Giant cell arteritis: Difference between revisions

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Notes:

*Radiology: halo sign; [[sensitivity]] 86% and [[specificity]] 78%.<ref name=pmid12064840>{{cite journal |~~vauthors~~=Nesher G, Shemesh D, Mates M, Sonnenblick M, Abramowitz HB |title=The predictive value of the halo sign in color Doppler ultrasonography of the temporal arteries for diagnosing giant cell arteritis |journal=J Rheumatol |volume=29 |issue=6 |pages=1224–6 |date=June 2002 |pmid=12064840 |doi= |url=}}</ref>

*Radiology: halo sign (on ultrasound); [[sensitivity]] 86% and [[specificity]] 78%.<ref name=pmid12064840>{{cite journal |authors=Nesher G, Shemesh D, Mates M, Sonnenblick M, Abramowitz HB |title=The predictive value of the halo sign in color Doppler ultrasonography of the temporal arteries for diagnosing giant cell arteritis |journal=J Rheumatol |volume=29 |issue=6 |pages=1224–6 |date=June 2002 |pmid=12064840 |doi= |url=}}</ref>

==Microscopic==

Features ~~- as per Le ''et al.''~~:<ref name=pmid25457237/>

Features:<ref name=pmid25457237/><ref name=pmid23543964/>

*Artery with intimal thickening.

*Artery with intimal thickening and luminal narrowing.

*Transmural inflammatory cells.

*Giant cells.

Notes:

*Inflammation classically [[granuloma|granulomatous]].

*Inflammation classically [[granuloma|granulomatous]]; however, granulomas not required for the diagnosis!

**Granulomas not required for the diagnosis!

**In one series, 11 of 15 patients (73%) had giant cells.<ref name=pmid23543964>{{cite journal |authors=Roberts WC, Zafar S, Ko JM |title=Morphological features of temporal arteritis |journal=Proc (Bayl Univ Med Cent) |volume=26 |issue=2 |pages=109–15 |date=April 2013 |pmid=23543964 |pmc=3603723 |doi=10.1080/08998280.2013.11928932 |url=}}</ref>

**In another series, 33 of 40 patients (83%) had giant cells on the initial biopsy.<ref name=pmid28256573>{{cite journal |authors=Maleszewski JJ, Younge BR, Fritzlen JT, Hunder GG, Goronzy JJ, Warrington KJ, Weyand CM |title=Clinical and pathological evolution of giant cell arteritis: a prospective study of follow-up temporal artery biopsies in 40 treated patients |journal=Mod Pathol |volume=30 |issue=6 |pages=788–796 |date=June 2017 |pmid=28256573 |pmc=5650068 |doi=10.1038/modpathol.2017.10 |url=}}</ref>

*Often accompanied by frank destruction of the arterial wall, e.g. fibrinoid necrosis (pink anucleate arterial wall).

*Luminal narrowing is common (>85% of cases) and typical marked.<ref name=pmid23543964/>

DDx:

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Note:

*The evidence is weak that the biopsy result influences management; a negative biopsy doesn't preclude treatment for clinically presumed giant cell arteritis.<ref name=pmid16287908>{{Cite journal | last1 = Lenton | first1 = J. | last2 = Donnelly | first2 = R. | last3 = Nash | first3 = JR. | title = Does temporal artery biopsy influence the management of temporal arteritis? | journal = QJM | volume = 99 | issue = 1 | pages = 33-6 | month = Jan | year = 2006 | doi = 10.1093/qjmed/hci141 | PMID = 16287908 }}</ref>

===Positive with giant cells===

<pre>

Left Temporal Artery, Biopsy:

- Consistent with temporal arteritis (medium size artery with

lymphohistocytic inflammation, giant cells, arterial wall thickening,

and elastic fibre fragmentation).

</pre>

===Positive===

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The sections show a focal histocytic response with intimal thickening. Giant cells are absent. Fibrinoid necrosis is absent. Significant transmural inflammation is absent.

</pre>

====Alternate====

<pre>

Temporal Artery, Right, Biopsy:

- Medium size artery with mild-to-moderate atherosclerosis, small calcifications and focal internal

elastic lamina disruption, otherwise within normal limits, see comment.

Comment:

A negative biopsy does not rule out the possibility of giant cell (temporal) arteritis, as this may be a focal disorder. The clinical management should be dependent upon the clinical impression.

</pre>

@@ Line 52: / Line 52: @@
 Notes:
-*Radiology: halo sign; [[sensitivity]] 86% and [[specificity]] 78%.<ref name=pmid12064840>{{cite journal |vauthors=Nesher G, Shemesh D, Mates M, Sonnenblick M, Abramowitz HB |title=The predictive value of the halo sign in color Doppler ultrasonography of the temporal arteries for diagnosing giant cell arteritis |journal=J Rheumatol |volume=29 |issue=6 |pages=1224–6 |date=June 2002 |pmid=12064840 |doi= |url=}}</ref>
+*Radiology: halo sign (on ultrasound); [[sensitivity]] 86% and [[specificity]] 78%.<ref name=pmid12064840>{{cite journal |authors=Nesher G, Shemesh D, Mates M, Sonnenblick M, Abramowitz HB |title=The predictive value of the halo sign in color Doppler ultrasonography of the temporal arteries for diagnosing giant cell arteritis |journal=J Rheumatol |volume=29 |issue=6 |pages=1224–6 |date=June 2002 |pmid=12064840 |doi= |url=}}</ref>
 ==Microscopic==
-Features - as per Le ''et al.'':<ref name=pmid25457237/>
+Features:<ref name=pmid25457237/><ref name=pmid23543964/>
-*Artery with intimal thickening.
+*Artery with intimal thickening and luminal narrowing.
 *Transmural inflammatory cells.
 *Giant cells.
 Notes:
-*Inflammation classically [[granuloma|granulomatous]].
+*Inflammation classically [[granuloma|granulomatous]]; however, granulomas not required for the diagnosis!
-**Granulomas not required for the diagnosis!
+**In one series, 11 of 15 patients (73%) had giant cells.<ref name=pmid23543964>{{cite journal |authors=Roberts WC, Zafar S, Ko JM |title=Morphological features of temporal arteritis |journal=Proc (Bayl Univ Med Cent) |volume=26 |issue=2 |pages=109–15 |date=April 2013 |pmid=23543964 |pmc=3603723 |doi=10.1080/08998280.2013.11928932 |url=}}</ref>
+**In another series, 33 of 40 patients (83%) had giant cells on the initial biopsy.<ref name=pmid28256573>{{cite journal |authors=Maleszewski JJ, Younge BR, Fritzlen JT, Hunder GG, Goronzy JJ, Warrington KJ, Weyand CM |title=Clinical and pathological evolution of giant cell arteritis: a prospective study of follow-up temporal artery biopsies in 40 treated patients |journal=Mod Pathol |volume=30 |issue=6 |pages=788–796 |date=June 2017 |pmid=28256573 |pmc=5650068 |doi=10.1038/modpathol.2017.10 |url=}}</ref>
 *Often accompanied by frank destruction of the arterial wall, e.g. fibrinoid necrosis (pink anucleate arterial wall).
+*Luminal narrowing is common (>85% of cases) and typical marked.<ref name=pmid23543964/>
 DDx:
@@ Line 89: / Line 91: @@
 Note:
 *The evidence is weak that the biopsy result influences management; a negative biopsy doesn't preclude treatment for clinically presumed giant cell arteritis.<ref name=pmid16287908>{{Cite journal  | last1 = Lenton | first1 = J. | last2 = Donnelly | first2 = R. | last3 = Nash | first3 = JR. | title = Does temporal artery biopsy influence the management of temporal arteritis? | journal = QJM | volume = 99 | issue = 1 | pages = 33-6 | month = Jan | year = 2006 | doi = 10.1093/qjmed/hci141 | PMID = 16287908 }}</ref>
+===Positive with giant cells===
+<pre>
+Left Temporal Artery, Biopsy:
+     - Consistent with temporal arteritis (medium size artery with
+       lymphohistocytic inflammation, giant cells, arterial wall thickening,
+       and elastic fibre fragmentation).
+</pre>
 ===Positive===
@@ Line 149: / Line 160: @@
 The sections show a focal histocytic response with intimal thickening. Giant cells are absent. Fibrinoid necrosis is absent. Significant transmural inflammation is absent.
+</pre>
+====Alternate====
+<pre>
+Temporal Artery, Right, Biopsy:
+- Medium size artery with mild-to-moderate atherosclerosis, small calcifications and focal internal
+  elastic lamina disruption, otherwise within normal limits, see comment.
+Comment:
+A negative biopsy does not rule out the possibility of giant cell (temporal) arteritis, as this may be a focal disorder. The clinical management should be dependent upon the clinical impression.
 </pre>

Giant cell arteritis: Difference between revisions

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