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Washington University Experience | VASCULAR | Vasculitis - PACNS | 14A0 Case 14 History
Case 14 History ---- The patient was a 53 year old woman with progressive neurological decline and patchy leptomeningeal enhancement with infarction. Operative procedure: Craniotomy for open brain biopsy. ---- There is chronic and granulomatous inflammation predominantly involving meningeal and parenchymal blood vessels. Focally, the inflammation spills out slightly to involve the adjacent leptomeninges and parenchyma. There is additional evidence of active vasculitis including fibrinoid necrosis and destruction of the vessel walls. An occasional vessel wall is markedly hyalinized or shows granulation tissue in the wall, consistent with prior damage or healed vasculitis. There is also marked microglial proliferation in the cerebral cortex, associated with patchy ischemic changes, such as neuronal loss, gliosis, and capillary prominence Histochemical stains (GMS and AFB) are negative for micro-organisms. Immunohistochemical studies reveal the inflammatory response to be rich in T-cells and histiocytes with a few small mature appearing B-cells. The CD68 immunostain also highlights the widespread microglial proliferation in the cerebral cortex. ---- This is not considered PACNS but may be a confusing element in the workup of PACNS cases.
