1. Inflammatory ascending aortic disease: Perspectives from pathology
Joseph J. Maleszewski, MD 
The Journal of Thoracic and Cardiovascular Surgery 
Volume 149, Issue 2, Pages S176-S183 (February 2015)
DOI: /j.jtcvs
Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

2. Figure 1
Aortic schematic diagram. Regional differences in aortic pathology are probably explained, at least in part, by the varying embryologic origins. The aortic root is derived primarily from the second heart field (lateral plate mesoderm), whereas the ascending aorta and arch are of neural crest derivation. The remaining aorta is derived from the paraxial mesoderm.
The Journal of Thoracic and Cardiovascular Surgery  , S176-S183DOI: ( /j.jtcvs )
Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

3. Figure 2
Gross specimens. A, This photograph depicts a segmental aortic resection received intact and easily orientable by the pathologist. B, This photograph depicts an opened specimen, difficult to orient and representatively sample.
The Journal of Thoracic and Cardiovascular Surgery  , S176-S183DOI: ( /j.jtcvs )
Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

4. Figure 3
Dissection and sampling of ascending aortic specimens. The specimen is measured, opened, and sampled. The intimal wrinkling in this example is a clue to the underlying aortitis.
The Journal of Thoracic and Cardiovascular Surgery  , S176-S183DOI: ( /j.jtcvs )
Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

5. Figure 4
Normal microanatomy of the aorta on elastic stain. This photomicrograph exhibits a normal, full-thickness section of aortic wall. The elastic lamellae are parallel and even in distribution from the adventitia to the intima (Verhoeff-van Gieson staining).
The Journal of Thoracic and Cardiovascular Surgery  , S176-S183DOI: ( /j.jtcvs )
Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

6. Figure 5
Disease histologic characteristics. A, Atherosclerosis with an intense chronic inflammatory infiltrate (hematoxylin and eosin staining). B, Giant cell arteritis involving the aorta with numerous giant cells and associated chronic inflammatory infiltrate. Note the puckered appearance of the intimal surface (arrows), the histologic correlate to gross intimal wrinkling (“tree barking”; hematoxylin and eosin staining). C, A Verhoeff-van Gieson elastic stain highlights the “moth-eaten” appearance of the aortic media, caused by underlying giant cell arteritis involving the aorta. D, Laminar medial necrosis, although not specific for aortitis, may occasionally be seen in areas away from active inflammation, characterized by smooth muscle myocyte nuclear loss and collapsed or condensed elastic lamellae (arrowheads; Verhoeff-van Gieson staining). E, Granulomatosis with polyangiitis, characterized by irregular basophilic (purple-blue) necrosis throughout the aortic wall, so-called geographic necrosis (hematoxylin and eosin staining). F, Sarcoidosis periaortitis, with numerous well-formed nonnecrotizing granulomas in the adventitia (asterisks) and focal extension into the media (hematoxylin and eosin staining). G, Purulent aortitis, characterized by exuberant neutrophilic infiltrate throughout the involved aorta (hematoxylin and eosin staining). H, Pyogenic aortitis, characterized by a neutrophilic infiltrate with tissue destruction.
The Journal of Thoracic and Cardiovascular Surgery  , S176-S183DOI: ( /j.jtcvs )
Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions