Dermawan Josephine K, Prayson Richard A
Department of Pathology, Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, OH 44195, USA.
Department of Pathology, Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, OH 44195, USA.
Ann Diagn Pathol. 2020 Jun;46:151517. doi: 10.1016/j.anndiagpath.2020.151517. Epub 2020 Apr 8.
Giant cell arteritis is a vasculitis that affects large- and medium-sized vessels in patients over the age of 50 years. The demonstration of granulomatous arteritis is the criterion standard to establish a definitive diagnosis. However, temporal arteritis is known to discontinuously involve the artery, and there is no standardization of the number of sections which should be examined in a length of sampled artery. The goal of the study is to determine, if by examining additional sections from temporal artery (TA) biopsy cases initially interpreted as negative, do we uncover cases of vasculitis. We conducted a retrospective review of the clinical and histologic features of 75 consecutive temporal artery biopsy cases. Our findings showed that the vast majority (94%) of cases that were biopsy "proven" to be negative for temporal arteritis on initial examination remained negative after examination of all subsequent deeper levels (median of 337 total levels examined). These cases were less likely to show classical GCA signs and symptoms and typically presented at a younger age than the biopsy-positive cases. However, 4 (6%) of the initially "biopsy-negative" cases did turn out to be positive on deeper levels, with 56, 109, 346, and 590 total levels examined, respectively. At least 2 of these 4 patients did not receive prednisone or were weaned off prednisone treatment and experienced persistent/recurrent GCA symptoms. We conclude that routine sampling may miss the diagnosis in a subset of cases and in some cases, sectioning deeper into the paraffin block may be warranted.
巨细胞动脉炎是一种血管炎，影响50岁以上患者的大中血管。肉芽肿性动脉炎的证实是确立明确诊断的标准。然而，颞动脉炎已知会间断累及动脉，且对于一段采样动脉应检查的切片数量没有标准化。本研究的目的是确定，通过检查最初被判定为阴性的颞动脉活检病例的额外切片，是否能发现血管炎病例。我们对75例连续的颞动脉活检病例的临床和组织学特征进行了回顾性研究。我们的研究结果表明，绝大多数（94%）在初次检查时活检“证实”为颞动脉炎阴性的病例，在检查所有后续更深层次（总共检查的中位数为337层）后仍为阴性。这些病例不太可能出现典型的巨细胞动脉炎体征和症状，且通常比活检阳性病例发病年龄更小。然而，4例（6%）最初“活检阴性”的病例在更深层次检查时结果为阳性，分别检查的总层数为56、109、346和590层。这4例患者中至少有2例未接受泼尼松治疗或已停用泼尼松治疗，并出现了持续性/复发性巨细胞动脉炎症状。我们得出结论，常规采样可能会遗漏一部分病例的诊断，在某些情况下，可能需要对石蜡块进行更深层次的切片。
