True Monckeberg-Type Calcification of Temporal Arteries: A Rare Pattern Associated with End-Stage Renal Disease
RM Hudacko, J Jaworski, W Chen, DJ Foran, BS Fyfe. Robert Wood Johnson Medical School, New Brunswick, NJ
Background: Three patterns of calcification of medium-sized arteries have been described: intimal calcification associated with atherosclerotic plaques, Monckeberg-type medial calcification, and a distinct pattern limited to the internal elastic lamina (IEL) which has been shown to be associated with increasing age. The high reported incidence of Monckeberg medial calcific sclerosis diagnosed at our institution prompted a review of the distribution of calcification in a series of biopsies from patients suspected to have temporal arteritis.
Design: 94 temporal arteries biopsied from 1998 to 2008 were reviewed, and qualitative and quantitative analysis of the histomorphology of the specimens containing calcification was performed. Qualitative data included intimal hyperplasia, medial calcification, arteritis, and IEL calcification (linear or nodular pattern with subclassification as nodular intimal or nodular medial). Quantitative data was calculated using ImageJ and included area of mineralization, intimal and medial area, and minimum and maximum intimal and medial thickness.
Results: 25 biopsies with mineralization (age range 47 to 89 years) were reviewed. IEL calcification was present in 24 cases including our only 2 cases of active giant cell arteritis. IEL calcification was linear in 13 and nodular in 11 cases. Nodular calcification involved the intima in 4 cases and the media in 7 cases. Calcification affected from 0.06% to 85% of the total (intimal + medial) area. There was no correlation between age and % of calcification. True medial calcification of Monckeberg-type was noted in 2 cases. Both patients were diabetic with end-stage renal disease on dialysis.
Conclusions: Calcification is common in temporal arteries biopsied for clinical suspicion of arteritis. The most common pattern is linear calcification of the IEL, which is not related to healed arteritis and may co-exist with active arteritis (2/2 cases). Atrophy of the media is seen with nodular calcification with medial extension. True Monckeberg medial calcific sclerosis is a separate and uncommon pattern of calcification in temporal arteries and is associated with end-stage renal disease/dialysis. Pathologists need to be aware of the different patterns of calcification and their clinicopathologic associations.
Tuesday, March 10, 2009 1:00 PM
Poster Session IV # 53, Tuesday Afternoon