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Monckeberg’s sclerosis in temporal artery biopsy specimens
  1. Department of Ophthalmology, University of Illinois at Chicago, Chicago, IL, USA
  1. Dr Deepak P Edward, Department of Ophthalmology, University of Illinois at Chicago, 1855 W Taylor Street, Chicago, IL 60612, USA.

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Editor,—Temporal artery biopsies are performed routinely on patients suspected of having giant cell arteritis. Of 131 pathology specimens examined at University of Illinois at Chicago Eye Center from 1975 to 1998, the most common diagnosis was atherosclerosis with myointimal fibrosis (63%) followed by giant cell arteritis (13%). In about 6% of cases we encountered calcific sclerosis confined to the tunica media which was associated with mild tissue disorganisation surrounding the calcific plaque and disruption of the internal elastic lamina (Fig 1).

Figure 1

Cross section through temporal artery showing disrupted internal elastic lamina (arrow) and large calcific plaques (C) in the tunica media (haematoxylin and eosin; original magnification ×40).

Monckeberg’s sclerosis as seen in these specimens was first described by Monckeberg in 1903. It commonly affects medium size muscular arteries and is described in femoral, tibial, radial, coronary, cerebral, and visceral arteries.1 However, its association with the temporal artery is uncommon. The infrequent occurrence of this condition in the temporal artery and the presence of a fragmented internal elastic lamina should not be erroneously interpreted as sequelae of previous arterial inflammation. The pathophysiology of Monckeberg’s arteriosclerosis is still unclear, but it can be induced in animal models by injecting adrenalin, nicotine, parathyroid hormone, and vitamin D.2 In addition, lumbar sympathectomy has been shown to promote occurrence of Monckeberg’s arteriosclerosis of the lower extremities in humans.3 Automatic dysfunction from diabetic neuropathy is thought to be responsible for the occurrence of Monckeberg’s in diabetic patients.4 Unlike atherosclerosis, Monckeberg’s arteriosclerosis is a benign condition and does not cause vascular thrombosis. In conclusion, Monckeberg’s arteriosclerosis of the temporal artery may be seen occasionally in the temporal artery.5 It is an interesting histological diagnosis that has little clinical significance but should be recognised in temporal biopsy specimens.