Juvenile Temporal Arteritis | Dermatopathology

This condition presents characteristically as a mass on the temple whereby it is held to clinically represent a cyst. Juvenile temporal arteritis is unrelated to adult temporal arteritis which is an autoimmune reaction typically a Gell-Coombs type IV immune response targeting the elastic of the temporal artery associated with polymyalgia rheumatica. In contrast, juvenile temporal arteritis is held to represent an arteriocentric form of angiolymphoid hyperplasia with eosinophilia. There is a component of neovascularization whereby the endothelial cells typically show a protuberant signet ring-like hobnailed morphology a finding that is very well exemplified by this arteriocentric variant of angiolymphoid hyperplasia with eosinophilia and certainly seen in this case.

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Slide 1: 45 year-old man with a temple lesion. The excision specimen is centered around a subsegmental branch of the temporal artery.

Slide 2: The lumen of the artery is thrombosed. A small rim of residual lumen is noted (far right of image).

Slide 3: There is a reactive pattern of endothelial cell hyperplasia.

Slide 4: There is an infiltrate comprising lymphocytes as well as eosinophils that transgress through the wall of the artery.

Slide 5: In examining the endothelial cells that are hyperplastic and appear rather plump showing a hobnailed morphology with intracytoplasmic vacuoles exactly akin to what one encounters in an epithelioid hemangioma/angiolymphoid hyperplasia with eosinophilia.