Cases reported "Necrosis"

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1/9. infection with jc virus and possible dysplastic ganglion-like transformation of the cerebral cortical neurons in a case of progressive multifocal leukoencephalopathy.

    infection of the cerebral cortical neurons with jc virus (JCV) with possible dysplastic ganglion-like alteration of the infected neurons found in a case of progressive multifocal leukoencephalopathy (PML) is described. The patient was a 21-year-old man with common variable immunodeficiency who died of PML after a 9-month clinical course. At autopsy, the white matter of the cerebrum, brainstem, cerebellum, and spinal cord exhibited extensive demyelination and necrosis. Numerous inclusion-bearing oligodendrocytes and bizarre astrocytes were found. In the occipital and temporal cortex, thick band-like aggregates of dysplastic ganglion-like cells (DGLCs) were found. These DGLCs showed immunohistochemical properties of neurons, and nuclei of some DGLCs were immunoreactive for large T antigen of SV40/JCV and p53, but not for capsid protein JCV VP1. in situ hybridization for mRNA of JCV large T antigen revealed positive signals in the nuclei of some DGLCs. These results indicate that JCV infected neurons and it is suggested that binding of the large T antigen with cellular proteins could have resulted in the dysplastic, ganglion cell-like change of the infected neurons, although the possibility that the aggregates of DGLCs represent a pre-existent malformative lesion of the cortex cannot be excluded completely.
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2/9. Desmoplastic infantile ganglioglioma: a rare tumor with an unusual presentation.

    Desmoplastic infantile ganglioglioma (world health organization grade I) is a rare neoplasm. Despite their common large size and spectacular radiologic and histologic features, the prognosis after surgical resection is good. We present a new case of this tumor in a 14-month-old boy with a recent history of intracranial hypertension. magnetic resonance imaging revealed a large tumor involving the left collateral trigone with dilatation of the lateral ventricles. Surgery revealed two separate solid tumors: one in the left falco-tentorial region and the other in the left rolandic area. Microscopic examination showed a proliferation of neoplastic astrocytes in reticulin-rich desmoplastic stroma associated with scattered ganglion cells. One year after surgery follow-up magnetic resonance imaging did not show tumor progression.
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3/9. Solitary retinal astrocytoma.

    A two-year-old female child presented with a left retinal mass in front of the optic disc and total serous retinal detachment. Enucleation was performed for suspected retinoblastoma. Histopathologically the tumour was composed of astrocytic giant cells with a few spindle-shaped astrocytes. Presence of multiple necrotic foci in the tumour resembling micro-abscesses and extension of tumour cells beyond lamina cribrosa were additional unusual features.
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4/9. Temporal relationships of neuropathologic conditions caused by perinatal asphyxia.

    The neuropathologic conditions in 120 perinatal deaths attributed to fetal or newborn asphyxia were examined. central nervous system necrosis was present in 16 of these deaths. The approximate time of asphyxial insult was established by determining the duration of the process, based on the findings of neuronal necrosis, macrophage response, or an astrocyte response, in conjunction with clinical data. The time of the asphyxial insult for the 16 perinatal deaths was as follows: antepartum fetal asphyxia, two cases; antepartum-intrapartum fetal asphyxia, five cases; intrapartum fetal asphyxia, four cases; and neonatal asphyxia, five cases. These observations indicate that an asphyxial insult may occur in the antepartum period, in the prodromal period of preterm labor, in the intrapartum period, and in the neonatal period. Five to ten percent of the asphyxial insults in each reproductive time period were initially sublethal, allowing necrosis of the brain of the fetus or newborn to develop.
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5/9. Primary necrosis of corpus callosum with dystrophic astrogliosis and Rosenthal-like fiber formation. The first Chinese case of Marchiafava-Bignami's disease (MBD).

    The first Chinese case of MBD is reported as an incidental finding in a non-alcoholic who died from syphilitic heart disease complicated by subacute endocarditis. The extensive necrotic and demyelinating lesion of the body of corpus callosum presents no sandwich appearance. The core of the corpus callosum shows dystrophic astrogliosis with Rosenthal-like fibers and Alzheimer astrocytes, while only reactive astrogliosis is observed in its subpia and subependyma. The development of dystrophic astrogliosis in which gemistocytosis is believed to be the central theme, with the presence of Rosenthal-like fibers and Alzheimer astrocytes in this case denotes possibly a severe metabolic derangement of the affected astroglia. The presence of the subpial and subependymal reactive astrogliosis of the body of corpus callosum to the dystrophic astrogliosis of its core suggests that the same injury may lead to different responses in different subtypes of astrocytes of the same anatomic locus.
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6/9. Posttherapeutic cerebral radionecrosis: a complication of head and neck tumor therapy.

    patients with treated head and neck cancer may have focal neurologic symptoms and personality changes due to delayed cerebral radionecrosis. A history of past treatment should direct the physician to consider these lesions in the differential diagnosis. craniotomy is the management recommended. Histopathologic changes include fibrotic response of the meninges with pleomorphic and vacuolated fibroblasts, capillary hyperplasia, reactive astrocytes, and fibrosis of the blood vessels. Amyloid is deposited in the arteriolar walls and extracellular space. Ischemic, autoimmune, or vascular mechanisms, and glial alterations have all been considered in the pathogensis of delayed cerebral radionecrosis. Some researchers have concluded that chemotherapeutic agents, such as methotrexate, may contribute to its production.
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7/9. Disseminated necrotizing leukoencephalopathy following irradiation and methotrexate therapy for central nervous system infiltration of leukemia and lymphoma.

    The authors report four adult patients with disseminated necrotizing leukoencephalopathy (DNL) following therapy for central nervous system (CNS) involvements of leukemia and lymphoma. Five to fourteen months after starting therapy with 30.6-62.5 Gy of whole brain irradiation and 120-500 mg of intrathecal methotrexate (MTX), DNL developed. brain CT scans demonstrated a characteristic symmetrical white matter low density area. Furthermore, the brain CT scans disclosed tumorous lesions with contrast enhancement in three cases. In two of the three cases autopsy proved the tumorous lesions to be necrotic foci but not leukemic tumors. Post-mortem neuropathological studies of three patients disclosed characteristic features of DNL: multiple coagulative necrosis in the white matter with myelin degeneration, swollen axons, prominent calcification, and enlarged reactive astrocytes. Three of the four patients obviously received greater doses of whole brain irradiation and intrathecal MTX than patients who remained free from DNL after treatment with whole brain irradiation and/or MTX. Analysis of the etiological factors in this series underscores the prevailing danger of treatment for neoplastic CNS involvement with excessive doses of whole brain irradiation combined with intrathecal MTX.
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8/9. An autopsy case of coexisting portal systemic encephalopathy and senile dementia of the Alzheimer type.

    An autopsy case of portal systemic encephalopathy and senile dementia of the Alzheimer type coexisting in a 77-year-old man is described. The patient had suffered recurrent episodes of delirium after a subtotal gastrectomy for gastric carcinoma. He died of DIC 45 months after the gastrectomy. A pathological examination revealed a vascular plexus around the liver which might have served as collateral circulation. Neuropathologically, spongy necrosis and Alzheimer type II changes of astrocytes were found in the basal ganglia and fronto-occipital cortices. In the same anatomical regions, only immunohistological staining using antibody against amyloid beta-protein and the periodic-acid methenamine silver method revealed abundant neuriticplaques, cerebral amyloid angiopathy and diffuse plaques. We discussed the clinicopathological findings in this case.
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9/9. Cerebral radiation necrosis with accumulation of thallium 201 on single-photon emission CT.

    A patient who had previously undergone resection of a malignant glioma followed by radiation therapy was found to have a focus of a high accumulation of thallous chloride Tl 201 on single-photon emission CT scans, suggesting recurrent tumor. Resection of this area was performed and the specimen showed radiation necrosis, including such reactive changes as reactive astrocytes and lymphocytes in the necrotic tissue. This case illustrates a diagnostic pitfall in the use of 201Tl single-photon emission CT for distinguishing radiation necrosis from recurrent tumor in patients treated for malignant glioma.
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