Colon
Other nonneoplastic
Idiopathic myointimal hyperplasia of mesenteric veins
Author: Raul S. Gonzalez, M.D.
Last author update: 26 February 2021
Last staff update: 5 March 2021
Copyright: 2002-2025, PathologyOutlines.com, Inc.
PubMed Search: Idiopathic myointimal hyperplasia of mesenteric veins
Table of Contents
Definition / general | Essential features | Epidemiology | Sites | Etiology | Clinical features | Case reports | Treatment | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Sample pathology report | Differential diagnosis | Board review style question #1 | Board review style answer #1Cite this page: Gonzalez RS. Idiopathic myointimal hyperplasia of mesenteric veins. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/colonmyointimalhyperplasia.html. Accessed January 9th, 2025.
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
- Rare; usually occurs in young male adults but can occur in older patients and in women (Gastroenterol Hepatol (N Y) 2012;8:700)
Sites
- Usually (but not always) involves the left colon
Etiology
- Might result from traumatic arteriovenous fistulization (Pathol Res Pract 2006;202:517)
Clinical features
- Diarrhea / constipation, abdominal pain, rectal bleeding
Case reports
- 38 year man with abdominal pain and 40 pound weight loss, clinically diagnosed with inflammatory bowel disease (J Clin Gastroenterol 2005;39:704)
Treatment
- Surgery usually required
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
Contributed by Raul S. Gonzalez, M.D.
Biopsy: mucosal
proliferation
of thick walled
vessels
Resection:
thickened
mural veins
2 thickened veins and 1 unaffected artery
Elastin stain
highlights
internal elastic
lamina of artery
Positive stains
- Elastin stain confirms that blood vessels with myointimal hyperplasia are veins, not arteries
Sample pathology report
- Descending colon, resection:
- Segment of colon with prominent vascular reactive changes and myointimal hyperplasia of mesenteric veins (see comment)
- Margins of resection unremarkable.
- Seven benign lymph nodes.
- Comment: There is no definitive evidence of chronic colitis. An elastic special stain highlights mesenteric veins with myointimal hyperplasia, distinguishing them from 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)
Board review style question #1
Which of the following is true about idiopathic myointimal hyperplasia of mesenteric veins?
- An elastin stain can help distinguish arteries from abnormal veins
- Histologic changes are seen in resection but not biopsy specimens
- It classically occurs along the right colon in older female patients
- It is asymptomatic and incidentally observed
Board review style answer #1
A. An elastin stain can help distinguish arteries from abnormal veins
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