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Washington University Experience | MYELIN (IMMUNE-MEDIATED) | Sentinel & Steroid Rx Lesions | 2K0 - Interpretation of first biopsy (Images 2A-J)
Interpretation of first biopsy (images 2A-J) - This initial biopsy (in August) showed a complex lesion which generated a differential diagnosis of vasculitis, lymphoma, demyelinating process, and NMO spectrum disorder. The lack of angionecrosis and intact vasculature staining with smooth muscle actin did not make vasculitis a compelling diagnosis. The presence of a mixed lymphocytic population with a benign morphologic appearance did not establish a lymphoma diagnosis, although there was worry about a steroid effect lysing B lymphoma cells. Our past experience with steroid-pretreatment of lymphoma, however, did not favor completely sterilizing a lesion of all malignant cells in the absence of large amounts of tumor cell necrosis. While myelin was indeed lost within the lesions, it was unusual, incomplete and patchy and resulted in damage to and loss of many axons. NMO spectrum disorder was considered but found no support.
