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Evangelatos G, Grivas A, Pappa M, Kouna K, Iliopoulos A, Fragoulis GE. Cranial giant cell arteritis mimickers: A masquerade to unveil. Autoimmun Rev 2022; 21:103083. [PMID: 35341973 DOI: 10.1016/j.autrev.2022.103083] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 03/23/2022] [Indexed: 12/20/2022]
Abstract
Giant cell arteritis (GCA) is a large-vessel vasculitis that affects cranial and extra-cranial arteries. Extra-cranial GCA presents mainly with non-specific symptoms and the differential diagnosis is very broad, while the cranial form has more typical clinical picture and physicians have a lower threshold for diagnosis and treatment. Although temporal artery biopsy (TAB) has an established role, ultrasound (US) is being increasingly used as the first-line imaging modality in suspected GCA. Vasculitides (especially ANCA-associated), hematological disorders (mainly amyloidosis), neoplasms, infections, atherosclerosis and local disorders can affect the temporal arteries or might mimic the symptoms of cranial GCA and produce US and TAB findings that resemble those of temporal vasculitis. Given that prompt diagnosis is essential and proper treatment varies significantly among these diseases, in this review we aimed to collectively present disorders that can masquerade cranial GCA.
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Affiliation(s)
- Gerasimos Evangelatos
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, School of Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Alexandros Grivas
- Clinical Immunology-Rheumatology Unit, Fourth Department of Internal Medicine, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Pappa
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, School of Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantina Kouna
- Rheumatology Department, 417 Army Share Fund Hospital (NIMTS), Athens, Greece
| | - Alexios Iliopoulos
- Rheumatology Department, 417 Army Share Fund Hospital (NIMTS), Athens, Greece
| | - George E Fragoulis
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, School of Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Brekke LK, Fevang BTS, Diamantopoulos AP, Assmus J, Esperø E, Gjesdal CG. Risk of Cancer in 767 Patients with Giant Cell Arteritis in Western Norway: A Retrospective Cohort with Matched Controls. J Rheumatol 2019; 47:722-729. [PMID: 31308209 DOI: 10.3899/jrheum.190147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the risk of cancer in a large Norwegian cohort of patients with giant cell arteritis (GCA). METHODS This is a hospital-based, retrospective, observational cohort study including patients diagnosed with GCA in the Bergen Health Area during 1972-2012. Patients were identified through computerized hospital records using the International Classification of Diseases coding system. Medical records were reviewed. Each patient was randomly assigned population controls matched on age, sex, and geography from the Central Population Registry of Norway. Data on the occurrence of cancer were obtained from the Cancer Registry of Norway. The cumulative risk of malignancy was estimated using Kaplan-Meier methods and potential differences were analyzed using the Gehan-Breslow and log-rank tests. RESULTS We identified 881 cases with a clinical diagnosis of GCA, of which 792 fulfilled the American College of Rheumatology (ACR) 1990 classification criteria and 528 were biopsy-verified. Cases with no registered cancer prior to GCA diagnosis were included in a time-to-event analysis, with first cancer as the event (n = 767 with clinical GCA diagnosis, 686 fulfilling ACR criteria for GCA, 463 biopsy-verified). These cases were matched with previously cancer-free population controls (n = 1437, 1284, 895, respectively). We found no significant difference in the risk of malignancy after time of diagnosis/matching for GCA patients compared to population controls (p > 0.05). CONCLUSION In this study of a large and well-characterized cohort of patients with GCA, there was no difference in the risk of malignancy in patients with GCA compared to matched population controls.
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Affiliation(s)
- Lene Kristin Brekke
- From the Hospital for Rheumatic Diseases, Haugesund; Department of Clinical Science, University of Bergen, Bergen; Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease (BEaBIRD), Department of Rheumatology, and Centre for Clinical Research, Haukeland University Hospital, Bergen; Martina Hansens Hospital, Bærum, Norway. .,L.K. Brekke, MD, Hospital for Rheumatic Diseases, and Department of Clinical Science, University of Bergen; B.T. Fevang, MD, PhD, Department of Clinical Science, University of Bergen, and BEaBIRD, Department of Rheumatology, Haukeland University Hospital; A.P. Diamantopoulos, MD, PhD, MPH, Martina Hansens Hospital; J. Assmus, PhD, Centre for Clinical Research, Haukeland University Hospital; E. Esperø, MD, Hospital for Rheumatic Diseases; C. Gram Gjesdal, MD, PhD, Department of Clinical Science, University of Bergen, and BEaBIRD, Department of Rheumatology, Haukeland University Hospital.
| | - Bjørg-Tilde Svanes Fevang
- From the Hospital for Rheumatic Diseases, Haugesund; Department of Clinical Science, University of Bergen, Bergen; Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease (BEaBIRD), Department of Rheumatology, and Centre for Clinical Research, Haukeland University Hospital, Bergen; Martina Hansens Hospital, Bærum, Norway.,L.K. Brekke, MD, Hospital for Rheumatic Diseases, and Department of Clinical Science, University of Bergen; B.T. Fevang, MD, PhD, Department of Clinical Science, University of Bergen, and BEaBIRD, Department of Rheumatology, Haukeland University Hospital; A.P. Diamantopoulos, MD, PhD, MPH, Martina Hansens Hospital; J. Assmus, PhD, Centre for Clinical Research, Haukeland University Hospital; E. Esperø, MD, Hospital for Rheumatic Diseases; C. Gram Gjesdal, MD, PhD, Department of Clinical Science, University of Bergen, and BEaBIRD, Department of Rheumatology, Haukeland University Hospital
| | - Andreas P Diamantopoulos
- From the Hospital for Rheumatic Diseases, Haugesund; Department of Clinical Science, University of Bergen, Bergen; Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease (BEaBIRD), Department of Rheumatology, and Centre for Clinical Research, Haukeland University Hospital, Bergen; Martina Hansens Hospital, Bærum, Norway.,L.K. Brekke, MD, Hospital for Rheumatic Diseases, and Department of Clinical Science, University of Bergen; B.T. Fevang, MD, PhD, Department of Clinical Science, University of Bergen, and BEaBIRD, Department of Rheumatology, Haukeland University Hospital; A.P. Diamantopoulos, MD, PhD, MPH, Martina Hansens Hospital; J. Assmus, PhD, Centre for Clinical Research, Haukeland University Hospital; E. Esperø, MD, Hospital for Rheumatic Diseases; C. Gram Gjesdal, MD, PhD, Department of Clinical Science, University of Bergen, and BEaBIRD, Department of Rheumatology, Haukeland University Hospital
| | - Jörg Assmus
- From the Hospital for Rheumatic Diseases, Haugesund; Department of Clinical Science, University of Bergen, Bergen; Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease (BEaBIRD), Department of Rheumatology, and Centre for Clinical Research, Haukeland University Hospital, Bergen; Martina Hansens Hospital, Bærum, Norway.,L.K. Brekke, MD, Hospital for Rheumatic Diseases, and Department of Clinical Science, University of Bergen; B.T. Fevang, MD, PhD, Department of Clinical Science, University of Bergen, and BEaBIRD, Department of Rheumatology, Haukeland University Hospital; A.P. Diamantopoulos, MD, PhD, MPH, Martina Hansens Hospital; J. Assmus, PhD, Centre for Clinical Research, Haukeland University Hospital; E. Esperø, MD, Hospital for Rheumatic Diseases; C. Gram Gjesdal, MD, PhD, Department of Clinical Science, University of Bergen, and BEaBIRD, Department of Rheumatology, Haukeland University Hospital
| | - Elisabet Esperø
- From the Hospital for Rheumatic Diseases, Haugesund; Department of Clinical Science, University of Bergen, Bergen; Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease (BEaBIRD), Department of Rheumatology, and Centre for Clinical Research, Haukeland University Hospital, Bergen; Martina Hansens Hospital, Bærum, Norway.,L.K. Brekke, MD, Hospital for Rheumatic Diseases, and Department of Clinical Science, University of Bergen; B.T. Fevang, MD, PhD, Department of Clinical Science, University of Bergen, and BEaBIRD, Department of Rheumatology, Haukeland University Hospital; A.P. Diamantopoulos, MD, PhD, MPH, Martina Hansens Hospital; J. Assmus, PhD, Centre for Clinical Research, Haukeland University Hospital; E. Esperø, MD, Hospital for Rheumatic Diseases; C. Gram Gjesdal, MD, PhD, Department of Clinical Science, University of Bergen, and BEaBIRD, Department of Rheumatology, Haukeland University Hospital
| | - Clara Gram Gjesdal
- From the Hospital for Rheumatic Diseases, Haugesund; Department of Clinical Science, University of Bergen, Bergen; Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease (BEaBIRD), Department of Rheumatology, and Centre for Clinical Research, Haukeland University Hospital, Bergen; Martina Hansens Hospital, Bærum, Norway.,L.K. Brekke, MD, Hospital for Rheumatic Diseases, and Department of Clinical Science, University of Bergen; B.T. Fevang, MD, PhD, Department of Clinical Science, University of Bergen, and BEaBIRD, Department of Rheumatology, Haukeland University Hospital; A.P. Diamantopoulos, MD, PhD, MPH, Martina Hansens Hospital; J. Assmus, PhD, Centre for Clinical Research, Haukeland University Hospital; E. Esperø, MD, Hospital for Rheumatic Diseases; C. Gram Gjesdal, MD, PhD, Department of Clinical Science, University of Bergen, and BEaBIRD, Department of Rheumatology, Haukeland University Hospital
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Bois MC, Eckhardt MD, Cracolici VM, Loe MJ, Ocel JJ, Edwards WD, McBane RD, Bower TC, Maleszewski JJ. Neoplastic embolization to systemic and pulmonary arteries. J Vasc Surg 2018; 68:204-212.e7. [PMID: 29502997 DOI: 10.1016/j.jvs.2017.09.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 09/23/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Arterial neoplastic emboli are uncommon, accounting for <1% of thromboemboli in the current literature. Nonetheless, this event may be associated with significant morbidity and mortality. Herein, we report a series of 11 cases of arterial neoplastic emboli from a single tertiary care center along with a comprehensive review of the literature to date. The aim of this study was to document the incidence, clinical presentations, and complications of arterial neoplastic emboli as well as to highlight the importance of routine histologic examination of thrombectomy specimens. METHODS Pathology archives from a single tertiary care institution were queried to identify cases of surgically resected arterial emboli containing neoplasm (1998-2014). Histopathology was reviewed for confirmation of diagnosis. Patient demographics and oncologic history were abstracted from the medical record. Comprehensive literature review documented 332 patients in 275 reports (1930-2016). RESULTS Eleven patients (six men) with a median age of 63 years (interquartile range, 42-71 years) were identified through institutional archives. Embolism was the primary form of diagnosis in seven (64%) cases. Cardiac involvement (primary or metastasis) was present in more than half of the cohort. Comprehensive literature review revealed that pulmonary primaries were the most common anatomic origin of arterial neoplastic emboli, followed by gastrointestinal neoplasia. Cardiac involvement was present in 18% of patients, and sentinel identification of neoplasia occurred in 30% of cases. Postmortem evaluation was the primary means of diagnosis in 27%. CONCLUSIONS This study highlights the importance of routine histopathologic evaluation of embolectomy specimens in patients with and without documented neoplasia.
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Affiliation(s)
- Melanie C Bois
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minn
| | - Michael D Eckhardt
- Department of Pathology and Laboratory Medicine, University of Chicago, NorthShore University HealthSystem, Evanston, Ill
| | | | - Matthew J Loe
- Interventional Radiology, St. Paul Radiology, St. Paul, Minn
| | - Joseph J Ocel
- Diagnostic Radiology, Mercy Health Services-Iowa Corporation, Mason City, Iowa
| | - William D Edwards
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minn
| | - Robert D McBane
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn
| | - Thomas C Bower
- Division of Vascular and Endovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, Minn
| | - Joseph J Maleszewski
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minn; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn.
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