49,256
edits
Difference between revisions of "Giant cell arteritis"
Jump to navigation
Jump to search
no edit summary
| (4 intermediate revisions by the same user not shown) | |||
| Line 55: | Line 55: | ||
==Microscopic== | ==Microscopic== | ||
Features | Features:<ref name=pmid25457237/><ref name=pmid23543964/> | ||
*Artery with intimal thickening. | *Artery with intimal thickening and luminal narrowing. | ||
*Transmural inflammatory cells. | *Transmural inflammatory cells. | ||
*Giant cells. | *Giant cells. | ||
Notes: | Notes: | ||
*Inflammation classically [[granuloma|granulomatous]] | *Inflammation classically [[granuloma|granulomatous]]; however, 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). | *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: | DDx: | ||
| Line 158: | 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. | 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> | </pre> | ||