Ormsby A H, Haskell R
Central Coast Area Health Service, Gosford, NSW, Australia.
Pathology. 1997 May;29(2):227-30. doi: 10.1080/00313029700169934.
We here report a rare case of giant cell arteritis (GCA) of the myometrium found incidentally in a 68-year-old Caucasian woman presenting with uterovaginal prolapse and a known past history of temporal arteritis/polymyalgia rheumatica. Histology revealed a segmental arteritis of small, medium and some quite large myometrial arteries with extensive destruction of both internal and external elastic laminae. Multinucleate giant cells, lymphocytes and histiocytes were most prominent in the inflammatory infiltrate. The findings in this case are compared with previous reports. In a review of the literature it was found that almost one third of cases presented with generalised symptoms such as fever, anemia, fatigue and weight loss. The symptoms were not immediately recognised as temporal arteritis or polymyalgia rheumatica. On routine physical examination or radiological investigation, benign gynecological pathology such as a simple ovarian cyst or uterine leiomyoma were found. The subsequent unexpected discovery of GCA on histological examination was the critical event in alerting clinicians to the diagnosis of temporal arteritis/polymyalgia rheumatica. Without exception steroid therapy was successful in achieving relief of generalised symptoms.
我们在此报告一例罕见的子宫肌层巨细胞动脉炎（GCA）病例，该病例偶然发现于一名68岁的白种女性，她因子宫阴道脱垂就诊，既往有颞动脉炎/风湿性多肌痛病史。组织学检查显示，子宫肌层的小、中及一些较大动脉呈节段性动脉炎，内、外弹性膜均有广泛破坏。炎症浸润中多核巨细胞、淋巴细胞和组织细胞最为突出。将该病例的发现与既往报告进行了比较。在文献回顾中发现，近三分之一的病例表现为发热、贫血、疲劳和体重减轻等全身症状。这些症状并未立即被识别为颞动脉炎或风湿性多肌痛。在常规体格检查或影像学检查中，发现了如单纯卵巢囊肿或子宫平滑肌瘤等良性妇科病变。随后在组织学检查中意外发现GCA是提醒临床医生诊断颞动脉炎/风湿性多肌痛的关键事件。无一例外，类固醇治疗成功缓解了全身症状。
