Image Article - (2016) Volume 4, Issue 5

Unexpected Giant Cell Arteritis and Aorta Aneurysm

Gouveia RH1,2*, Ramos S1, Koukoulis G3 and Neves JP3
1Department of Anatomy Pathology, CHLO - Hospital de Santa Cruz, Lisboa, Portugal
2Forensic Pathology Department, Delegação do Centro, Instituto Nacional de Medicina Legal e Ciências Forenses, I.P., Coimbra and Medical Faculty, Coimbra University, Coimbra, Portugal
3Department of Cardiothoracic Surgery, CHLO - Hospital de Santa Cruz, Lisboa, Portugal
*Corresponding Author: Gouveia RH, Forensic Pathology Department, Delegação do CentroNational Institute of Legal Medicine and Forensic Sciences, I.P.Largo Da Sé Nova3000-213; Coimbra, Portugal, Tel: +351962685650 Email:

Abstract

Aorta Aneurysms may range from asymptomatic to disabling or even fatal, thus requiring adequate and timely therapeutic approach. The aging of industrialized countries’ population, due to the rise of life-expectancy, increased the degenerative causes of aneurysms. Yet, it is of major importance to search for other underlying pathologies; which, in the case of Giant Cell Aortitis may be diagnostic of an immunologic disorder with systemic involvement. Histopathological examination of surgical and/or post-mortem aorta specimens plays a relevant role in the etiopathogenic diagnosis. Unexpected extra-cranial involvement, namely of the aorta, may be diagnostic of Giant Cell Arteritis (Horton’s Disease) and performed on histopathological examination of surgical and/or post-mortem specimens.

Keywords: Giant cell; Arteritis; Aorta; Aneurysm

Text

Aorta involvement in Giant Cell Arteritis (Temporal Giant Cell Arteritis/Horton’s Disease) ranges 10-40%, usually affecting persons older than 50 years, more frequently females; like our hypertensive, with Menière Syndrome, 76 year-old female, submitted to cardiothoracic surgery due to thoracic ascending aorta aneurysm (diameter=6.5 cm) [1-4]. Histopathological examination of samples procured from the surgical specimen and stained with haematoxylin/eosin (HE) and special stains, namely elastic van Gieson (EvG), did not find an hypertensive-related degenerative aortopathy, but instead, an aortitis (Figure 1) with multinucleated histiocytic CD68 positive (Figure 2) giant cells, negative for microorganisms, destroying the tunica media (Figure 3) and containing elastic fibers’ fragments (Figure 4), leading to the aortic wall structural damage and arterial dilatation. Adequate diagnosis of unexpected non-classical cranial manifestations (like audio-vestibular Menière Syndrome) and extra-cranial Giant Cell Arteritis (like Aortitis) is relevant for the correct therapeutic strategy and follow-up, in vivo and, post-mortem, for the establishment of cause/manner of death [5-8].

vascular-medicine-surgery-histopathological-features-giant-cell

Figure 1: Histopathological features of Giant Cell (Equation) Aortitis [A: HE x100].

vascular-medicine-surgery-the-multinucleated-cells-positive

Figure 2: The multinucleated cells (Equation) are positive for histiocytic immunomarker [B: CD68 x200].

vascular-medicine-surgery-they-destroy-tunica-media-framework

Figure 3: They destroy the tunica media framework [C: EvG x40].

vascular-medicine-surgery-elastic-fibers-fragments

Figure 4: Elastic fibers’ fragments (red circle) [D: EvG x400].

Acknowledgements

To the CHLO – Hospital de Santa Cruz.

Conflict of Interest

The authors declare no financial interests or other conflict of interest in relation to the work submitted.

References

  1. Henriet JP, Marin J, Gosselin J, Hamel-Desnos C, Ducrocq M, et al. (1989) The history of Horton’s disease or 10 centuries of a fascinating adventure. J Mal Vasc 14 suppl C: 93-97.
  2. Guedes M, Patrício MS, Galveia JN, Almeida A, Gouveia R, et al. (2011) Giant Cell Arteritis: Retrospective evaluation of 21 patients. Oftalmologia 35: 221-225.
  3. Amor-Dourado JC, Llorca J, Garcia-Porrua C, Costa C, Perez-Fernandez N, et al. (2003) Audiovestibular manifestations in giant cell arteritis: a prospective study. Medicine (Baltimore) 82: 13-26.
  4. Gonzalez-Gay MA, Garcia-Porrua C, Piñeiro A, Pego-Reigosa R, Llorca J, et al. (2004) Aortic aneurysm and dissection in patients with biopsy-proven giant cell arteritis from northwestern Spain: a population-based study. Medicine (Baltimore) 83: 335-334.
  5. Milchert M, Brzosko M (2014) Should Patients With Giant Cell Arteritis Be Tested For Aortic Aneurysms? Ann Acad Med Stetin 60: 37-39.
  6. García-Martínez A, Arguis P, Prieto-González S, Espígol-Frigolé G, Alba MA, et al. (2014) Prospective long term follow-up of a cohort of patients with giant cell arteritis screened for aortic structural damage (aneurysm or dilatation). Ann Rheum Dis 73: 1826-1832.
  7. Stone JR, Bruneval P, Angelini A, Bartoloni G, Basso C, et al. (2015) Consensus statement on surgical pathology of the aorta from the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology: I. Inflammatory diseases. Cardiovascular Pathol 24: 267-278.
  8. Halushka MK, Angelini A, Bartoloni G, Basso C, Batoroeva L (2016) Consensus statement on surgical pathology of the aorta from the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology: II. Noninflammatory degenerative diseases – nomenclature and diagnostic cri teria. Cardiovasc Pathol 25: 247-257.
Citation: Gouveia RH, Ramos S Koukoulis G, Neves JP (2016) Unexpected Giant Cell Arteritis and Aorta Aneurysm. J Vasc Med Surg 4: 288.

Copyright: © 2016 Gouveia RH, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.