Background

Not rarely aortitis is firstly identified in thoracic aorta aneurysm/dissection specimens only by histopathology in the absence of clinical evidence of systemic inflammatory disease emphasizing the importance of histology for the diagnosis of aortitis. Regardless of the improvement of the pathological assessment of aortic diseases by the recent consensus statements on surgical pathology of the aorta, histology can be confusing since medial degenerative changes (MDC) can be prominent in a background where inflammation is sometimes limited. This raises the question of the role of aging or other degenerative process versus the role of inflammation in the damage to aorta wall.

Patients and Methods

In this study, besides inflammation, we evaluated aorta samples from aortitis cases focusing on the histological scoring of MDC. In this retrospective single center study, we retrieved 719 cases of ascending aorta aneurysms or dissections operated on from January 2010 until June 2018. MDC (elastic fiber fragmentation and/or loss, smooth muscle nuclei loss, mucoid extracellular matrix accumulation intralemellar or translamellar) were estimated using a scoring system derived from that of the consensus statement. Noninfectious aortitis group versus age-matched non-inflammatory degenerative aortic disease group were compared.

Results

Noninfectious aortitis was pathologically diagnosed in 62 patients (8.6%). Among the 62 noninfectious aortitis patients, 47 patients (75.8%) had aortitis identified pathologically prior to the clinical diagnosis. Higher MDC scores were observed at all aortic sizes in aortitis group versus non-aortitis group, especially for elastic fiber damage and smooth muscle cell loss.

Conclusions

Aortitis is remarkably associated with severe damage to the aorta wall resulting in advanced MDC scores. Inflammatory process is responsible for higher MDC in the aorta wall than aging or other degenerative process.

中文翻译：

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主动脉炎与非炎症性主动脉疾病对主动脉壁损伤的比较

背景

在缺乏全身性炎症疾病的临床证据的情况下，仅通过组织病理学首先在胸主动脉瘤/夹层标本中发现主动脉炎并不罕见，这强调了组织学对主动脉炎诊断的重要性。尽管最近关于主动脉手术病理学的共识声明改善了主动脉疾病的病理学评估，但组织学可能会令人困惑，因为内侧退行性变化 (MDC) 在炎症有时有限的背景下可能很突出。这提出了老化或其他退行性过程的作用与炎症在主动脉壁损伤中的作用的问题。

患者和方法

在这项研究中，除了炎症之外，我们还评估了主动脉炎病例的主动脉样本，重点是 MDC 的组织学评分。在这项回顾性单中心研究中，我们检索了 2010 年 1 月至 2018 年 6 月间手术的 719 例升主动脉瘤或夹层。使用源自共识声明的评分系统进行估计。比较了非感染性主动脉炎组与年龄匹配的非炎性退行性主动脉疾病组。

结果

62 名患者 (8.6%) 经病理诊断为非感染性主动脉炎。在 62 名非感染性主动脉炎患者中，47 名患者 (75.8%) 在临床诊断前病理学确定了主动脉炎。与非主动脉炎组相比，主动脉炎组所有主动脉大小的 MDC 评分均较高，尤其是弹性纤维损伤和平滑肌细胞丢失。

结论

主动脉炎与主动脉壁的严重损伤显着相关，导致 MDC 评分升高。与衰老或其他退行性过程相比，炎症过程导致主动脉壁中更高的 MDC。