Studies on the Histopathology of Temporal Arteritis

Abstract

Aims: The aim of this paper was to identify the location and to grade the severity of most significant inflammation within positive temporal artery biopsies along with other key clinical and histologic characteristics. Methods: Charts and pathology slides for 70 patients diagnosed with temporal arteritis at the University of Wisconsin (UW) Hospital and Clinics from 1989 to 2015 were reviewed. A subset of 48 specimens was immunostained for CD68 and graded on a scale from 0 to +++; the location of staining was recorded. Results: The most severe granulomatous inflammation was in the media and adventitia in 13% (9/70) of the biopsies; the remaining had uniform full thickness inflammation. Of the slides that were stained with CD68, 94% (45/48) were positive. In 42% (19/45), the stained cells were found mainly in the muscularis and adventitia. Seven percent (3/45) of the slides had staining solely around the internal elastic lamina, and 2% (1/45) had staining limited to the intima. Conclusions: With a few exceptions, granulomatous inflammation in positive temporal artery biopsies is most evident at the media and adventitia or is uniform throughout the layers of the artery. Our study lends support to the theory that the muscularis and adventitia may play an inciting role in the pathogenesis of temporal arteritis.

Diagnosis and management of giant cell arteritis: Major review

“…The arteritis may involve a segment as short as 330 m with the rest of the biopsy specimen being normal 125 . Skip lesions can be seen in 12% to 28% of the cases 123,125 . Features of healed arteritis have been described in literature but the findings are similar to histopathological changes in atherosclerosis 105,126,127 .…”

“…Giant cells can be absent in 18% to 50% of biopsy specimens. 123 Giant cells are not specific for GCA but can also be seen in infectious, autoimmune, neoplastic, foreign body-related inflammatory and genetic conditions. 124 The arteritis may involve a segment as short as 330 m with the rest of the biopsy specimen being normal.…”

Giant-cell Arteritis of the Ovarian Arteries: A Rare Manifestation of a Common Disease

“…GCA is the most common form of systemic vasculitis in adults, with an annual incidence of 20 per 100,000 individuals among Northern Europeans above 50 years of age [4] . GCA is caused by dendritic cells in the vessel wall, recruiting T-cells and macrophages to locally form a granulomatous infiltrate, characterized by giant cells (fused macrophages) [5] . GCA most commonly involves the superficial temporal artery, but it can also affect the carotid arteries, the vertebral arteries, the subclavian, axillary and proximal brachial arteries, the ascending aorta and the coronary arteries [3] .…”

The diagnosis and management of temporal arteritis

“…1,120 CD4+ T lymphocytes are thought to enter the vessel wall in response to an unidentified antigen, influencing macrophage differentiation via Toll-like receptors resulting in myofibroblast proliferation, luminal stenosis, and interleukin (IL) production. 121 In particular, IL-6 and IL-12 are two inflammatory cytokines that are considered targets for immunotherapy. 122 The degree of intimal hyperplasia appears to be directly proportional to the degree of inflammation.…”

“…102 Other studies report that the internal elastic lamina may incite TA as giant cells sometimes contain elastic lamina fragments, and that the inflammation is centred in the elastic lamina. 121 In TA, the presence of giant cells is not required for diagnosis, with up to 50 per cent of positive TABs featuring chronic inflammation without multinucleated giant cells. 122…”