Boleslaw Lach

Association of pleomorphic xanthoastrocytoma with cortical dysplasia and neuronal tumors: A report of three cases

Several recent publications indicate that pleomorphic xanthoastrocytoma (PXA) may occasionally express ganglionic cell differentiation, linking this type of tumor to other benign, mixed glioneuronal neoplasms. Furthermore, ganglionic tumors, and less frequently some benign glial tumors in the central nervous system, could be associated with a variety of mild developmental abnormalities of the cerebral cortex that are classified under the broad term cortical dysplasia. The association of cortical dysplasia with PXA and a neuronal pattern of differentiation has not been reported previously.

Intraparenchymal epithelial (Enterogenous) cyst of the medulla oblongata

Intraparenchymal solitary cyst of the medulla oblongata was diagnosed on MRI examination in a 66-year-old woman with a nine year history of progressive brainstem dysfunction and three negative CT scan examinations. Craniotomy and drainage of the cyst to the IVth ventricle led to remarkable clinical recovery. Biopsy of the wall of the cyst revealed an epithelial lining with tonofilaments, desmosomes and surface coating on ultrastructural examination. Immunohistochemistry demonstrated positive reactions of epithelium for keratins, cytokeratins, epithelial membrane antigen and Ulex Europeus lectin, indicating endodermal origin of the cyst.

Lumbar Radiculopathy Secondary to Gouty Tophi in the Filum Terminale in a Patient without Systemic Gout: Case Report

OBJECTIVE AND IMPORTANCE Gouty arthritis and gouty tophi of the spine are very rare. We present a patient with the clinical manifestations of an intradural tumor and histologically proven gouty deposits in the filum terminale. CLINICAL PRESENTATION The patient presented with typical symptoms of lumbar radiculopathy and neurogenic claudication. There was no evidence of peripheral gout. INTERVENTION Imaging studies, including computed tomography and magnetic resonance imaging, demonstrated a 1-cm, round, intradural, calcified lesion at the L3 vertebral level, causing moderate spinal stenosis. The patient underwent a two-level laminectomy and removal of the mass. A pathological examination of the specimen revealed gouty deposits in the region of the filum terminale. CONCLUSION Spinal involvement in gout is very rare, and intradural gouty deposits have not been previously described. Intradural gout should be considered in the differential diagnosis of intradural masses.

Colloid Cyst of the Third Ventricle: A Comparative Ultrastructural Study of Neuraxis Cysts and Choroid Plexus Epithelium

Thirteen colloid cysts (CC), four Rathke cleft cysts (RCC), three follicular cysts of normal pituitary gland (FCP), four enterogenous cysts (EC), three normal choroid plexi (CP), three choroid plexus papillomas (CPP), and several samples of normal bronchial mucosa and ependyma were studied by electron microscopy. The ultrastructure of most of the CC was indistinguishable from that of RCC, FCP, EC, and normal bronchial mucosa in demonstrating nonciliated and ciliated epithelial cells, goblet cells, basal cells, and intermediate forms, some showing evidence of early squamous differentiation. Two CC displayed mostly squamous differentiation, and one contained basally situated cells resembling myoepithelial cells. Although the RCC and FCP displayed features similar to those of CC, they also contained cells with electron-dense granules indicating pituitary hormone production and scattered cells showing oncocytic change. EC were lined by either squamous cells or mucin-producing columnar cells. Every CC, RCC, FCP, and EC contained cells covered by glycocalyx. In contrast to aforementioned lesions, ependymal lining, CP, and CPP were composed of a single cell type, one with numerous villi, few cilia, and no signs of keratinization, mucin production, or glycocalyx coating. It is concluded that the ultrastructural properties of CC are the same as those of cysts of endodermal or ectodermal origin and of respiratory mucosa. No ultrastructural similarities were observed between CC and normal or neoplastic neuroepithelium. These ultrastructural findings support the concept of an enterogenous origin of colloid cysts and highlight their similarity to RCC.

Intravascular Papillary Endothelial Hyperplasia in an Intracranial Cavernous Hemangioma

A novel presentation of intravascular papillary endothelial hyperplasia within a cerebral cavernous angioma in an adult is described. The pathogenesis of the lesion and its histological differentiation from malignant angiosarcoma are stressed.

Radiation therapy in lymphomatoid granulomatosis

Two female patients with lymphomatoid granulomatosis have received radiation therapy for local, progressive, symptomatic lesions. One patient was a 56‐year‐old woman with concomitant brain and pulmonary lesions which progressed on cyclophosphamide and prednisone therapy. The second patient was a 62‐year‐old woman with a supraorbital mass which appeared and progressed on prednisone therapy. Both patients exhibited rapid response to radiation therapy, in terms of relief of symptoms and objective evidence of subsidence of local disease. A discussion of the nature of lymphomatoid granulomatosis and its treatment is presented with a review of the literature. One hundred sixty‐five cases have now been described including the two in this study, and in only one previous case was radiation therapy utilized to treat local disease, prior to the two cases described herein. Cancer 42:2572–2580, 1978.

PRIMARY INTRACRANIAL PLEOMORPHIC ANGIOLEIOMYOMA : A NEW MORPHOLOGIC VARIANT : AN IMMUNOHISTOCHEMICAL AND ELECTRON MICROSCOPIC STUDY

Background. Angioleiomyomas usually are benign subcutaneous neoplasms that occur most often in extremities of middle‐aged individuals. Very few cases have been described in other locations; none along the neuroaxis. An intracranial example of angioleiomyoma displaying unusual morphologic features not seen in the typical peripheral variants of this tumor is described.

Gangliocytoma of the cerebellum: ultrastructure and immunohistochemistry.

A 31-year-old man presenting with a cerebellopontine angle syndrome underwent subtotal resection of a gangliocytoma of the left middle cerebellar peduncle. The tumor was positive for 68-kD neurofilament protein and vasoactive intestinal peptide. No glial cells were identified on immunohistochemical or ultrastructural examination. Electron microscopic study of neoplastic ganglionic cells revealed the presence of dense core vesicles, synaptic junctions, Hirano bodies, and marked dystrophic changes in the neuritic processes. The nosology of this lesion is discussed. Similarities between the morphological changes shown by mature neoplastic ganglion cells and comparable structural alterations seen in the physiological senescence of nonneoplastic neurons are stressed.

Expression of Retrovirally Transduced IL-1 α in IL-6-Dependent B Cells: A Murine Model of Aggressive Multiple Myeloma

Retroviral-mediated gene transfer was employed to introduce an IL-1 alpha cDNA into an IL-6-dependent murine B-cell line. Bone marrow metastases and bone lesions were frequently observed following intravenous injection of these B cells into syngeneic mice. Because the retroviral vector also contained the neomycin phosphotransferase gene, metastatic cells could be easily recovered from bone marrow by addition of G418 to the culture medium. Interestingly, the metastatic B cells were found to retain their IL-6 dependency through several transplant generations. By comparison, intravenous injection of autonomously-growing B-cell lines generated in vitro by retroviral introduction of an IL-6 cDNA rarely resulted in bone marrow metastases. These results demonstrate that abrogation of growth factor dependency is neither necessary nor sufficient for the in vivo growth and dissemination of tumor cells in this experimental system. It is proposed that the increased metastasis of the IL-1 alpha-producing B-cells to bone marrow is due to alterations in cell adhesion molecules. The B-cell bone marrow metastasis model described here may be useful for studies of bone marrow homing and for evaluation of therapeutic regimens for multiple myeloma.

Vasculitic basilar artery thrombosis in chronic Candida albicans meningitis

BACKGROUND Cerebrovascular complications of meningitis have been most extensively documented in the setting of acute bacterial or chronic tuberculous meningitis. Involvement of major cerebral vessels is rare and basilar artery thrombosis has not been reported in fungal meningitis secondary to candida infection. METHODS We describe the clinical course and neuropathological findings in a woman with chronic meningitis due to Candida albicans. RESULTS The diagnosis remained elusive antemortem despite analysis of 7 large volume CSF samples and examination of a meningeal and cortical biopsy. Death followed extensive brainstem and temporo-occipital infarction secondary to basilar artery thrombosis. The basilar artery occlusion was secondary to an intense, granulomatous and necrotizing basal meningitis focally extending to the media and intima. CONCLUSIONS This paroxysmal and devastating complication of untreated chronic candida meningitis reinforces that a trial of empirical therapy with both antituberculous and antifungal agents should be considered in most cases of chronic culture-negative lymphocytic meningitis.