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Washington University Experience | MYELIN (NON-IMMUNE MEDIATED) | Necrotizing Leukoencephalopathy | 4B2 MTX & Radiation (Case 4) WM 20X 1
Punctate calcifications, spheroids and vacuoles are accompanied by gemistocytic astrocytosis. ---- Comment; Sections of the hippocampus, hypothalamus, right and left amygdalae, midbrain tegmentum, dorsal medulla, cervical spinal cord and optic nerves show multifocal areas of necrosis involving white and grey matter with some sparing of neurons. Vascular alterations, including intimal and medial thickening, enlarged endothelial cells, occasionally with pleomorphic hyperchromatic nuclei, and fibrinoid vascular necrosis are also present. There is no residual neoplasm. The pattern of injury in this case is more extensive than DNL alone, and likely represents a combination of DNL with delayed radionecrosis.
