Myriad Pillars Formed By Intussusceptive Angiogenesis As The Basis Of Intravascular Papillary Endothelial Hyperplasia (Ipeh). Ipeh Is Intussusceptive Angiogenesis Made A Lesion

Intussusceptive angiogenesis (IA) is the process by which pre-existing blood vessels split, expand and remodel through intravascular pillar formation. In previous works, we studied the morphologic characteristics of intravascular papillary endothelial hyperplasia (IPEH) and suggested the participation of IA in the histogenesis of the lesion. Our current goal is to demonstrate that myriad papillae in IPEH are in fact myriad pillars, the hallmarks of IA. For this purpose, specimens of 14 cases of IPEH were used for conventional histologic techniques, immunohistochemistry and immunofluorescence in confocal microscopy. The studies showed the following pillar characteristics: a) structural composition by an endothelial cell (EC) cover and a connective core, b) characteristic pillar image and its appearance and disappearance in whole-mounted and series of individual views in confocal microscopy (requirements for pillar identification), c) arrangement in masses, alignments and meshes, and d) formation from vein intimal ECs, which extend and originate loops that encircle vein wall components (interstitial tissue structures: ITSs) and fibrin. The encircling ECs form the pillar cover and the encircled ITSs or fibrin form the initial core. Intraluminal endothelial bridges also originate from the vessel wall and from the pillars (nascent and thin pillars). In conclusion, the formation of myriad pillars, predominantly in veins, is the basis of IPEH. This lesion may therefore be considered an excessive expression of IA: IA becomes a lesion.