Abstract #10

Presenter

I finished medical school and a residency in Anatomical and Clinical Pathology in Iran where I practiced as a pathologist before
moving to Canada. Following my passion for research, I joined a master’s program in Biochemistry and Medical Genetics at the
University of Manitoba. There, I got the chance to follow my research interest in Neuropathology by completing my thesis project
that integrated both Neuropathology and Molecular Science. I continued my collaboration with the University of Manitoba as a
research associate before starting my residency in Neuropathology at the University of Western Ontario in 2020.

Authors

Shervin Pejhan¹, Lillian Barra², Pari Basharat², Larry Allen³, Lulu L.C.D. Bursztyn^3,4 Alain Proulx³, Ruo Yan Chen², Morgan Smith¹, Montana Hackett⁵, Robert Hammond^1,4

¹ Department of Pathology & Lab Medicine, London Health Sciences Centre, Schulich Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada

² Department of Medicine, Division of Rheumatology, London Health Sciences Centre, Schulich Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada

³ Ivey Eye Institute, St. Joseph’s Hospital, Schulich Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada

⁴ Department of Clinical Neurological Sciences, London Health Sciences Centre, Schulich Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada

⁵ Schulich Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada

CanMEDS:
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Isolated small vessel inflammation in temporal artery biopsies: small red flags

Abstract

Temporal arteritis (TA) is the most common vasculitis over age 50.  Untreated, many patients will suffer blindness or stroke.  Gold standard diagnosis is achieved by temporal artery biopsy. The aim of this research is to investigate the relevance of small vessel inflammation in such biopsies. Our dataset is comprised of 72 temporal artery biopsies subjected to a uniform re-examination paired with clinical data including demographics, history, physical examination, and laboratory findings. Documented pathology variables include the presence or absence of TA, angiitis of vasa vasorum (AVV), and inflammation of small peri-adventitial vessels consistent with small vessel vasculitis (SVV). Clinical and pathological variables were subjected to multivariate analysis. In brief, 25% of cases were identified as TA, 21% as isolated AVV, 7% as isolated SVV, and 5% as mixed AVV/SVV, while 42% showed no inflammation. All cases of TA were accompanied by small vessel inflammation: 94.4% exhibiting AVV with or without SVV, and 5.6% exhibiting SVV, demonstrating a strong association between TA and small vessel inflammation. Of the 24 cases with isolated AVV/SVV, 25% progressed to a clinical diagnosis of TA within one year whereas only 10% of cases with no identifiable inflammation showed such progression. Furthermore, isolated AVV/SVV was identified in 25% of patients with a high clinical probability for TA, 60% of whom acquired a diagnosis of TA on clinical grounds within one year of follow up. Our findings suggest that isolated AVV/SVV identifies a subgroup of patients with a higher risk of harboring or developing TA.