammatory cells: Present around periphery of vein & In perimysium
![](../pics/biopsy/inflammation/hivvasc/hivveinmusccrmp2.jpg)
Congo red stain
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![](../pics/biopsy/inflammation/hivvasc/hivveinmuscgt.jpg)
Gomori trichrome stain
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Perimysial Cell Foci
Contain scattered esterase-positive histiocytes (Below)
![](../pics/biopsy/inflammation/hivvasc/hivveinmuscvestmp2.jpg)
Esterase stain
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![](../pics/biopsy/inflammation/hivvasc/hivveinmuschemp.jpg)
H&E stain
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HIV-Vasculitis: Muscle fiber involvement
Morphology: Mostly normla
![](../pics/biopsy/inflammation/hivvasc/hivveinmuschemp4.jpg)
H&E stain
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![](../pics/biopsy/inflammation/hivvasc/hivveinmuscmhc1.jpg)
MHC I stain
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HIV-Vasculitis: Muscle fiber involvement
MHC I: Upregulated on muscle fiber surfaces
![](../pics/biopsy/inflammation/hivvasc/hivveinmuscmhc1b.jpg)
MHC I stain
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HIV-Vasculitis: Capillaries
Sizes: Midly large
Numbers: Normal or Mildly increased
![](../pics/biopsy/inflammation/hivvasc/hivveinmusculex.jpg)
UEA I stain
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6/1/2023