Case report: morphological aspects of Buerger's disease

N.S Tsimbalist,A.V Kriuchkova,B.A Suftin,E.A Chupyatova,I.I Babichenko

doi:10.24075/brsmu.2020.004

Abstract

Buerger's disease is a rather rare pathology characterized by nonatherogenic vascular lesion associated with the inflammation in the intima of the vessel and the thrombus formation. Most often the pathological process affects small and medium caliber arteries. Vascular occlusion can lead to tissue ischemia and the trophic ulcers, and cause the extremity amputation. The disorder pathogenesis has not been fully explored. Literature data indicate that the disease development may be associated with autoimmune processes. The paper presents the results of immunohistochemical study of the material obtained after amputation of the lower extremity in a patient diagnosed with Buerger's disease. The patient had a 15-year tobacco smoking experience. In the inflammatory cell infiltrates around the affected vessels, lymphocytes with CD4, CD8 antigens and IgG immunoglobulin deposits were found, which could be considered as the evidence of the autoimmune mechanisms’ involvment. Immunohistochemical reactions with markers of NK cells CD56 and the central component of the C3d complement system were negative. The results of the study suggest that the key role is played by helper and suppressor T lymphocytes, as well as by humoral antibodies of the IgG class.

Highlights

МОРФОЛОГИЧЕСКАЯ ХАРАКТЕРИСТИКА КЛИНИЧЕСКОГО СЛУЧАЯ БОЛЕЗНИ БЮРГЕРАВ статье представлены результаты иммуногистохимического исследования материала, полученного после ампутации нижней конечности у пациента с клиническим диагнозом болезнь Бюргера, имевшего 15-летний стаж курения
Buerger's disease is a rare pathology that is most common in Eastern Europe and Asia
The disease pathogenesis may be associated with endothelial dysfunction [9]

Summary

МОРФОЛОГИЧЕСКАЯ ХАРАКТЕРИСТИКА КЛИНИЧЕСКОГО СЛУЧАЯ БОЛЕЗНИ БЮРГЕРА

В статье представлены результаты иммуногистохимического исследования материала, полученного после ампутации нижней конечности у пациента с клиническим диагнозом болезнь Бюргера, имевшего 15-летний стаж курения. Thromboangiitis obliterans (Buerger's disease) is a progressive, nonatherosclerotic disease that most often affects small and medium arteries [2]. The incidence of the disease in patients with circulatory disorders ranges from 0.5–5% in Europe, and in Japan this indicator can reach 16% [6]. If the patient does not stop smoking tobacco, the disease would progress, which leads to the extremities’ amputation [14]. The paper presents the case of an immunohistochemical study of the affected vessels in patient with Buerger's disease (thromboangiitis obliterans) aimed to clarify the inflammatory infiltrate cellular composition and to identify the IgG deposits

Clinical case report

Findings

Clinical case discussion