A 75 year old woman complains to a physician of facial pain, headache, and intermittent visual symptoms. Both temporal aeries are biopsied. If the biopsies show abnormal vessels, which of the following would be the most likely pathological finding?

The suspected disease is temporal aeritis, also known as giant cell aeritis, because of the focal granulomatous inflammation (with giant cells) that characterizes the process. The cranial aeries (branches of the carotid system) are most often involved. Vigorous attempts at diagnosis, which may require biopsying 2-cm lengths of each temporal aery, are indicated because the process can be patchy. Correct diagnosis is essential because untreated temporal aeritis can involve the ophthalmic aery, leading to irreversible blindness. Atherosclerosis is almost never seen in the distal (lower blood pressure) pa of the temporal aery. Fibrinoid necrosis is a feature of polyaeritis nodosa, not temporal aeritis. Fungal hyphae would suggest a fungal infection rather than temporal aeritis. Ref: Suurmond D. (2009). Section 14. The Skin in Immune, Autoimmune, and Rheumatic Disorders. In D. Suurmond (Ed), Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology, 6e.