A 62-year-old man with a 40-pack-year smoking history presents with bilateral hand ulceration and digital gangrene. He has a history of superficial migratory thrombophlebitis. Allen's test is abnormal bilaterally. Which histopathological finding is pathognomonic of the underlying condition?

• A Granulomatous inflammation with multinucleated giant cells in the tunica media
• B Foam cell accumulation with cholesterol clefts in the intima
• C Acute thrombus with intact internal elastic lamina and microabscesses ✓
• D Fibrinoid necrosis of the vessel wall with eosinophilic infiltration

Explanation

Thromboangiitis obliterans (Buerger's disease) affects small and medium-sized vessels in young smokers. Pathognomonic histology shows an acute thrombus with microabscesses and intact internal elastic lamina, distinguishing it from atherosclerosis. The inflammatory process involves all three vessel layers but spares the internal elastic lamina. Giant cell involvement suggests Takayasu arteritis. Cholesterol clefts indicate atherosclerosis. Fibrinoid necrosis is seen in polyarteritis nodosa.

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.