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Adeyemi OA, Backous CA. Giant cell arteritis of the uterus. J Osteopath Med 2021; 121:441-442. [PMID: 33694339 DOI: 10.1515/jom-2020-0259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 12/22/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Oluwadamilola A Adeyemi
- Department of Medicine, Section of Infectious Diseases, Swedish Hospital NorthShore University HealthSystem, Swedish Hospital Professional Plaza Building, 2740 W. Foster Avenue, Suite 401, Chicago, IL60625-3532, USA.,Department of Medicine, Section of Infectious Diseases, Northwestern Medicine Lake Forest Hospital, Lake Forest, IL, USA
| | - Craig A Backous
- Department of Medicine, Section of Pulmonary and Critical Care, Swedish Hospital NorthShore University HealthSystem, Chicago, IL, USA
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Theunissen P, Kliffen M, Dees A. Giant-cell Arteritis of the Ovarian Arteries: A Rare Manifestation of a Common Disease. Eur J Case Rep Intern Med 2019; 5:000779. [PMID: 30756029 PMCID: PMC6346925 DOI: 10.12890/2018_000779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 01/22/2018] [Indexed: 11/07/2022] Open
Abstract
We describe a 58-year-old woman presenting with headache and an elevated erythrocyte sedimentation rate (ESR), who was diagnosed with and successfully treated for giant-cell arteritis (GCA). Seven months after the end of treatment, ovarian GCA was incidentally found after ovariectomy for a simple cyst. GCA of extracranial vessels like the ovarian arteries is rare. Nevertheless, we stress that extracranial GCA should be considered in patients older than 50 years with an elevated ESR, even if a temporal artery biopsy is negative or specific symptoms are absent. Moreover, we discuss the importance of imaging techniques when GCA of the extracranial large vessels is suspected.
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Affiliation(s)
- Prisca Theunissen
- Department of Internal Medicine, Ikazia Ziekenhuis, Rotterdam, The Netherlands
| | - Mike Kliffen
- Department of Clinical Pathology, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - Ad Dees
- Department of Internal Medicine, Ikazia Ziekenhuis, Rotterdam, The Netherlands
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BUTENDIECK RONALDROLF, ABRIL ANDY, CORTESE CHERISE. Unusual Presentation of Giant Cell Arteritis in 2 Patients: Uterine Involvement. J Rheumatol 2018; 45:1201-1202. [DOI: 10.3899/jrheum.171341] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Pradhan D, Amin RM, Jones MW, Surti U, Parwani AV. Giant Cell Arteritis of the Female Genital Tract With Occult Temporal Arteritis and Marginal Zone Lymphoma Harboring Novel 20q Deletion. Int J Surg Pathol 2015; 24:78-84. [DOI: 10.1177/1066896915605165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Giant cell arteritis (GCA) is an immunologically mediated vasculitis of large and medium-sized vessels, typically affecting the cranial arteries and usually occurring in the elderly. GCA of the female genital tract is extremely rare with only 31 cases reported in the English literature. An 83-year-old white female with postmenopausal vaginal bleeding revealed an endometrial polyp on pelvic ultrasonography following which polypectomy and subsequently hysterectomy with bilateral salpingo-oophorectomy was done. Microscopy revealed a well-differentiated endometrioid adenocarcinoma. Interestingly, classic GCA involving numerous small to medium-sized arteries of the cervix, myometrium, bilateral fallopian tubes, and ovaries was also identified. Hematologic evaluation revealed marginal zone lymphoma with an exceptionally rare 20q deletion. Bilateral temporal artery biopsy was done subsequently, which exhibited GCA on microscopy. Corticosteroid was started that improved her polymyalgia rheumatica symptoms. The patient is on follow-up for 3 years and is doing well. To our knowledge, this is the first case of GCA of the female genital tract associated with a lymphoma and the second case of marginal zone lymphoma with the novel 20q deletion.
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Affiliation(s)
- Dinesh Pradhan
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | | | - Urvashi Surti
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Anil V. Parwani
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Massasso D, Cheruvu C, Joshua F, Yong J, Gotis-Graham IG, Graham IG. Ovarian vasculitis in an adult with fatal systemic lupus erythematosus. Lupus 2009; 18:364-7. [PMID: 19276306 DOI: 10.1177/0961203308097567] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Vasculitis of the ovary is a rare condition that can occur as an isolated finding or in association with systemic vasculitis. We describe a case of a 36-year-old female with vasculitis involving the left ovary on a background of severe active systemic lupus erythematosus (SLE). Despite a florid histopathological picture of ovarian vasculitis, the clinical and imaging findings were nonspecific. We have compared the current case to the literature on ovarian vasculitis, including relating to SLE. Ovarian vasculitis in SLE may be an underestimated entity as it may not be looked for routinely in the context of vasculitic involvement of other organs.
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Affiliation(s)
- D Massasso
- Department of Rheumatology, Liverpool Hospital, New South Wales, Australia.
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Hernández-Rodríguez J, Tan CD, Rodríguez ER, Hoffman GS. Gynecologic vasculitis: an analysis of 163 patients. Medicine (Baltimore) 2009; 88:169-181. [PMID: 19440120 DOI: 10.1097/md.0b013e3181a577f3] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Gynecologic vasculitis (GynV) has been reported as part of systemic vasculitis (SGynV) and as single-organ (isolated gynecologic) vasculitis (IGynV). In the current study, we analyzed the clinical and histologic characteristics of patients with GynV and sought to identify features that differentiate the isolated from the systemic forms of the disease. We used pathology databases from our institution and an English-language literature search (PubMed) to identify affected patients with biopsy-proven GynV. Using a standardized format for data gathering and analysis, we recorded clinical manifestations, laboratory and histologic features, and surgical and medical therapies. Patients were analyzed as 2 subsets: IGynV and SGynV.A total of 163 patients with GynV were included (152 from the literature and 11 from the Cleveland Clinic pathology database). The incidence of vasculitis among all gynecologic surgeries in our institution over 16 years was 0.15%. Half of the patients presented with vaginal bleeding. Other less common presentations included the finding of an asymptomatic abdominal mass, uterine prolapse, atypical cervical smear, and pelvic pain. Constitutional and musculoskeletal symptoms were reported in 24% of patients. One hundred fifteen (70.6%) patients had IGynV, and 48 (29.4%) had SGynV. Compared to patients with SGynV, those with IGynV were younger (median age, 51 yr; range, 18-80 yr vs. median, 68 yr; range, 32-83 yr; p = 0.0001) and presented more often with vaginal bleeding (57% vs. 25%; p = 0.0002) and less frequently with asymptomatic pelvic masses (6% vs. 35%; p = 0.0001). IGynV was less often associated with constitutional or musculoskeletal symptoms (7% vs. 74%; p = 0.0001). Patients with IGynV were much less likely to have abnormal erythrocyte sedimentation rates (26% vs. 97%; p = 0.0001) and anemia (17% vs. 80%; p = 0.0001) than patients with SGynV. None of the patients with IGynV received corticosteroids, whereas almost all patients with SGynV received corticosteroids and about one-third also received cytotoxic therapy. In IGynV, the site most often involved was the uterus, particularly the cervix, whereas in SGynV lesions were more often multifocal, affecting mainly ovaries, fallopian tubes, and myometrium. Nongranulomatous inflammation occurred in most patients with IGynV, while the predominant histologic pattern noted in SGynV was granulomatous.While vasculitis was the only lesion in 32% of the resected specimens, leiomyomas (18.4%) and endometrial carcinoma (8.3%) were the most frequent concomitant benign and malignant (nonvasculitic) lesions, respectively. Except for benign ovarian abnormalities, which were more frequent in SGynV than in IGynV (21% vs. 4%; p = 0.001), other benign (50%) and malignant (18%) conditions were similarly present in both groups. Among SGynV patients, giant cell arteritis was diagnosed in 29 of the 48 (60.4%) patients, and one-third presented without symptoms of vascular involvement or polymyalgia rheumatica. In summary, GynV is rare and most often occurs as a single-organ disease. It is usually an incidental finding in the course of surgery. The isolated form is associated with the absence of systemic symptoms and normal acute phase reactants, and does not require systemic therapy. Among systemic vasculitides, giant cell arteritis is the most frequently reported form of systemic vasculitis with gynecologic involvement.
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Affiliation(s)
- José Hernández-Rodríguez
- From the Center for Vasculitis Care and Research, Department of Rheumatic and Immunologic Diseases (JHR, GSH) and Department of Anatomic Pathology (CDT, ERR), Cleveland Clinic, Cleveland, Ohio
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Abstract
PURPOSE OF REVIEW To provide a critical analysis of a rare disorder, single-organ vasculitis, emphasizing those organs in which the excision of the vasculitic lesion can be curative. To recommend a rational approach to diagnosis, longitudinal follow-up and treatment. RECENT FINDINGS Patients with focal single-organ vasculitis affecting abdominal and genitourinary organs, breast and aorta have been reported as individual cases and small series. Single-organ vasculitis differs from systemic forms of vasculitis in disease expression and prognosis. Occasionally, what appears to be a localized process evolves into a systemic disease. Depending on the organ affected, some clinical, serological and histopathologic features may be helpful in predicting the extent of the vasculitic process. With the exception of severe ischemic or hemorrhagic complications affecting the abdominal organs and dissection or rupture of the aortic arch, the prognosis of focal single-organ vasculitis tends to be excellent. Resection of the inflammatory lesion may be curative. SUMMARY The diagnosis of focal single-organ vasculitis is always presumptive and requires exclusion of systemic illness at the time of diagnosis as well as throughout the period of continued care. Clues from clinical symptoms, laboratory tests and histopathologic features at the time of diagnosis may assist in devising surveillance strategies.
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Onuma K, Chu CT, Dabbs DJ. Asymptomatic Giant-Cell (Temporal) Arteritis Involving the Bilateral Adnexa. Int J Gynecol Pathol 2007; 26:352-5. [PMID: 17581424 DOI: 10.1097/01.pgp.0000250152.31130.23] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Giant-cell arteritis involving the bilateral adnexa was identified incidentally in a bilateral salpingo-oophorectomy specimen obtained as a result of an ovarian cyst in a 75-year-old woman. Although the patient was asymptomatic, extensive giant-cell arteritis was present in the ovaries, paraovarian tissue, and fallopian tubes along with Brenner tumors of the ovaries. This finding prompted a temporal artery biopsy that revealed typical temporal arteritis. Giant-cell arteritis rarely involves the female genital tract and may present as an isolated form or a part of systemic disease. We discuss female genital tract giant-cell arteritis with a review of the English literature.
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Affiliation(s)
- Kazuya Onuma
- Department of Pathology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15231, USA.
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Abstract
Granulomas in the uterine corpus and cervix are rare, with most examples obviously a result of a previous operative or ablative procedure. In this report, we describe 8 cases where granulomas, not associated with a previous procedure, were identified as an incidental finding in the myometrium or cervical stroma. A review of the clinical records revealed no obvious cause for the granulomatous inflammation, and we propose the term "idiopathic uterine granulomas." In all cases, the granulomas, which in most cases were multiple, were well circumscribed and intimately related to thin-walled vascular channels that showed no evidence of vasculitis. This resulted in a characteristic histological appearance similar to that seen with so-called "idiopathic ovarian cortical granulomas." Although local and systemic causes of granulomatous inflammation should be excluded, granulomas in the myometrium and cervical stroma may occur without an obvious underlying cause.
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Affiliation(s)
- Paul Kelly
- From the Department of Pathology, Royal Group of Hospitals Trust, Belfast, Northern Ireland
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Patel RK, Carrick K. Giant Cell Arteritis of the Female Genital Tract: Report of a Case and Review of the Literature. South Med J 2005; 98:469-71. [PMID: 15898526 DOI: 10.1097/01.smj.0000136262.78708.0c] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 65-year-old female presented with constitutional symptoms of fever and weight loss with bilateral adnexal masses on physical examination. Total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed and subsequently revealed giant cell arteritis involving numerous small arteries in the ovaries, fallopian tubes, paraovarian and paratubal soft tissues, myometrium, and cervix. After surgery, the patient continued to have constitutional symptoms. Corticosteroid therapy led to a significant improvement and eventual resolution of symptoms. Several similar cases of giant cell arteritis of the female genital tract have been described, both with and without concomitant temporal arteritis. Implications for diagnosis and treatment are discussed.
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Affiliation(s)
- Rahul K Patel
- UNT Health Science Center at Fort Worth, Fort Worth, TX, USA.
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Orbo A, Steffensen A. Endometrial cancer, vasculitis of the genital tract and occult temporal arteritis. Histopathology 2001; 38:178-9. [PMID: 11207832 DOI: 10.1046/j.1365-2559.2001.01072-2.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kariv R, Sidi Y, Gur H. Systemic vasculitis presenting as a tumorlike lesion. Four case reports and an analysis of 79 reported cases. Medicine (Baltimore) 2000; 79:349-59. [PMID: 11144033 DOI: 10.1097/00005792-200011000-00001] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Systemic vasculitis might present as a tumorlike lesion that initially could misdirect the correct diagnosis and the appropriate medical treatment. The aim of the present study is to summarize all reported cases of tumorlike presentation in systemic vasculitides, in order to have comprehensive data on the characteristics of this unusual phenomenon. We report 4 cases of systemic vasculitis presenting as a tumorlike lesion. In addition, we performed a MEDLINE search of all English-language papers published from 1966 to 1999, looking for vasculitis presenting as tumorlike lesion. Details were included concerning vasculitis classification, specific characteristics, location of the "tumor," the presence or absence of systemic involvement, and whether surgery was performed before diagnosis. Seventy-nine cases of vasculitis presenting as a tumorlike lesion were found in the literature, in addition to the 4 new cases described. The average age of the reported cases was 50.5 +/- 15.8 years, and 51% were female. In 82% of the cases the "tumor" was associated with constitutional symptoms and elevated erythrocyte sedimentation rate (ESR). The most common vasculitis categories with tumorlike presentation were Wegener granulomatosis (WG; 28 cases) and giant cell arteritis (GCA; 17 cases). In almost half the patients, surgery was performed before diagnosis. All patients with GCA presented with either a breast or an ovarian tumor. The most common location of a tumorlike lesion was the breast (22%), followed by central nervous system lesions (16%). Other frequent locations were the ovary (10%), caused exclusively by GCA and polyarteritis nodosa (PAN), and the male genitourinary system, almost all caused by PAN. Including vasculitis in the differential diagnosis of a tumorlike lesion might lead to an earlier diagnosis and consequently to prompt and appropriate treatment, avoiding needless operations. Constitutional symptoms and elevated ESR should alert clinicians to the possible diagnosis of vasculitis rather than a tumor. The association of GCA with ovarian pseudotumor is distinct and has not been emphasized before. We therefore suggest that GCA should be included in the list of differential diagnosis of an ovarian or breast tumor in an elderly woman, particularly when systemic symptoms and parameters of inflammation are present.
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Affiliation(s)
- R Kariv
- Department of Medicine C, Chaim Sheba Medical Center, Tel Hashomer, Israel
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Abstract
We here report a rare case of giant cell arteritis (GCA) of the myometrium found incidentally in a 68-year-old Caucasian woman presenting with uterovaginal prolapse and a known past history of temporal arteritis/polymyalgia rheumatica. Histology revealed a segmental arteritis of small, medium and some quite large myometrial arteries with extensive destruction of both internal and external elastic laminae. Multinucleate giant cells, lymphocytes and histiocytes were most prominent in the inflammatory infiltrate. The findings in this case are compared with previous reports. In a review of the literature it was found that almost one third of cases presented with generalised symptoms such as fever, anemia, fatigue and weight loss. The symptoms were not immediately recognised as temporal arteritis or polymyalgia rheumatica. On routine physical examination or radiological investigation, benign gynecological pathology such as a simple ovarian cyst or uterine leiomyoma were found. The subsequent unexpected discovery of GCA on histological examination was the critical event in alerting clinicians to the diagnosis of temporal arteritis/polymyalgia rheumatica. Without exception steroid therapy was successful in achieving relief of generalised symptoms.
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Affiliation(s)
- A H Ormsby
- Central Coast Area Health Service, Gosford, NSW, Australia
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Weiss LM, Gonzalez E, Miller SB, Agudelo CA. Severe anemia as the presenting manifestation of giant cell arteritis. ARTHRITIS AND RHEUMATISM 1995; 38:434-6. [PMID: 7880198 DOI: 10.1002/art.1780380323] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Giant cell (temporal, cranial) arteritis (GCA) is usually confirmed in patients presenting with classic features. Those who present with atypical features often undergo prolonged evaluations until a diagnosis is established. Severe anemia as an initial manifestation of GCA has rarely been described. We describe herein 2 patients with biopsy-proven GCA who presented with severe anemia and significant weight loss, which corrected after corticosteroid therapy.
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Russo MG, Waxman J, Abdoh AA, Serebro LH. Correlation between infection and the onset of the giant cell (temporal) arteritis syndrome. A trigger mechanism? ARTHRITIS AND RHEUMATISM 1995; 38:374-80. [PMID: 7880192 DOI: 10.1002/art.1780380312] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To assess for a correlation between infection and the onset of the giant cell (temporal) arteritis (GCA) syndrome. METHODS A matched case-control study design was used. Records of 100 patients with biopsy-proven GCA and 100 patients undergoing corrective surgery for hip fracture who did not have GCA were retrospectively reviewed. Non-GCA patients were sex-matched with GCA patients and were as old or older in age. The review period for GCA patients was up to 4 months before and during the occurrence of symptoms (median 2 months), and for non-GCA patients, it was up to 7 months before hip fracture. The prevalence of infection was compared using matched-pairs odds ratios and their 95% confidence intervals. RESULTS Infections were 3 times more likely to occur in GCA patients than in non-GCA patients (P < 0.05). CONCLUSION A correlation between the occurrence of infection and the onset of GCA is strongly suggested. We speculate that infection may act as a trigger mechanism in the pathogenesis of this syndrome.
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Affiliation(s)
- M G Russo
- Ochsner Clinic, New Orleans, LA 70121
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