Histologische Sicherung der Arteriitis temporalis (AT) mittels Biopsie: Indikation, Durchführung, Interpretation

Zusammenfassung

Die histologische Untersuchung der Arteria temporalis hat durch den Fortschritt bei den bildgebenden Verfahren etwas an Bedeutung verloren, gehört jedoch nach wie vor zum diagnostischen Repertoire bei Arteriitis temporalis (AT). Die typischen histologischen Veränderungen bei AT bestehen in einer granulomatösen Entzündung aller Wandschichten, in der sich mehrkernige Riesenzellen finden. Das Gefäßlumen kann durch Intimaproliferation und subintimale fibromuskuläre Hyperplasie eingeengt oder ganz verschlossen sein. Außerdem lässt sich im klassischen Fall eine Fragmentierung der Lamina elastica interna nachweisen. Neuere Arbeiten demonstrieren eine Vaskulitis der vasa vasorum, oder eine Vaskulitis kleiner Gefäße der Adventitia als histologische Untergruppen der AT.

Abstract

Although the histological examination of the temporal artery has lost some importance due to the progress in imaging techniques, the method still belongs to the diagnostic repertoire in cases of suspected temporal arteritis. Histological changes typical for temporal arteritis are granulomatous infiltrates that affect all layers of the vessel wall and contain multinucleated giant cells. The lumen of the vessel can be occluded or narrowed by proliferating cells of the intima and by subintimal fibromuscular hyperplasia. Classical findings also include the fragmentation of the internal lamina elastica. Recent investigations have identified 2 histological subgroups, dominated by either a vasculitis of the vasa vasorum or a vasculitis of small vessels of the adventitia of the temporal artery.

Schlüsselwörter

Arteriitis temporalis - Biopsie - histologische Untersuchung - Riesenzellen

Key words

temporal arteritis - biopsy - histological examination - multinucleated giant cells

• Literatur

• 1 Hamidou MA, Batard E, Trewick D et al. Silent versus cranial giant cell arteritis. Initial presentation and outcome of 50 biopsy-proven cases. European journal of internal medicine 2005; 16: 183-186
• 2 Martinez-Lado L, Calvino-Diaz C, Pineiro A et al. Relapses and recurrences in giant cell arteritis: a population-based study of patients with biopsy-proven disease from northwestern Spain. Medicine 2011; 90: 186-193
• 3 Carmona FD, Rodriguez-Rodriguez L, Castaneda S et al. Role of the CCR5/Delta32CCR5 polymorphism in biopsy-proven giant cell arteritis. Human immunology 2011; 72: 458-461
• 4 Bustamante Maldonado E, Mari Alfonso B, Monteagudo Jimenez M et al. Analysis of a series of 55 patients with biopsy proven giant cell temporal arteritis. Anales de medicina interna (Madrid, Spain: 1984) 2004; 21: 473-476
• 5 Karahaliou M, Vaiopoulos G, Papaspyrou S et al. Colour duplex sonography of temporal arteries before decision for biopsy: a prospective study in 55 patients with suspected giant cell arteritis. Arthritis research & therapy 2006; 8: R116
• 6 Eskridge EP. Temporal Artery Biopsy. Operative Technol Gen Surg 2002; 4: 239-250
• 7 Albert DM, Ruchman MC, Keltner JL. Skip areas in temporal arteritis. Archives of ophthalmology 1976; 94: 2072-2077
• 8 Albertini JG, Ramsey ML, Marks VJ. Temporal artery biopsy in a dermatologic surgery practice. Dermatologic surgery: official publication for American Society for Dermatologic Surgery [et al.] 1999; 25: 501-508
• 9 Hall JK, Volpe NJ, Galetta SL et al. The role of unilateral temporal artery biopsy. Ophthalmology 2003; 110: 543-548 discussion 548
• 10 Mahr A, Saba M, Kambouchner M et al. Temporal artery biopsy for diagnosing giant cell arteritis: the longer, the better?. Annals of the rheumatic diseases 2006; 65: 826-828
• 11 Rieck KL, Kermani TA, Thomsen KM et al. Evaluation for clinical predictors of positive temporal artery biopsy in giant cell arteritis. Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 2011; 69: 36-40
• 12 Lavignac C, Jauberteau-Marchan MO, Liozon E et al. Immunohistochemical study of lesions in Horton's temporal arteritis before and during corticotherapy. La Revue de medecine interne/fondee par la Societe nationale francaise de medecine interne 1996; 17: 814-820
• 13 Dastgir G, Gutman J, Shinder R. Facial nerve injury: a complication of superficial temporal artery biopsy. American journal of ophthalmology 2012; 153: 187 author reply 187–188
• 14 Albert DM, Searl SS, Craft JL. Histologic and ultrastructural characteristics of temporal arteritis. The value of the temporal artery biopsy. Ophthalmology 1982; 89: 1111-1126
• 15 Font RL, Prabhakaran VC. Histological parameters helpful in recognising steroid-treated temporal arteritis: an analysis of 35 cases. The British journal of ophthalmology 2007; 91: 204-209
• 16 Banks PM, Cohen MD, Ginsburg WW et al. Immunohistologic and cytochemical studies of temporal arteritis. Arthritis and rheumatism 1983; 26: 1201-1207
• 17 Mambo NC. Temporal (granulomatous) arteritis: a histopathological study of 32 cases. Histopathology 1979; 3: 209-221
• 18 Gallagher P, Jones K. Immunohistochemical findings in cranial arteritis. Arthritis and rheumatism 1982; 25: 75-79
• 19 Schmidt D, Loffler KU. Temporal arteritis. Comparison of histological and clinical findings. Acta ophthalmologica 1994; 72: 319-325
• 20 Chatelain D, Duhaut P, Schmidt J et al. Pathological features of temporal arteries in patients with giant cell arteritis presenting with permanent visual loss. Annals of the rheumatic diseases 2009; 68: 84-88
• 21 Restuccia G, Cavazza A, Boiardi L et al. Small-vessel vasculitis surrounding an uninflamed temporal artery and isolated vasa vasorum vasculitis of the temporal artery: two subsets of giant cell arteritis. Arthritis and rheumatism 2012; 64: 549-556
• 22 Weyand CM, Tetzlaff N, Bjornsson J et al. Disease patterns and tissue cytokine profiles in giant cell arteritis. Arthritis and rheumatism 1997; 40: 19-26
• 23 Genereau T, Lortholary O, Pottier MA et al. Temporal artery biopsy: a diagnostic tool for systemic necrotizing vasculitis. French Vasculitis Study Group. Arthritis and rheumatism 1999; 42: 2674-2681