Mönckeberg sclerosis revisited: a clarification of the histologic definition of Mönckeberg sclerosis.
BACKGROUND
Medial calcification of muscular arteries is known as Mönckeberg sclerosis (MS). Although this was first described in 1903, disagreement persists over its precise histologic appearance. Some, including Mönckeberg, have written that the media alone are calcified, whereas others maintain that both the media and internal elastic lamina (IEL) are involved. Since vascular calcification is of great interest to investigators and clinicians, defined criteria for classifying calcified arterial lesions are important.


OBJECTIVE
To clarify the histologic definition of MS with regard to calcification of the IEL.


METHODS
We reviewed slides from 14 incisional and excisional surgical biopsies and autopsy specimens containing arteries with previously diagnosed MS. We looked specifically for medial and IEL calcification and used von Kossa, alizarin red, and trichrome/elastic stains to confirm our findings. We also performed a literature search on the histologic appearance of MS.


RESULTS
Both medial and IEL calcification were present in all specimens. Medial calcification extended alongside calcified IEL. In focal regions, calcification appeared limited to the IEL, with minimal medial calcification. Occasionally, calcified nodules in the media appeared separated from the IEL yet were connected to it in other planes of section. Despite these variations in appearance, IEL involvement was universal. Of 25 journal articles and texts, 10 state that MS involves the IEL with calcification, whereas 15 state or suggest that it does not.


CONCLUSIONS
Our findings indicate MS involves both the IEL and media with calcification in spite of inconsistencies on this point in the medical literature.
Micheletti
Robert G
RG
Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at the University of California, Los Angeles, USA. mrobert@mednet.ucla.edu
Fishbein
Gregory A
GA
Currier
Judith S
JS
Fishbein
Michael C
MC
D001158:Arteries / Q000378:metabolism / Q000473:pathology*; D002114:Calcinosis / Q000378:metabolism / Q000473:pathology*; D002118:Calcium / Q000378:metabolism; D004547:Elastic Tissue / Q000378:metabolism / Q000473:pathology; D006801:Humans; D050380:Monckeberg Medial Calcific Sclerosis / Q000378:metabolism / Q000473:pathology*; D017539:Tunica Intima / Q000378:metabolism / Q000473:pathology*; D017540:Tunica Media / Q000378:metabolism / Q000473:pathology*
D002118:Calcium