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Dieulafoy Lesion / Caliber Persistent Artery

Definition

  • Presence in the mucosa of an abnormally large artery for that level

Alternate/Historical Names

  • Cirsoid aneurysm

Diagnostic Criteria

  • Large artery present at the level of muscularis mucosae or higher
    • Abnormally large for that level (0.68-2.42 mm)
      • Normal size for submucosa is (0.7-1.29 mm)
      • Normal size for muscularis mucosae is ≤0.13 mm
    • Normal in structure and size for submucosa
    • Accompanied by vein of similar caliber
  • Significant risk of ulceration with significant bleeding
    • Ulcer is generally very small (2-10 mm)
    • Localized precisely to area where artery and vein reach the mucosa
    • Both artery and vein are perforated
    • Vessels may show inflammation and necrosis if perforated
  • Primarily gastric but has been reported at other sites
  • Mean age 50’s
    • Range 16-91

Robert V Rouse MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342

Original posting : November 11, 2009

Differential Diagnosis

  • Vascular malformations are composed of vessels with abnormal structure
    • Dieulafoy vessels are normal in structure, but out of place
  • Deep ulcers eroding vessels below the level of the muscularis mucosae are not this lesion
Dieulafoy Lesion / Caliber Persistent Artery Gastric Antral Vascular Ectasia
Abnormaly large vessel in lamina propria Capillary ectasia and thrombosis in lamina propria
No specific submucosal lesion Submucosal vessels may be tortuous
No microthrombi Microthrombi characteristic
Lamina propria normal except for large vessels Fibromuscular hyperplasia with hyalinization of lamina propria

Bibliography

  • Noffsinger A, Fenoglio-Preiser CM, Maru D, Gilinisky N.  Gastrointestinal Diseases, AFIP Atlas of Nontumor Pathology, First Series, Fascicle 5, 2007.
  • Mikó TL, Thomázy VA. The caliber persistent artery of the stomach: a unifying approach to gastric aneurysm, Dieulafoy's lesion, and submucosal arterial malformation. Hum Pathol. 1988 Aug;19(8):914-21.
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