A 71-year-old female presents with pain and a throbbing, right-sided headache. Examination reveals a tender temporal artery, and a biopsy is immediately done. What are the classic histopathology findings?
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Histopathology in giant cell arteritis (GCA) reveals inflammatory infiltrate surrounding a fragmented internal elastic lamina within the media of an arterial wall.
The infiltrate consists predominantly of mononuclear cells with giant cell formation.
Patients should be placed on high-dose corticosteroids as soon as the diagnosis is suspected to prevent blindness.
As GCA is a disease characterized by cell-mediated immunity, the pathophysiology is thought to involve the body's inappropriate response to vascular endothelial injury. The initial insult to the vascular wall causes a massive release of cytokines, in turn attracting macrophages and multinucleated giant cells. This inflammatory cascade causes activation of CD4 helper T cells, causing further inflammation and hyperplasia.
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