A 32-year-old male heavy smoker presents with rest pain in his right foot, superficial thrombophlebitis of the leg veins, and dry gangrene of two toes. Distal pulses are absent while proximal pulses are preserved. Angiography shows segmental occlusion of tibial and pedal arteries with corkscrew collaterals. Which finding on biopsy of an affected vessel is most characteristic?

• A Highly cellular inflammatory thrombus containing microabscesses ✓
• B Granulomatous inflammation with multinucleated giant cells in the media
• C Fibrinoid necrosis of the entire wall thickness with aneurysmal dilatation
• D Intimal fibroplasia with fragmentation of the internal elastic lamina

Explanation

Thromboangiitis obliterans (Buerger disease) shows an acute, intensely cellular thrombus composed of polymorphs and mononuclear cells, often with microabscesses, involving medium and small arteries along with adjacent veins and nerves. The classic granulomatous reaction with giant cells points instead to Takayasu or giant cell arteritis, and fibrinoid necrosis with aneurysm formation suggests polyarteritis nodosa. Absolute discontinuation of smoking is the single definitive intervention.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.