Block 2 Case 5 Answers

A 60 year old women presents to the office with a localized headache and temporal artery tenderness.  She also complains of muscle weakness and fatigue. Her blood-work shows an ESR  of 100.

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1. How is this condition diagnosed? Temporal artery biopsy

2. Why is she experiencing muscle pains: Giant cell arteritis is associated with polymyalgia rheumatica

3.  What are the large straight arrows pointing to?

The arrow on the left is pointing at a granuloma and on the right giant cells. Note the abundance of lymphocytes, macrophages, and multinucleiated giant cells.  The thickening of the intima and media will lead to narrowing of the vessel's lumen.

4. What is the arrow pointing to below?

The elastin stain highlights the internal elastic lamina fragmentation.