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Surgical Pathology of Noninfectious Ascending Aortitis: A Study of 45 Cases With Emphasis on an Isolated Variant

Miller, Dylan V. MD*; Isotalo, Phillip A. MD*; Weyand, Cornelia M. MD, PhD; Edwards, William D. MD*; Aubry, Marie-Christine MD*; Tazelaar, Henry D. MD

The American Journal of Surgical Pathology: September 2006 - Volume 30 - Issue 9 - p 1150-1158
doi: 10.1097/01.pas.0000213293.04026.ec
Original Articles
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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.

Divisions of *Anatomic Pathology

Rheumatology, Mayo Clinic, Rochester, Minnesota

Department of Laboratory Medicine and Pathology, Mayo Clinic, Arizona

Reprints: Henry D. Tazelaar, MD, Mayo Clinic Arizona, 13400 East Shea Blvd. Scottsdale, AZ 85259 (e-mail: tazelaar.henry@mayo.edu)

Dr Isotalo is currently in the Department of Pathology at Queen's University, Kingston, Ontario, Canada. Dr Weyand is currently in the Department of Internal Medicine at Emory University, Atlanta, Georgia.Poster Presentation: At the annual meeting of the United States-Canadian Academy of Pathology, Vancouver, British Columbia, March 8, 2004, for which Dr Miller received the Young Investigator Award by the Society for Cardiovascular Pathology, March 7, 2004.

© 2006 Lippincott Williams & Wilkins, Inc.