CASE STUDIES to the aortic disease. There was a dense mononuclear infiltrate, composed predominantly of lymphocytes with focal neutrophils and hi.stiocytes and occasional giant cells (Fig 2). The uninvolved portions of the \-alve contained areas of intimal proliferation1 and myxomatous change. DISCUSSION The unique feature of this case is the presence of a giant cell granulomatous valvulitis in association with the aortitis. which, to our knowledge, has not been previously described in Takayasu aortitis. A report by Saito et al’ of five autopsied cases oi “aortitis syndrome” described a diffuse round cell infiltrate in the aortic. valve of one of the patients. The infiltrate was described as being present from the subendothelium to the media; hl)wever, there was no mention of a granulomatous component. Other reports’,’ of valvular abnormalities in Takayasi’s disease described a nonspecific fibrosis with or without mononuclear cells. A recent report’” described a patient with Reiter’s syndrome who had a severe giant cell valvulitis of both mitral and aortic valves with an otherwise nongranulomatous aor-titis. To our knowledge, this is the only other previous report of giant cell granulomatous valvulitis. The difrerential diagnosis of giant cell granulomatous aortitis includes syphilitic aortitis and giant cell arteritis, which can be morpholo@cally indistinguishable from Takayasu aortitis.” Takdyasu aortitis has also been described in association with systemic rheumatologic diseases such as rheumatoid arthritis, ankylosing spondylitis, and progressive systemic sclerosis.“,” Although thr patient reported here may have an underlying rheumatologic disorder that has yet to become overt, the oresence of all underlvincr disease does not exclude the diagLosis of Takayasu aortitis.Y Moreover, both syphilitic and tenlporal giant cell arteritis are unlikely possibilities, in view of the patient’s age and the clinical setting. The patient was

young and had no other stigmata commonly associated with syphilitic or temporal giant cell arteritis. Finally, aortir insufficiency occurs in a minority of patients with Takayasu aortitis,“.” and is usually attributed to annuloaortic ectasia, as was present in our case. Severe aortic insufficiency is infrequent.” and the clinical presentation of aortic insufficiencv as the sole manifestation of Takayasu aortitis is rare.’ ’ The presence of a giant cell granulomatous aortitis in a patient with aortic insufficiency without the classical clinical features of Takayasu aortitis should not preclude the diagnosis, especially in a young woman. irrespective of ethnic origin.

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GASTRIC

ANTRAL

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ECTASlA

‘~.WLJI T.AN.AL~. MD, YOSHIO MOKI, MD, YLWO MORISHITA, MD, TOSHIHIRO KOJIM~Z,MD, TOSHIHIIW K~~W,UJOKI,MD. K,ULX) ASIANO, MD, M.C.~YOSHI ICHIHAR,~, MD, M.~crro

TAKAO. MD, AKIHIK~ &TOH,

.A IUC o/ga.s/rrc autml vasrular rrtasia corzfincd to the antrum in an elderly Ja,bnnr~ mle patient is described. The condition is a cause of t&d 10s.~ and chronic iron deJiciency anemia, particularly in the elderly. The clinical. endosropic, and pathologic findings. which were coutractrd with other h@erplastic or gastric zmcular ore described. -HrFnr PATHOL 22:1053abnormalities. 105 5, O’opyrl,qht 168199 I 1)~ B’.H. Saunders C.knpa?q

Gastric antral vascular ectasia.

A case of gastric antral vascular ectasia confined to the antrum in an elderly Japanese male patient is described. The condition is a cause of blood l...
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