Sloane Jake, Aziz Abdul, Makhdoomi Khalid
Vascular Surgery Department, Kings Mill Hospital, Mansfield Road, Sutton in Ashfield, Nottinghamshire NG17 4JL, United Kingdom.
Int J Surg Case Rep. 2013;4(10):852-4. doi: 10.1016/j.ijscr.2013.05.001. Epub 2013 May 16.
A 32 year old man presented to our vascular clinic with a lump over the left eyebrow. It had become larger in size and was cosmetically unacceptable.
Clinical examination of the lump demonstrated a pulsatile swelling consistent with an aneurysm of the superficial temporal artery (STA). Doppler ultrasound demonstrated arterial flow within the lump that could be controlled with pressure over the proximal branch of the vessel. The STA aneurysm was excised under local anaesthesia by ligation of the feeding and draining branches. It measured 3.4cm×3.7cm. Histological examination confirmed a rare finding of a true aneurysm of the STA.
Aneurysms are classified into false or true types, with false aneurysms of the STA accounting for 95% of cases reported. It has therefore been suggested that true aneurysms of the STA may develop from a yet unknown pre-existing vessel condition. The histological findings in our case demonstrated myxoid/mucoid deposits replacing elastin fibres of the media layer, in addition to cystic lesions seen in the adventitia. These features were thought to be nonspecific but have been reported in rare conditions known as cystic adventitial disease and cystic medial necrosis. Such is their obscurity that we speculate that both of these may represent variations of the same underlying pathology. As myxoid/mucoid changes are also noted in more well-known connective tissue disorders including Marfan's syndrome, imaging was arranged to screen our patient for thoracic and abdominal aneurysms. These proved negative and there were no Marfanoid features noted prior.
Aneurysms of the STA are easily treated by surgical excision. This should be considered when they become large, painful or are cosmetically undesirable. Unusual histological findings in the specimen may indicate a connective tissue disorder that should be investigated if indicated.
一名32岁男性因左眉上方出现肿块就诊于我们的血管诊所。肿块尺寸增大，从美容角度看难以接受。
对肿块进行临床检查发现是一个搏动性肿胀，与颞浅动脉（STA）动脉瘤相符。多普勒超声显示肿块内有动脉血流，可通过对血管近端分支施压来控制。在局部麻醉下，通过结扎供血和引流分支切除了STA动脉瘤。其大小为3.4厘米×3.7厘米。组织学检查证实为STA真性动脉瘤这一罕见发现。
动脉瘤分为假性或真性类型，STA假性动脉瘤占报告病例的95%。因此有人提出，STA真性动脉瘤可能由尚未明确的先前存在的血管状况发展而来。我们病例的组织学检查结果显示，除了在外膜可见囊性病变外，黏液样/黏液状沉积物取代了中膜层的弹性纤维。这些特征被认为是非特异性的，但在称为囊性外膜炎和囊性中膜坏死的罕见病症中已有报道。它们非常罕见，以至于我们推测这两者可能代表同一潜在病理的不同变体。由于在包括马凡综合征在内的更知名的结缔组织疾病中也注意到黏液样/黏液状变化，因此安排了影像学检查以筛查我们的患者是否存在胸主动脉和腹主动脉瘤。结果证明为阴性，且之前未发现马凡样特征。
STA动脉瘤通过手术切除很容易治疗。当它们变大、疼痛或在美容上不可接受时，应考虑进行手术切除。标本中不寻常的组织学发现可能表明存在结缔组织疾病，如有指征应进行调查。
