Which histopathology findings of the arterial lesion indicate giant cell arteritis (GCA) (temporal arteritis)?

Updated: Sep 03, 2020
  • Author: Mythili Seetharaman, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

The histopathology of the diagnostic arterial lesion in giant cell arteritis (GCA; see the image below) includes the following:

  • Intimal proliferation with resulting luminal stenosis
  • Disruption of the internal elastic lamina by a mononuclear cell infiltrate
  • Invasion and necrosis of the media progressing to involvement of the entire vessel wall (ie, panarteritis) with an inflammatory infiltrate consisting predominantly of mononuclear cells
  • Giant cell formation with granulomata within the mononuclear cell infiltrate
  • Intravascular thrombosis (less consistently found)

     

    Hematoxylin- and eosin-stained femoral artery bran Hematoxylin- and eosin-stained femoral artery branch, cross section, taken from a lower limb amputation specimen. Mononuclear cell invasion and necrosis in the media of this large artery can be observed. Extensive lower limb vasculitis from GCA resulted in ischemic necrosis of the lower limb, necessitating amputation.

Involvement of an affected artery is patchy, with skip lesions and normal intervening segments. It is commonly accepted that because of the patchy involvement of the arteries, biopsies may be nondiagnostic in many patients, and nondiagnostic biopsy specimens do not exclude the diagnosis of GCA. Some authors even suggest that biopsy may not be necessary. [110]


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