Surgical pathology of noninfectious ascending aortitis: A study of 45 cases with emphasis on an isolated variant
Surgical pathology of noninfectious ascending aortitis: A study of 45 cases with emphasis on an isolated variant
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DOI：
10.1097/01.pas.0000213293.04026.ec
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发表时间：
2006-09-01
影响因子：
5.6
通讯作者：
Tazelaar, Henry D.
中科院分区：
文献类型：
--
作者：
Miller, Dylan V.;Isotalo, Phillip A.;Tazelaar, Henry D.
背景：主动脉炎是老年人升主动脉瘤的一个重要原因。设计：对1985年至1999年连续进行的513例升主动脉切除术中45例活动性非感染性主动脉炎的临床病理资料进行回顾性分析。在复习苏木精-伊红和Verhoff-van Gieson染色的切片时记录组织病理学特征。病例按预先定义的临床标准进行分类。比较不同组别的临床病理特征，重点是无全身动脉炎的意外大动脉炎。结果：最大的两组为孤立性大动脉炎(47%)和巨细胞性大动脉炎(31%)。其他大动脉炎组包括Takayasu(14%)、类风湿(4%)和未分类(4%)。孤立性大动脉炎和巨细胞动脉炎患者多为女性(80%；平均年龄73岁)。所有6例大动脉炎患者均为女性(平均年龄26岁)。虽然巨细胞动脉炎和孤立性大动脉炎在组织学上难以区分，但它们的临床病程有很大的不同。在21例单纯性主动脉炎患者中(2例使用皮质类固醇治疗)，只有10%的患者后来发展为主动脉瘤。相比之下，在14例巨细胞性动脉炎患者中(11例接受皮质类固醇治疗)，21%的患者随后发展为动脉瘤(P=0.09)。患有孤立性大动脉炎和巨细胞性动脉炎的患者一般都在50岁以上，而根据定义，那些患有大动脉炎的患者更年轻。在孤立性大动脉炎患者中，尽管没有抗炎治疗，结果总体上是好的。因此，对于这类大动脉炎患者，保守治疗可能是有必要的。
Background: Aortitis is emerging as an important cause of ascending aortic aneurysm in the elderly. Its features have not been described in a surgical population.Design: Retrospective clinicopathologic review of 45 cases of active noninfectious aortitis among 513 consecutive ascending aortic resections (1985 to 1999).Methods Clinical data were collected from medical records. Histopathologic features were recorded during review of slides stained with hematoxylin-eosin and Verhoeff-van Gieson. Cases were categorized by predefined clinical criteria. Clinicopathologic features were compared among groups, with emphasis on unsuspected aortitis without systemic arteritis.Results: The 2 largest groups were isolated aortitis (47%) and giant cell arteritis (31%). Other aortitis groups included Takayasu (14%), rheumatoid (4%), and unclassified (4%). Patients with isolated aortitis and giant cell arteritis were generally women (80%; mean age 73 y). All 6 with Takayasu arteritis were women (mean age 26). Although giant cell arteritis and isolated aortitis were histologically indistinguishable, their clinical courses differed substantially. Among 21 patients with isolated aortitis (2 treated with corticosteroids), only 10% later developed aortic aneurysms. In contrast, of 14 patients with giant cell arteritis (11 treated with corticosteroids), 21% subsequently developed aneurysms (P = 0.09).Conclusions: Aortitis primarily affected women. Patients with isolated aortitis and giant cell arteritis were generally older than 50 years and, by definition, those with Takayasu arteritis were younger. In patients with isolated aortitis, outcomes were generally good, despite the absence of anti-inflammatory therapy. Accordingly, a conservative approach may be warranted for managing this subset of patients with aortitis.