Font Ramon L, Prabhakaran Venkatesh C
Department of Ophthamology, Cullen Eye Institute, Baylor College of Medicine, One Baylor Plaza, Houston, Texas 77030, USA.
Br J Ophthalmol. 2007 Feb;91(2):204-9. doi: 10.1136/bjo.2006.101725. Epub 2006 Sep 20.
To establish the histological and immunohistochemical parameters that are helpful in recognising temporal arteritis in patients who have been treated with steroids before biopsy, and to analyse the clinical features and correlate them with the histological findings.
A retrospective review of charts of 35 patients treated with steroids before obtaining temporal artery biopsy specimens, spanning a 11-year period from 1995 to 2005. The study was conducted at the Ophthalmic Pathology Laboratory, Cullen Eye Institute, Houston, Texas, USA. The clinical features were evaluated and correlated with the histopathological findings. Each case was evaluated with respect to age, sex, race, clinical findings, erythrocyte sedimentation rate, corticosteroid dosage (oral versus intravenous) and the duration of treatment. The time interval between obtaining the biopsy specimen and the onset of steroid treatment was carefully recorded for each patient. In selected cases, histiocytic markers (CD-68 and HAM-56) were used to identify the presence of epithelioid histiocytes, which characterises a granulomatous inflammation. Other immunohistochemical studies (CD3, CD20, CD4, CD8, CD45RO, CD45RA and S-100 protein) were performed in selected cases to characterise the inflammatory cells.
The three most reliable histopathological parameters of corticosteroid-treated temporal arteritis are the following: (1) complete or incomplete mantle of lymphocytes and epithelioid histiocytes located between the outer muscular layer and the adventitia; (2) large circumferential defects in the elastic lamina (best seen with the Movat's pentachrome); and (3) absent or few small multinucleated giant cells. In some cases the main artery appears normal, whereas the primary branches show evidence of a healing arteritis. The histological findings vary according to the duration of treatment before obtaining the biopsy specimen.
Striking histological differences can be recognised objectively between patients with active (untreated) giant cell arteritis and patients who have been treated with corticosteroids. The earliest histopathological changes were detected by the end of the first week after steroid treatment (usually after day 4 to the end of the first week). The histological findings were more difficult to recognise at 2-3 months after steroid treatment. Ophthalmic and general pathologists should be able to recognise this entity on the basis of the histological findings including the special stains and results of immunohistochemical studies (CD-68 and HAM-56).
确立有助于识别在活检前已接受类固醇治疗患者的颞动脉炎的组织学和免疫组化参数，并分析临床特征并将其与组织学发现相关联。
对1995年至2005年这11年间35例在获取颞动脉活检标本前接受类固醇治疗患者的病历进行回顾性研究。该研究在美国得克萨斯州休斯顿市卡伦眼科研究所眼科病理实验室进行。对临床特征进行评估并与组织病理学发现相关联。对每个病例评估年龄、性别、种族、临床发现、红细胞沉降率、皮质类固醇剂量（口服与静脉注射）及治疗持续时间。仔细记录每位患者获取活检标本与开始类固醇治疗之间的时间间隔。在选定病例中，使用组织细胞标志物（CD-68和HAM-56）识别上皮样组织细胞的存在，其为肉芽肿性炎症的特征。在选定病例中进行其他免疫组化研究（CD3、CD20、CD4、CD8、CD45RO、CD45RA和S-100蛋白）以对炎症细胞进行特征描述。
类固醇治疗的颞动脉炎最可靠的三个组织病理学参数如下：（1）位于外肌层和外膜之间的淋巴细胞和上皮样组织细胞的完整或不完整套膜；（2）弹性膜的大的环形缺损（用莫瓦特五色染色法最易观察到）；（3）无或少量小的多核巨细胞。在某些病例中，主要动脉看似正常，而主要分支显示有愈合性动脉炎的证据。组织学发现根据获取活检标本前的治疗持续时间而有所不同。
在活动性（未治疗）巨细胞动脉炎患者与接受皮质类固醇治疗的患者之间可客观识别出显著的组织学差异。最早的组织病理学变化在类固醇治疗后第一周结束时（通常在第4天至第一周结束）被检测到。在类固醇治疗后2至3个月时，组织学发现更难识别。眼科和普通病理学家应能够根据包括特殊染色及免疫组化研究（CD-68和HAM-56）结果在内的组织学发现识别该疾病。
