Perivascular Extension Research Articles

Juvenile temporal arteritis: A clinicopathological multicentric experience.

Juvenile temporal arteritis (JTA) is a recently-described and little-known inflammatory disease and its etiology is undetermined. Less than forty cases have been published. This paper is aimed at reporting the largest JTA series and to compare it to literature data to better evaluate its characteristics at diagnosis, its evolution and treatment options. We conducted a retrospective and descriptive multicentric study in France by identifying adult patients under the age of 50 which had a pathological temporal artery biopsy owing to the presence of a temporal arteritis. Patients with temporal arteritis as a manifestation of systemic vasculitis were excluded. We included 12 patients and the literature review identified 32 cases described in 27 articles, thus a total of 44 patients - 34 men and 10 women - with a median age of 30 and a maximum of 44. All patients presented either a lump in the temporal region or prominent temporal arteries, and 47.7% of patients suffered from headaches. Only 11.4% of patients presented general symptoms and 6.8% a biological inflammatory syndrome; 34.1% had peripheral blood eosinophilia; 83.7% presented a single episode and complete excision without further treatment was documented for 72.7%. Pathology analysis revealed infiltrate of inflammatory cells in the arterial wall in 97.6% of patients but also sparse giant cells for 25% and granuloma for 22.9%, perivascular extension of the inflammation for 82.6%, and presence of lymphoid follicles or germinal centres for 60%. Clinical relapses were present in 16.3% of cases. JTA is a rare, localized and benign disease. The majority of cases have only one episode which is cured by local surgery.

Abstract No. 239 - Perivascular extension of Microwave ablation (MWA) zone: Demonstrated using an ex vivo porine perfusion liver model

Abstract No. 239 - Perivascular extension of Microwave ablation (MWA) zone: Demonstrated using an ex vivo porine perfusion liver model

Surgical management of the neck in oral cancers: A single-institute experience from South India

Background: Oral cancers are not uncommon. We have analyzed the incidence of nodal metastasis in oral cancer clinically and compared it with the final histopathology examination (HPE) report, correlating the pathologically positive lymph nodes with different parameters such as tumor sites, pathological stage, differentiation, lymphovascular, perivascular extension and perineural invasion. Materials and Methods: This retrospective study was carried out on patients who were evaluated with a histological diagnosis of oral cancer from 2008 to 2012. Lymph node positivity was established by clinical and ultrasound evaluation in 218 patients who underwent neck dissection for oral cancer. This was compared with the histopathology findings. Results: The most common site of oral cancer was buccal mucosa. Histopathologically, majority were squamous cell carcinoma (SCC). Lymph node positivity was observed for different sites as follows: buccal mucosa (26.7%), gingivo-buccal sulcus (20.8%), retromolar trigone (40%), tongue (50%), and floor of mouth (100%). In well-differentiated SCC, node positivity was 25.4%. In moderately differentiated SCC, it was 52.3% and in poorly differentiated SCC, it was 50%. Five cases of verrucous carcinoma did not show any lymph node positivity. According to the pathological staging, the lymph node positivity was as follows: T1 (25.58%), T2 (23.59%), T3 (37%), and T4 (34.78%). Out of 218 patients, 5.5% patients showed positive resected margin, 1.8% patients showed skip metastasis, and 14.6% patients had lymphovascular or perivascular invasion. Univariate analysis showed significant correlation of lymph nodal metastasis with various clinicopathological parameters like tumor site, stage, and differentiation. Conclusion: In our female predominant study group, mostly locally advanced tumors were encountered involving the alveobuccal subsites. Standard neck dissections play an important role in the control of neck disease.

Reticular erythematous mucinosis – a review

Reticular erythematous mucinosis (REM) is a rare cutaneous condition often referred to as plaque-like mucinosis and midline mucinosis. Although the exact etiology remains undefined, efforts to elucidate pathogenesis, disease associations, and prospective treatment modalities have been encouraging. Induction of the disease has been associated with viral processes, solar irradiation, specific cell lines, and cytokines such as Interleukin (IL)-1β. Clinically, patients typically develop erythematous macules and papules that coalesce into reticulated patterns on the midline of the chest or back. The lesions have a tendency to respond to systemic antimalarial therapy, but novel therapeutic approaches with ultraviolet A1 light (UVA1) and pulse dye laser (PDL) have been promising. Histologically, REM is associated with a mild, predominantly lymphocytic infiltrate with variable deep perivascular extension. Mucin may be seen in the upper and mid dermis and is prominent around the infiltrate and appendages. IgM deposits may be visualized under direct immunoflourescence along the basal layer. Because of the similarities between REM and tumid lupus, the two disease processes have often been grouped together. The remarkable overlap between the two diseases suggests that the two conditions may actually be the same disease.

Anaplastic Astrocytoma in the Spinal Cord of an African Pygmy Hedgehog (Atelerix albiventris)

A 2-year-old, female hedgehog presented with an 8-month history of progressive, ascending paresis/paralysis and was tentatively diagnosed with wobbly hedgehog syndrome. She died awaiting further diagnostic tests, and the owners consented to postmortem examination. Grossly, the bladder was large and flaccid and the cervical and lumbar spinal cord were regionally enlarged, light grey, and friable with multifocal hemorrhages. The thoracic spinal cord was grossly normal. Microscopically all regions of the spinal cord had similar changes, although the cervical and lumbar sections were most severely affected. These regions were completely effaced by a moderately cellular infiltration of highly pleomorphic polygonal to spindle shaped cells, mineralization, and necrosis, which were most consistent with anaplastic astrocytoma. The thoracic spinal cord white matter was similarly infiltrated by the neoplastic cells, with perivascular extension into the otherwise normal grey matter. A diagnosis of anaplastic astrocytoma was confirmed using immunohistochemical stains that were positive for glial fibrillary acidic protein and S100.

Clinicopathologic Case Report: Progressive Aphasia in a 77-Year-Old Man

Clinicopathologic Case Report: Progressive Aphasia in a 77-Year-Old Man

Primary central nervous system lymphoma: radiologic-pathologic correlation.

Once an extremely rare neoplasm, primary lymphoma of the central nervous system (CNS) now ranks behind only meningiomas and low-grade astrocytomas in prevalence. Understanding of primary CNS lymphoma has increased greatly in recent years as a result of special immunohistochemical stains. Virtually all primary CNS lymphomas are composed of B cells. Although a viral cause has been suggested in some cases, the exact cause of the disease is still under investigation. Primary CNS lymphoma has a distinct affinity for perivascular extension. Although granular nodules may be seen at gross pathologic inspection, diffuse microscopic spread is always present, which accounts for the ability of this tumor to produce distant disease and local recurrences. The dense cellularity of the tumor and its predilection for the periventricular region also explains its typical hyperattenuated appearance on unenhanced computed tomographic scans and hypointensity on T2-weighted magnetic resonance images. Virtually all lesions enhance with contrast material. Although the overall prognosis for patients with primary CNS lymphoma remains poor, some advances have been made with radiation therapy and chemotherapy for this once uniformly fatal disease.

Mixed connective tissue disease. A clinical, histologic, and immunofluorescence study of eight cases.

A study of the cutaneous eruptions of eight patients with mixed connective tissue disease (MCTD) was performed to better characterize its dermatopathology and to explore a role for the membrane attack complex of complement C5b-9 in lesional pathogenesis. Nine lesional skin biopsies were obtained from eight patients with MCTD and analyzed by conventional light microscopy. Direct immunofluorescence (IF) and indirect IF using a monoclonal antibody to C5b-9 were applied in six and five cases respectively. The biopsied cutaneous eruptions were characterized clinically as photo-distributed erythematosus annular and/or papulosquamous lesions mimnicking subacute cutaneous lupus erythematosus (SCLE) in five of eight patients as an ill-defined, telangiectatic, scaly patch on the face in one patient, palpable purpura in one patient, and dorsal hand blisters resembling porphyria cutanea tarda (PCT) in another. With the exception of the latter two patients, the histology appeared similar, comprising a cell poor and/or lichenoid interface dermatitis with suprabasilar exocytosis around necrotic keratinocytes in the absence of deep periadnexal or perivascular extension or conspicuous follicular plugging, a pattern similar to that of SCLE. However, the lesions differed from SCLE by virtue of vasculopathic alterations comprising vascular ectasia, hypovascularity, and/or luminal thrombosis confined to the superficial vascular plexus and a sclerodermoid tissue reaction, the latter seen in two cases. One biopsy showed a pustular leukocytoclastic vasculitis (LCV). In another case, a biopsied hand blister demonstrated a PCT-like appearance histologically, namely, pauci-inflammatory subepithelial blister formation with hyalinization of dermal papillae capillaries accompanied by an LCV. There was nuclear keratinocyte decoration with IgG and C5b-9 in all cases studied, accompanied by a positive lupus band test in two cases and homogenous deposition of immunoreactants along the dermoepidermal junction and within vessels in the PCT-like eruption. Granular vascular decoration with immunoreactants including C5b-9 was seen in two LCV cases and in two biopsies from rashes clinically mimicking SCLE. Although the epidermal pathology of MCTD mimicks that of SCLE, a concomitant vasculopathy paralleling that seen in skin lesions of dermatomyositis distinquishes the dermatopathology of MCTD from that of SCLE. Corroborating the role of microangiopathy in the pathogenesis of the skin lesions of MCTD was the demonstration of C5b-9 in blood vessels. The deposition of C5b-9 in keratinocytes may explain the pattern Of IgG decoration of keratinocytes; the formation of plasmalemmal pores may permit binding of immunoglobulin to antigens in the nucleus and/or cytosol. The C 5b-9 complex may be the effector mechanism of epithelial and/or endothelial cell injury in MCTD or may serve to augment the effects of antibody-dependent cellular cytotoxicity.

Ultrastructural changes in the brain of mice given Clostridium perfringens type D epsilon toxin

Mice were given lethal and sublethal doses of Clostridium perfringens Type D epsilon toxin and the early morphological changes in perfusion-fixed intoxicated brains were examined from 30 min to 6 h post-inoculation. The initial ultrastructural finding was swelling of astrocytes, especially the perivascular extensions of these cells. Astrocytes in the cerebellum appeared to be particularly sensitive to this toxin. These changes were quickly followed by evidence of severe endothelial damage, with the endothelial cytoplasm becoming attenuated, vacuolated and very electron-dense. A pathogenetic sequence of events leading to malacia, derived from ultrastructural observations, is proposed.

Cyclitis and peripheral chorioretinitis.

We classify uveitis into anterior, posterior, and diffuse types. The anterior forms can be subdivided into iridocyclitis and cyclitis. Most often it is easy to decide whether an inflammation affects both the iris and the ciliary body, or the ciliary body alone. Also, when extension from the ciliary body occurs to the peripheral choroid and to the retina, characteristic signs develop. In addition to the preceding classification we use the term granulomatous if the anterior eye shows the features of this type of inflammation, as described by Woods. 1 Anterior uveitis which primarily involves the ciliary body may exist as a separate entity, or there may be involvement of adjacent structures, such as the peripheral choroid and retina, vitreous, lens, and anterior chamber. Remote effects also may develop in the posterior retina and optic nerve as a result of perivascular extension of the inflammation along the retinal vessels. The following

A Study of the Allergic Phenomena in the Central Nervous System.

These experiments were designed to study the allergic response of the central nervous system and to determine what part this phenomena might play in certain types of meningitis and encephalitis. Tuberculous animals were first employed because it is known that their tissues are sensitive to tuberculin. Guinea pigs were inoculated subcutaneously in the groin with a known quantity of virulent human tubercle bacilli sufficient to give rise to an extensive generalized tuberculosis within 3 to 6 weeks. At varying intervals, up to 5 weeks, following the initial inoculation different animals had injected in their subarachnoid spaces by the way of the basal cisterns 0.3 cc. of a 1/10, 1/100, and 1/1000 dilution of old tuberculin. If the animals failed to develop fatal central nervous system disturbances they were killed by means of decapitation under ether anesthesia. Gross and microscopic studies were made of the brain and viscera. Cultures were prepared of the brains for the presence of the tubercle bacilli and other pathogenic organisms. As controls, both tuberculous and non-tuberculous animals were employed in each experiment. In this investigation 112 guinea pigs were employed, 42 of which were controls. Following the subarachnoid injection of tuberculin the animals with advanced visceral tuberculosis showed definite and constant clinical central nervous system manifestations as well as a striking histological response in the leptomeninges. Restlessness, ruffled hair, progressive weakness, twitching and loss of sphincter control occurred 3 to 4 hours after the inoculation of tuberculin. Death usually occurred within 6 to 12 hours. Histological studies of the brains revealed an extensive polymorphonuclear exudate in the subarachnoid space. In the more advanced cases there was a definite perivascular extension and some glial proliferation around the vessels of the cerebral parenchyma.

LOCAL SPECIFIC THERAPY OF EXPERIMENTAL PNEUMOCOCCAL MENINGITIS

1. In experimental Type I pneumococcal meningitis of dogs central cord involvement is common after the 2nd day of the disease. 2. These central cord lesions may progress toward extensive suppurative myelitis. 3. Abscesses are infrequent; they arise either as direct perivascular extensions of the meningeal disease or at the site of infected purpuric lesions. 4. In prolonged untreated meningitis of reinfected animals, nothing resembling the disappearance of exudate following crisis in pneumonia occurs. The tendency is toward organization. 5. Late lesions are characterized by the marked development of a perivascular clasmatocytic apparatus, similar to, but more extensive than that hitherto reported in experimental herpetic encephalitis.