Mönckeberg sclerosis with giant cells as a masquerade of giant cell arteritis

Abstract

Giant cell arteritis (GCA) is the most common type of vasculitis in adults, which is classified as a large/medium vessel vasculitis. It has a predilection for the ophthalmic circulation and extracranial carotid system. Temporal artery biopsy specimens can show the presence of inflammatory multinucleated giant cells. Here, we report just the third case of Mönckeberg sclerosis with multinucleated giant cells affecting the temporal artery and mimicking GCA. This rare finding in the evaluation of a common vasculitis is important for rheumatologists to be aware of and emphasizes close collaboration between clinicians and pathologists.

Figure 1

Some areas of the wall had circumferential calcification of the tunica media with attenuation of the tunica media smooth muscle. The calcium is basophilic (purple) and has fragmented during histological sectioning leaving empty spaces in the arterial wall (bar=200 μm).

Figure 2

Other areas of the superficial temporal artery had segmental calcification (left side of artery) with inflammatory cells localized only in this area (bar=200 μm).

Figure 3

Inflammatory cells were seen only in association with the medial calcification (bar=200 μm).

Figure 4

A multinucleated giant cells from the TAB of our patient is shown near the center of the image surrounded by macrophages (bar=20 μm).

Figure 5

Another multinucleated giant cell from a different cross-section of the temporal artery (bar=20 μm).

Figure 6

Multinucleated giant cell (near the center of the image) from a TAB of a patient with active GCA (bar=20 μm).

Figure 7

Osteoclast (near the center of the image) in vertebral bone from the autopsy of a patient with renal osteodystrophy (bar=20 μm).