Onion-skin arteriolosclerosis is best described as:

Onion-skin arteriolosclerosis is best described as:

• A. Atherosclerotic plaque formation in large arteries.
• B. Concentric laminated thickening of arterioles due to hyperplastic arteriolosclerosis.
• C. Fibrinoid necrosis of small vessels in immune vasculitis.
• D. Hyperplastic arteriolosclerosis with concentric laminated thickening; associated with malignant hypertension.

Answer: (D)

Onion-skin arteriolosclerosis is the pattern of hyperplastic arteriolosclerosis seen in malignant hypertension. It shows concentric, laminated thickening of the small-artery/intima due to proliferation of smooth muscle cells with reduplication of the basement membrane, giving an onion-skin appearance on microscopic exam. This feature is specific to small vessels and is strongly associated with malignant or severely elevated blood pressure, rather than with atherosclerosis of large arteries or fibrinoid necrosis seen in immune vasculitis. Therefore, the description that best fits is hyperplastic arteriolosclerosis with concentric laminated thickening, associated with malignant hypertension.

Onion-skin arteriolosclerosis is the pattern of hyperplastic arteriolosclerosis seen in malignant hypertension. It shows concentric, laminated thickening of the small-artery/intima due to proliferation of smooth muscle cells with reduplication of the basement membrane, giving an onion-skin appearance on microscopic exam. This feature is specific to small vessels and is strongly associated with malignant or severely elevated blood pressure, rather than with atherosclerosis of large arteries or fibrinoid necrosis seen in immune vasculitis. Therefore, the description that best fits is hyperplastic arteriolosclerosis with concentric laminated thickening, associated with malignant hypertension.