Giant cell arteritis - Revision history

Michael at 16:49, 7 June 2024

2024-06-07T16:49:16Z

← Older revision		Revision as of 16:49, 7 June 2024
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	==Microscopic==		==Microscopic==
	Features ~~- as per Le ''et al.''~~:<ref name=pmid25457237/><ref name=pmid23543964/>		Features:<ref name=pmid25457237/><ref name=pmid23543964/>
	*Artery with intimal thickening and luminal narrowing.		*Artery with intimal thickening and luminal narrowing.
	*Transmural inflammatory cells.		*Transmural inflammatory cells.

Michael at 16:30, 7 June 2024

2024-06-07T16:30:03Z

← Older revision		Revision as of 16:30, 7 June 2024
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	*Inflammation classically [[granuloma\|granulomatous]]; however, granulomas not required for the diagnosis!		*Inflammation classically [[granuloma\|granulomatous]]; however, granulomas not required for the diagnosis!
	**In one series, 11 of 15 patients (73%) had giant cells.<ref name=pmid23543964>{{cite journal \|authors=Roberts WC, Zafar S, Ko JM \|title=Morphological features of temporal arteritis \|journal=Proc (Bayl Univ Med Cent) \|volume=26 \|issue=2 \|pages=109–15 \|date=April 2013 \|pmid=23543964 \|pmc=3603723 \|doi=10.1080/08998280.2013.11928932 \|url=}}</ref>		**In one series, 11 of 15 patients (73%) had giant cells.<ref name=pmid23543964>{{cite journal \|authors=Roberts WC, Zafar S, Ko JM \|title=Morphological features of temporal arteritis \|journal=Proc (Bayl Univ Med Cent) \|volume=26 \|issue=2 \|pages=109–15 \|date=April 2013 \|pmid=23543964 \|pmc=3603723 \|doi=10.1080/08998280.2013.11928932 \|url=}}</ref>
	**~~A study with 40 patients~~, 33 patients (83%) had giant cells on the initial biopsy.<ref name=pmid28256573>{{cite journal \|authors=Maleszewski JJ, Younge BR, Fritzlen JT, Hunder GG, Goronzy JJ, Warrington KJ, Weyand CM \|title=Clinical and pathological evolution of giant cell arteritis: a prospective study of follow-up temporal artery biopsies in 40 treated patients \|journal=Mod Pathol \|volume=30 \|issue=6 \|pages=788–796 \|date=June 2017 \|pmid=28256573 \|pmc=5650068 \|doi=10.1038/modpathol.2017.10 \|url=}}</ref>		**In another series, 33 of 40 patients (83%) had giant cells on the initial biopsy.<ref name=pmid28256573>{{cite journal \|authors=Maleszewski JJ, Younge BR, Fritzlen JT, Hunder GG, Goronzy JJ, Warrington KJ, Weyand CM \|title=Clinical and pathological evolution of giant cell arteritis: a prospective study of follow-up temporal artery biopsies in 40 treated patients \|journal=Mod Pathol \|volume=30 \|issue=6 \|pages=788–796 \|date=June 2017 \|pmid=28256573 \|pmc=5650068 \|doi=10.1038/modpathol.2017.10 \|url=}}</ref>
	*Often accompanied by frank destruction of the arterial wall, e.g. fibrinoid necrosis (pink anucleate arterial wall).		*Often accompanied by frank destruction of the arterial wall, e.g. fibrinoid necrosis (pink anucleate arterial wall).
	*Luminal narrowing is common (>85% of cases) and typical marked.<ref name=pmid23543964/>		*Luminal narrowing is common (>85% of cases) and typical marked.<ref name=pmid23543964/>

Michael at 16:29, 7 June 2024

2024-06-07T16:29:00Z

← Older revision		Revision as of 16:29, 7 June 2024
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	*Inflammation classically [[granuloma\|granulomatous]]; however, granulomas not required for the diagnosis!		*Inflammation classically [[granuloma\|granulomatous]]; however, granulomas not required for the diagnosis!
	**In one series, 11 of 15 patients (73%) had giant cells.<ref name=pmid23543964>{{cite journal \|authors=Roberts WC, Zafar S, Ko JM \|title=Morphological features of temporal arteritis \|journal=Proc (Bayl Univ Med Cent) \|volume=26 \|issue=2 \|pages=109–15 \|date=April 2013 \|pmid=23543964 \|pmc=3603723 \|doi=10.1080/08998280.2013.11928932 \|url=}}</ref>		**In one series, 11 of 15 patients (73%) had giant cells.<ref name=pmid23543964>{{cite journal \|authors=Roberts WC, Zafar S, Ko JM \|title=Morphological features of temporal arteritis \|journal=Proc (Bayl Univ Med Cent) \|volume=26 \|issue=2 \|pages=109–15 \|date=April 2013 \|pmid=23543964 \|pmc=3603723 \|doi=10.1080/08998280.2013.11928932 \|url=}}</ref>
			**A study with 40 patients, 33 patients (83%) had giant cells on the initial biopsy.<ref name=pmid28256573>{{cite journal \|authors=Maleszewski JJ, Younge BR, Fritzlen JT, Hunder GG, Goronzy JJ, Warrington KJ, Weyand CM \|title=Clinical and pathological evolution of giant cell arteritis: a prospective study of follow-up temporal artery biopsies in 40 treated patients \|journal=Mod Pathol \|volume=30 \|issue=6 \|pages=788–796 \|date=June 2017 \|pmid=28256573 \|pmc=5650068 \|doi=10.1038/modpathol.2017.10 \|url=}}</ref>
	*Often accompanied by frank destruction of the arterial wall, e.g. fibrinoid necrosis (pink anucleate arterial wall).		*Often accompanied by frank destruction of the arterial wall, e.g. fibrinoid necrosis (pink anucleate arterial wall).
	*Luminal narrowing is common (>85% of cases) and typical marked.<ref name=pmid23543964/>		*Luminal narrowing is common (>85% of cases) and typical marked.<ref name=pmid23543964/>

Michael at 16:22, 7 June 2024

2024-06-07T16:22:20Z

← Older revision		Revision as of 16:22, 7 June 2024
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	==Microscopic==		==Microscopic==
	Features - as per Le ''et al.'':<ref name=pmid25457237/>		Features - as per Le ''et al.'':<ref name=pmid25457237/><ref name=pmid23543964/>
	*Artery with intimal thickening.		*Artery with intimal thickening and luminal narrowing.
	*Transmural inflammatory cells.		*Transmural inflammatory cells.
	*Giant cells.		*Giant cells.

	Notes:		Notes:
	*Inflammation classically [[granuloma\|granulomatous]].		*Inflammation classically [[granuloma\|granulomatous]]; however, granulomas not required for the diagnosis!
	**Granulomas not required for the diagnosis!		**In one series, 11 of 15 patients (73%) had giant cells.<ref name=pmid23543964>{{cite journal \|authors=Roberts WC, Zafar S, Ko JM \|title=Morphological features of temporal arteritis \|journal=Proc (Bayl Univ Med Cent) \|volume=26 \|issue=2 \|pages=109–15 \|date=April 2013 \|pmid=23543964 \|pmc=3603723 \|doi=10.1080/08998280.2013.11928932 \|url=}}</ref>
	*Often accompanied by frank destruction of the arterial wall, e.g. fibrinoid necrosis (pink anucleate arterial wall).		*Often accompanied by frank destruction of the arterial wall, e.g. fibrinoid necrosis (pink anucleate arterial wall).
			*Luminal narrowing is common (>85% of cases) and typical marked.<ref name=pmid23543964/>

	DDx:		DDx:

Michael at 15:54, 21 November 2022

2022-11-21T15:54:06Z

← Older revision		Revision as of 15:54, 21 November 2022
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	The sections show a focal histocytic response with intimal thickening. Giant cells are absent. Fibrinoid necrosis is absent. Significant transmural inflammation is absent.		The sections show a focal histocytic response with intimal thickening. Giant cells are absent. Fibrinoid necrosis is absent. Significant transmural inflammation is absent.
			</pre>

			====Alternate====
			<pre>
			Temporal Artery, Right, Biopsy:
			- Medium size artery with mild-to-moderate atherosclerosis, small calcifications and focal internal
			elastic lamina disruption, otherwise within normal limits, see comment.

			Comment:
			A negative biopsy does not rule out the possibility of giant cell (temporal) arteritis, as this may be a focal disorder. The clinical management should be dependent upon the clinical impression.
	</pre>		</pre>

Michael: /* Positive with giant cells */

2022-06-06T19:27:53Z

Positive with giant cells

← Older revision		Revision as of 19:27, 6 June 2022
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	- Consistent with temporal arteritis (medium size artery with		- Consistent with temporal arteritis (medium size artery with
	lymphohistocytic inflammation, giant cells, arterial wall thickening,		lymphohistocytic inflammation, giant cells, arterial wall thickening,
	and elastic fibre fragmentation).		and elastic fibre fragmentation).
	</pre>		</pre>

Michael: /* Sign out */ +w/ gcs

2022-06-06T19:27:36Z

Sign out: +w/ gcs

← Older revision		Revision as of 19:27, 6 June 2022
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	Note:		Note:
	*The evidence is weak that the biopsy result influences management; a negative biopsy doesn't preclude treatment for clinically presumed giant cell arteritis.<ref name=pmid16287908>{{Cite journal \| last1 = Lenton \| first1 = J. \| last2 = Donnelly \| first2 = R. \| last3 = Nash \| first3 = JR. \| title = Does temporal artery biopsy influence the management of temporal arteritis? \| journal = QJM \| volume = 99 \| issue = 1 \| pages = 33-6 \| month = Jan \| year = 2006 \| doi = 10.1093/qjmed/hci141 \| PMID = 16287908 }}</ref>		*The evidence is weak that the biopsy result influences management; a negative biopsy doesn't preclude treatment for clinically presumed giant cell arteritis.<ref name=pmid16287908>{{Cite journal \| last1 = Lenton \| first1 = J. \| last2 = Donnelly \| first2 = R. \| last3 = Nash \| first3 = JR. \| title = Does temporal artery biopsy influence the management of temporal arteritis? \| journal = QJM \| volume = 99 \| issue = 1 \| pages = 33-6 \| month = Jan \| year = 2006 \| doi = 10.1093/qjmed/hci141 \| PMID = 16287908 }}</ref>


			===Positive with giant cells===
			<pre>
			Left Temporal Artery, Biopsy:
			- Consistent with temporal arteritis (medium size artery with
			lymphohistocytic inflammation, giant cells, arterial wall thickening,
			and elastic fibre fragmentation).
			</pre>

	===Positive===		===Positive===

Michael at 22:28, 9 October 2021

2021-10-09T22:28:40Z

← Older revision		Revision as of 22:28, 9 October 2021
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	Notes:		Notes:
	*Radiology: halo sign (on ultrasound); [[sensitivity]] 86% and [[specificity]] 78%.<ref name=pmid12064840>{{cite journal \|~~vauthors~~=Nesher G, Shemesh D, Mates M, Sonnenblick M, Abramowitz HB \|title=The predictive value of the halo sign in color Doppler ultrasonography of the temporal arteries for diagnosing giant cell arteritis \|journal=J Rheumatol \|volume=29 \|issue=6 \|pages=1224–6 \|date=June 2002 \|pmid=12064840 \|doi= \|url=}}</ref>		*Radiology: halo sign (on ultrasound); [[sensitivity]] 86% and [[specificity]] 78%.<ref name=pmid12064840>{{cite journal \|authors=Nesher G, Shemesh D, Mates M, Sonnenblick M, Abramowitz HB \|title=The predictive value of the halo sign in color Doppler ultrasonography of the temporal arteries for diagnosing giant cell arteritis \|journal=J Rheumatol \|volume=29 \|issue=6 \|pages=1224–6 \|date=June 2002 \|pmid=12064840 \|doi= \|url=}}</ref>

	==Microscopic==		==Microscopic==

Michael: /* Gross */

2021-08-04T15:06:47Z

Gross

← Older revision		Revision as of 15:06, 4 August 2021
Line 52:		Line 52:

	Notes:		Notes:
	*Radiology: halo sign; [[sensitivity]] 86% and [[specificity]] 78%.<ref name=pmid12064840>{{cite journal \|vauthors=Nesher G, Shemesh D, Mates M, Sonnenblick M, Abramowitz HB \|title=The predictive value of the halo sign in color Doppler ultrasonography of the temporal arteries for diagnosing giant cell arteritis \|journal=J Rheumatol \|volume=29 \|issue=6 \|pages=1224–6 \|date=June 2002 \|pmid=12064840 \|doi= \|url=}}</ref>		*Radiology: halo sign (on ultrasound); [[sensitivity]] 86% and [[specificity]] 78%.<ref name=pmid12064840>{{cite journal \|vauthors=Nesher G, Shemesh D, Mates M, Sonnenblick M, Abramowitz HB \|title=The predictive value of the halo sign in color Doppler ultrasonography of the temporal arteries for diagnosing giant cell arteritis \|journal=J Rheumatol \|volume=29 \|issue=6 \|pages=1224–6 \|date=June 2002 \|pmid=12064840 \|doi= \|url=}}</ref>

	==Microscopic==		==Microscopic==

Michael: tweak

2021-08-04T15:06:30Z

tweak

← Older revision		Revision as of 15:06, 4 August 2021
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	\| Prevalence = uncommon		\| Prevalence = uncommon
	\| Bloodwork = ESR elevated		\| Bloodwork = ESR elevated
	\| Rads =		\| Rads = halo sign
	\| Endoscopy =		\| Endoscopy =
	\| Prognosis = good if treated		\| Prognosis = good if treated
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	==Gross==		==Gross==
	*Recommended length of artery >20 mm.<ref name=pmid17501882>{{Cite journal \| last1 = Sharma \| first1 = NS. \| last2 = Ooi \| first2 = JL. \| last3 = McGarity \| first3 = BH. \| last4 = Vollmer-Conna \| first4 = U. \| last5 = McCluskey \| first5 = P. \| title = The length of superficial temporal artery biopsies. \| journal = ANZ J Surg \| volume = 77 \| issue = 6 \| pages = 437-9 \| month = Jun \| year = 2007 \| doi = 10.1111/j.1445-2197.2007.04090.x \| PMID = 17501882 }}</ref>		*Recommended length of artery >20 mm.<ref name=pmid17501882>{{Cite journal \| last1 = Sharma \| first1 = NS. \| last2 = Ooi \| first2 = JL. \| last3 = McGarity \| first3 = BH. \| last4 = Vollmer-Conna \| first4 = U. \| last5 = McCluskey \| first5 = P. \| title = The length of superficial temporal artery biopsies. \| journal = ANZ J Surg \| volume = 77 \| issue = 6 \| pages = 437-9 \| month = Jun \| year = 2007 \| doi = 10.1111/j.1445-2197.2007.04090.x \| PMID = 17501882 }}</ref>

			Notes:
			*Radiology: halo sign; [[sensitivity]] 86% and [[specificity]] 78%.<ref name=pmid12064840>{{cite journal \|vauthors=Nesher G, Shemesh D, Mates M, Sonnenblick M, Abramowitz HB \|title=The predictive value of the halo sign in color Doppler ultrasonography of the temporal arteries for diagnosing giant cell arteritis \|journal=J Rheumatol \|volume=29 \|issue=6 \|pages=1224–6 \|date=June 2002 \|pmid=12064840 \|doi= \|url=}}</ref>

	==Microscopic==		==Microscopic==