Samruay Shuangshoti

Regional distribution of rabies viral antigen in central nervous system of human encephalitic and paralytic rabies

We studied the distribution of rabies viral antigen in the brain and spinal cord of 7 patients with rabies by immunohistochemical techniques. Four patients presented with encephalitis, the remaining 3 had paralysis. Neither the rabies viral antigen distribution nor inflammation paralleled clinical presentations. Patients who had survival times of 7 days or less (4/7) had a greater amount of antigen-positive neurons in brainstem and spinal cord regardless of the clinical type. Neuroglial cells were also found to contain rabies antigen. Our findings suggest that virus localization may not account for the difference in clinical manifestations.

Intraspinal melanotic arachnoid cyst and lipoma in neurocutaneous melanosis.

A 22-year-old woman with neurocutaneous melanosis is reported in whom an intraspinal melanotic congenital arachnoid cyst and melanotic lipoma occurred at the same thoracic location. Such combined occurrence of lesions of the central nervous system, producing compression of the spinal cord, has not been noted in any previously reported case of neurocutaneous melanosis. The pathogenesis of these two unusual melanotic lesions is discussed in relation to the ectomesenchymal properties of the neural crest. The concurrent melanotic arachnoid cyst and lipoma, in juxtaposition, were demonstrated by a computed tomography scan in which the preoperative diagnosis of lipoma was possible through the density of the lesion.

Symptomatic neuroepithelial cysts in the posterior cranial fossa. Immunohistochemical and electron-microscopic studies.

A 2-year-old boy had increased intracranial pressure and convulsions because of two extraventricular cysts in the posterior cranial fossa. Releasing the watery cyst contents resulted in disappearance of such clinical manifestations. Immunohistochemically, the epithelial cytoplasm of the cyst was strongly positive for glial fibrillary acidic protein. Electron-microscopically, the cells that lined the cysts had microvilli which were coated with finely granular material to represent fuzzy coat, intercellular junctions linking the plasma membranes of adjacent cells, and numerous cytoplasmic glial filaments. The strong positivity for glial fibrillary acidic protein, then, is well correlated with an abundance of the latter. Cilia were also identified. Thus, the cysts were unequivocally neuroepithelial (ependymal) cysts. Only nine cases of neuroepithelial cysts in the posterior cranial fossa, including the current one, have been reported. Three patients were children; six were adults. The age of the patients ranged from 7 months to 60 years. The average age was 21.7 years The sex was known in eight patients with a male to female ratio of 3:5. The pathogenesis of these neuroepithelial cysts was proposed as related to developmental anomalies.

Cerebellar medulloblastomas: A study of 35 cases with particular reference to cellular differentiation ☆

A series of 35 cerebellar medulloblastomas was studied using light microscopy and immunohistochemistry for localization of glial fibrillary acidic protein, an antigen specific for neuroglia. Most medulloblastomas occurred in children less than 15 years of age (77.1%), especially in the first decade of life (65.7%), with the peak incidence (40.0%) between 6 and 10 years. The rest were found in adults beyond 15 years of age (22.9%). The male to female ratio was 4:3. Ependymal differentiation was observed in 100% of medulloblastomas, astrocytic differentiation in 88.6%, oligodendroglial differentiation in 34.3%, glioblastomatous differentiation in 8.9%, and neuronal differentiation in 8.9%. These data suggest that medulloblastoma is a primitive (stem cell) neuroepithelial neoplasm with the capacity of differentiating along both neuroglial and neuronal directions. Excessive mucin production was encountered in one medulloblastoma. Leptomeningeal invasion occurred in 34.3% of medulloblastomas and endothelial hyperplasia in 28.6%. One medulloblastoma (2.9%) spread postoperatively to several bones.

Primary phycomycosis of the brain in heroin addicts

Two heroin addicts had fatal primary phycomycosis of the brain. The first case is unique. A 28-year-old man displayed unusual symptoms of unilateral hydrocephalus confirmed by both computed tomography (CT) scanning of the brain and craniotomy. The nature of the fungal granuloma was verified histopathologically. The second case, a 40-year-old man, possessed bilateral basal ganglionic lesions in which the CT scanning suggested abscesses. Postmortem examination confirmed the presence of phycomycotic abscesses. There was no evidence of systemic mycoses in both cases. Review of the clinical features of this fatal complication in drug abusers and narcotic addicts disclosed that hemiparesis and facial weakness are common. Brain or CT scan along with brain biopsy are necessary for rapid diagnosis and prompt treatment.

Combined angioma and glioma (angioglioma)

Ten patients in whom tissue proliferation akin to angioglioma occurred within the brain are described; seven of the lesions were supratentorial and three infratentorial. Only 31 accepted instances of such neoplasms have been found in the literature. The combined lesions usually become symptomatic in the second and third decades. In all 10 cases, the angiomatous part of the combined tumors showed characteristic vascular malformation such as severe hyalinization, tortuosity, and some were even calcified. The number of abnormal blood vessels were excessive in all examples. The glial portion consisted of either astrocytoma, oligodendroglioma, or mixtures of these gliomas. Dedifferentiation of the neuroglia combined with neoplastic endothelial proliferation indicates the true neoplastic nature rather than reactive gliosis associated with a vascular anomaly.

Neoplasm of mixed mesenchymal and neuroepithelial origin: liposarcomatous meningioma combined with gliomas.

A case is reported of an intracranial neoplasm of mixed mesenchymal and neuroepithelial (glial) origin occurring in the parieto-parasagittal region of the brain of a 19 year old man. A meningioma with liposarcomatous and psammomatous components comprised the mesenchymal part of the combined tumour. The neuroepithelial portion was composed of mixed ependymoma and astrocytoma. The combined neoplasm had the gross appearances and several microscopic features of giant-celled glioblastoma, giant cell sarcoma, and monstrocellular sarcoma. The findings suggest that these tumours have a mixed mesenchymal and neuroepithelial origin.

Extramedullary subdural meningioma after trauma.

A 61-year-old man had an extramedullary subdural meningioma occurring close to the site of an old vertebral traumatic fracture and spinal cord injury. The tumor was discovered 3 years after the spinal trauma. This finding supports the existence of a causal relationship between trauma and subsequent tumor development. A review of the literature disclosed only one other case of intraspinal meningioma after the traumatic fracture of the spine with spinal cord compression.

Association of primary intraspinal meningiomas and subcutaneous meningioma of the cervical region: Case report and review of literature ☆

A report is made of a unique combination of occurrences of primary intraspinal epidural and subdural meningiomas and primary subcutaneous meningioma in the cervical region of a 15-year-old boy. The subcutaneous meningioma was detected at birth. Review of 92 recorded cases of primary dermal meningiomas revealed that they tended to occur in young patients, with an average age of 34 years for both sexes. The female-to-male ratio was 4:5. Most cutaneous meningiomas occurred in the head and neck, and the scalp was the most common site.

Combined occurrence of mucin-producing ependymoma and neuroepithelial (colloid) cysts.

A three-month-old girl had a generalized convulsion which later recurred intermittently. She eventually suffered a right hemiparesis and died at two years of age. An ependymoma, probably congenital, with papillary formation and an excessive production of mucin was present, both above and below the tentorium. Part of the supratentorial tumor filled the left lateral and third ventricles. The choroid plexus of the left lateral ventricle contained multiple small neuroepithelial (colloid) cysts. Although both these lesions of neuroepithelial origin have been encountered throughout the neuraxis, their combined occurrence is rare. Multiple neuroepithelial cysts should be differentiated from cystic ependymoma and follicular adenoma of the choroid plexus. Neuroepithelial cells, both normal and abnormal may produce mucin. A few instances of intracranial neuroepithelial (colloid) cysts together with other lesions have been reported. The associated disorders include hydranencephaly (28); xanthogranuloma (xanthoma) in the third ventricle (35); frontoethmoidal meningoencephalocele, acqueductal stenosis, obstructive hydrocephalus, and microphthalmia (34) and congenital vascular anomalies of the brain (31). The subject of the present report is the combined occurrence of an intracranial ependymoma producing excessive mucin, and multiple neuroepithelial cysts of the choroid plexus of one lateral ventricle.