Colon non tumor
Non-neoplastic, non-congenital lesions
Idiopathic myointimal hyperplasia of mesenteric veins

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

Revised: 13 May 2016, last major update May 2016

Copyright: (c) 2002-2016, PathologyOutlines.com, Inc.

PubMed Search: Idiopathic myointimal hyperplasia of mesenteric veins

Cite this page: Idiopathic myointimal hyperplasia of mesenteric veins. PathologyOutlines.com website. http://pathologyoutlines.com/topic/colonmyointimalhyperplasia.html. Accessed July 25th, 2017.
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 servers - contributed by Dr. Raul S. Gonzalez:

Biopsy: mucosal proliferation
of thick walled vessels

Resection: thickened
mural veins

High power: 2 thickened veins
and one unaffected artery

Elastin stain highlighs
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)