Pathologic Findings Light Microscopy

By light microscopy, polyarteritis nodosa is characterized by segmental transmural fibrinoid necrosis and accompanying inflammation (Fig. 9.10), which initially has predominantly neutrophils and sometimes eosinophils, but within several days has predominantly mononuclear leukocytes. The segmental inflammation and necrosis in artery walls may produce an aneu-rysm (actually a pseudoaneurysm) by eroding through the artery wall into the perivascular tissue. Infarction and hemorrhage are the major consequences of renal involvement by polyarteritis nodosa.

Polyarteritis nodosa is treated with high-dose corticosteroids, often in combination with cytotoxic drugs such as cyclophosphamide (21). Polyar-

Figure 9.10. Arcuate artery in a renal biopsy from a patient with polyarteritis nodosa showing segmental fibrinoid necrosis with associated leukocyte infiltration and leukocytoclasia (H&E).

teritis nodosa is less likely to recur after induction of remission than is microscopic polyangiitis.

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