What histologic findings you should expect to see in the biopsy of the patient in the following case?
A 57-year-old woman with unilateral headache, vision loss and "morning joint stiffness" has a biopsy of her temporal artery done in your office.Â What are the histologic findings you would expect to see in the biopsy?
A. Large vessel giant cell vasculitis with fragmentation of elastic lamina B. Small vessel eosinophilic vasculitis C. Medium vessel vasculitis with fibrinoid necrosis D. Large vessel granulomatous vasculitis with massive intimal fibrosis E. Medium vessel transmural vasculitis
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C. Wasek, Philanthropist, Post Graduate, Corpus Christi
Answered on Jan 31, 2019
The answer to this question is letter A. This is also known as a condition called temporal arteritis. This is a condition wherein the temporal arteries that are in charge of providing the blood supply to the brain and the head becomes damaged. There are some who do not have damaged arteries but the arteries are inflamed due to various possible reasons.
Do remember that this is a type of condition that may be connected to a lot of other conditions which means that without proper treatment, it can start to become serious after some time. If this is detected early, there are some treatments that can be done in order to stabilize one’s condition.
1. large vessel giant cell vasculitis with fragmentation of elastic lamina-giant cell (temporal) arteritis:
histology: granulomatous inflammation
media and intima
multinucleated giant cells
necrosis and fragmentation of the internal elastic membrane
later stage: intimal thickening and medial fibrosis
superficial temporal artery is thickened, swollen and tender
ipsilateral visual loss
polymyalgia rheumatica (pain and morning stiffness in the neck, shoulders, and hips)
diagnosed by temporal artery biopsy
treat with anti-inflammatory drugs (corticosteroids)
prognosis is good
subsides in 6 to 12 months
if left untreated blindness akayasu arteritis:
granulomatous inflammation with [[ massive intimal fibrosis ]]
aortic arch and its major branches
irregular thickening (intimal fibrosis) of the vascular wall
narrowing of the orifices of major arterial branches (carotid, subclavian)
giant cell granulomas
transmural mononuclear inflammation
later changes: [[ fibrosis and intimal proliferation ]]