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Case Reports
. 2024 Aug 30;16(8):e68222.
doi: 10.7759/cureus.68222. eCollection 2024 Aug.

Intraoperative Frozen Section Diagnosis of Giant Cell Arteritis

John Mallow  1 , Moretta Nielson  1 , Achal Jadhav  1 , Shriya Sridhar  2 , Trevor Killeen  3 , Christopher J Tignanelli  1 , Michael A Linden  3 , Faqian Li  3 , James V Harmon  1
Affiliations
Case Reports

Intraoperative Frozen Section Diagnosis of Giant Cell Arteritis

John Mallow et al. Cureus. .

Abstract

Giant cell arteritis (GCA) is a systemic vasculitis of medium and large vessels that is diagnosed using temporal artery biopsy (TAB). In this case report, we explored the benefits of frozen section analysis as a rapid intraoperative diagnostic technique for GCA. We present the cases of two patients who underwent TAB with frozen section analysis, to demonstrate the value of this technique in initiating immediate treatment and potentially avoiding unnecessary contralateral biopsies when the frozen section of the first biopsy confirms GCA. We recommend further investigation into the use of frozen section analysis for patients suspected of having GCA, who might otherwise undergo bilateral TAB.

Keywords: case report; frozen section; giant cell arteritis; temporal artery biopsy; vasculitis.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Clinical courses of patients 1 and 2.
CRP: C-reactive protein, ESR: erythrocyte sedimentation rate, GCA: giant-cell arteritis, TAB: temporal artery biopsy, ANA: antinuclear antibody
Figure 2
Figure 2. Frozen (A–B) and permanent (C–D) tissue sections of the right temporal artery of Patient 1. H&E-stained frozen sections at 10× (A) and 20× (B) magnification, exhibiting a diffuse inflammatory lymphohistiocytic infiltrate, involving the tunica intima, media, and adventitial layers (arrow transcending all three layers), consistent with inflammatory changes occurring in giant cell arteritis. H&E-stained permanent section at 10× (C) and 50× (D) magnification, exhibiting an almost occluded temporal artery (star), with prominent intimal hyperplasia and diffuse inflammatory infiltrate, comprising lymphocytes (thick arrow showing a representative cell) and epithelioid histiocytes (thin arrow showing a representative cell).
Figure 3
Figure 3. Permanent (A–D) sections of the left temporal artery of Patient 2. H&E-stained section at 20× magnification (A), exhibiting a marked thickening of the tunica intima (arrow transcending the intimal layer) with a granulomatous inflammation involving the tunica media and tunica adventitia (starred regions). H&E-stained section at 50× magnification (B), showing a multinucleated giant cell (thick arrow) and epithelioid histiocytes (thin arrow showing a representative cell). Verhoeff Van Gieson elastin staining at 20× (C) and 50× (D) magnification, showing disruption and segmental loss of the internal elastic lamina (arrows indicating segments of the internal elastic lamina).
See this image and copyright information in PMC

References

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