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Biomedical subjects

Leila Chimelli

Publications and source records attributed to Leila Chimelli.

At least 19 recordsLinked to original sources

Interactive properties of human glioblastoma cells with brain neurons in culture and neuronal modulation of glial laminin organization.

The harmonious development of the central nervous system depends on the interactions of the neuronal and glial cells. Extracellular matrix elements play important roles in these interactions, especially laminin produced by astrocytes, which has been shown to be a good substrate for neuron growth and axonal guidance. Glioblastomas are the most common subtypes of primary brain tumors and may be astrocytes in origin. As normal laminin-producing glial cells are the preferential substrate for neurons, and glial tumors have been shown to produce laminin, we questioned whether glioblastoma retained the same normal glial-neuron interactive properties with respect to neuronal growth and differentiation. Then, rat neurons were co-cultured onto rat normal astrocytes or onto three human glioblastoma cell lines obtained from neurosurgery. The co-culture confirmed that human glioblastoma cells as well as astrocytes maintained the ability to support neuritogenesis, but non-neural normal or tumoral cells failed to do so. However, glioblastoma cells did not distinguish embryonic from post-natal neurons in relation to neurite pattern in the co-cultures, as normal astrocytes did. Further, the laminin organization on both normal and tumoral glial cells was altered from a filamentous arrangement to a mixed punctuate/filamentous pattern when in co-culture with neurons. Together, these results suggest that glioblastoma cells could identify neuronal cells as partners, to support their growth and induce complex neurites, but they lost the normal glia property to distinguish neuronal age. In addition, our results show for the first time that neurons modulate the organization of astrocytes and glioblastoma laminin on the extracellular matrix.

Animals↗

Central nervous system paracoccidioidomycosis: diagnosis and treatment.

BACKGROUND: Paracoccidioidomycosis (PCM) is a systemic mycosis caused by Paracoccidioides brasiliensis. The involvement of the central nervous system (CNS) in paracoccidioidomycosis is higher than previously thought and 2 clinical presentations have been reported, meningitis and pseudotumoral. METHODS: Twenty medical records of patients with CNS paracoccidioidomycosis treated from 1986 to 2003 were analyzed. The follow-up ranged from 1 to 18 years (mean = 8.9 +/- 4.2). RESULTS: Besides CNS paracoccidioidomycosis, all patients but one had the chronic systemic form and the pseudotumoral clinical presentation was the most frequent. Based on computed tomography scan findings, 4 image patterns were identified: low-density lesion with ring enhancement, lesion with calcification and ring enhancement, multiloculated low-density lesion with ring enhancement, and diffuse subarachnoid enhancement. The magnetic resonance imaging was performed in 3 patients and showed subarachnoid enhancement in 1 patient and heterogeneous lesion with ring enhancement in 2 patients. Eleven patients were submitted to medical treatment and 9 needed neurosurgical treatment; ventriculoperitoneal shunts in 4 patients, brain lesions resection in 3 patients, and partial resection of spinal cord lesions in 2 patients. Eleven patients had excellent outcome, 4 patients died, 3 are in good clinical condition with residual pulmonary dysfunction, and 1 patient was lost to follow-up. CONCLUSIONS: The diagnosis of paracoccidioidomycosis with involvement of the CNS is difficult and clinical suspicion is a key point to achieve the correct diagnosis. Patients with early diagnosis have a favorable outcome with clinical or surgical treatment.

Adult↗

Expression of retinoblastoma protein in human growth hormone-secreting pituitary adenomas.

The retinoblastoma gene (RB1) is a tumor-suppressor gene in chromosomal region 13q14.2. Its role in the pathogenesis of pituitary tumors has not been fully clarified. Some studies have shown that losses in this chromosomal region are related to aggressive tumor behavior, although the retinoblastoma protein (pRB) is still expressed. Conversely, lack of expression of pRB was observed in one fourth of GH-secreting pituitary adenomas (GH-tumors). In order to further study the expression of pRB in GH-tumors, we evaluated this protein in 49 tumors from patients with acromegaly (20 noninvasive, 25 invasive, and 4 with no information) and 8 normal pituitaries using immunohistochemistry (IHC). Nuclear staining for pRB ranged from 0 to 90% (median 40%) in the tumors and from 40 to 80% (median 58%) in normal pituitaries. In 10 tumors (20% of total) the adenomatous cells were negative (5 cases) or had very low labeling (5 cases) for pRB. Sixty three percent (31/49) of the tumors showed staining in 10-80% of the cells and in 16% (8/49) of the cases >80% of the adenomatous cells were positive for pRB. The expression of pRB was not different in invasive and noninvasive tumors. In conclusion, pRB is underexpressed in a subgroup of GH-tumors, and this may represent an early event in the pathogenesis of this tumor subtype.

Acromegaly↗

[Oligodendroglial and neuronal component in glioblastomas: possible relation with prognosis].

Glioblastomas are high grade astrocytic tumors and current histology criteria does not explain the longer survival in some cases. Presence of oligodendroglial component has been suggested as possible marker for better outcome by the international WHO Working Group of experts and by the proponents of the Sainte-Anne Hospital Classification (2000). The latter also states that a neuronal component is associated with better survival. The aim of this study was to analyze a series of 40 patients with tumors classified as glioblastomas based on the WHO criteria, in order to identify: the presence of an oligodendroglial component, using morphologic criteria; the presence of a neuronal component, using immunohistochemical markers (antibodies anti-neurofilament and synaptofisin). The histological and immunohistochemical findings were correlated with patients' survival and other variables of possible prognostic significance were also studied. Oligodendroglial component was identified in 11 cases and neuronal component in 7. Despite the small number of patients studied, this review detected a longer survival in patients with oligodendroglial component. The significance of expression of neuronal markers in malignant gliomas is still to be confirmed, with the evaluation of larger series.

Adult↗

Creutzfeldt-Jakob disease and inclusion body myositis: abundant disease-associated prion protein in muscle.

Pathologicalprion protein (PrP(Sc)) is the hallmark of prion diseases affecting primarily the central nervous system. Using immunohistochemistry, paraffin-embedded tissue blot, and Western blot, we demonstrated abundant PrP(Sc) in the muscle of a patient with sporadic Creutzfeldt-Jakob disease and inclusion body myositis. Extraneural PrP(C)-PrP(Sc) conversion in Creutzfeldt-Jakob disease appears to become prominent when PrP(C) is abundantly available as substrate, as in inclusion body myositis muscle.

Aged↗

Experimental microaneurysms in rats: I. Model for induction.

BACKGROUND: Small aneurysms (lesser than 2 mm) in humans called sessile, baby aneurysms, or microaneurysms, generally are not able to be clipped or to be coil-packed through endovascular route. Among the modalities of treatment that have been used for treating microaneurysms, bipolar coagulation and wrapping of the lesion are outstanding. Nevertheless, demonstration of the efficacy of these treatments is difficult because most reported experimental models for inducting aneurysms are complex and difficult to be reproduced. This study aimed to develop a simple and reproducible model for inducing microaneurysms. METHODS: Microaneurysms were induced using a mechanical lesion of the bifurcation of the aorta in 72 rats. Three groups of 10 animals were sacrificed 7, 14, and 21 days after the lesion and 2 groups (35 and 7 animals) after 30 days. The aortic bifurcation was macro/microscopically analyzed in the first 4 groups and a resistance test was applied in the fifth group. RESULTS: Microaneurysms occurred in 77.8% of cases. Microscopically, degenerative changes were observed in the intima, media, and adventitia and in the internal elastic lamina. The bursting pressure ranged from 368 to 1,472 mm Hg during the resistance test in the fifth group. CONCLUSIONS: The presented model of experimental microaneurysm induction is simple, reproducible and gives a high rate of positivity.

Aneurysm, Ruptured↗

Genetic and expression profiles of cerebellar liponeurocytomas.

Cerebellar liponeurocytoma, a rare, newly identified CNS neoplasm of adults, is characterized by advanced neuronal/neurocytic and focal lipomatous differentiation, low proliferative potential and a favorable clinical prognosis. Despite the different age distribution and benign biological behavior, the cerebellar liponeurocytoma shares several features with the cerebellar medulloblastoma, which may include an origin from the periventricular matrix of the fourth ventricle or the external granular layer of the cerebellum. To establish the genetic profile of cerebellar liponeurocytomas, we have formed an international consortium and collected tumor samples from 20 patients. DNA sequencing revealed TP53 missense mutations in 4 (20%) of 20 cerebellar liponeurocytomas, a frequency higher than in medulloblastomas. There was no case with PTCH, APC, or beta-catenin mutations, each of which may be present in subsets of medulloblastomas. Isochromosome 17q, a genetic hallmark of classic medulloblastomas, was not observed in any of the cases investigated by FISH analysis. cDNA array analyses were carried out on 4 cerebellar liponeurocytomas, 4 central neurocytomas, and 4 classic medulloblastomas. Cluster analysis of the cDNA expression data of 1176 genes grouped cerebellar liponeurocytomas close to central neurocytomas, but distinct from medulloblastomas. These results suggest cerebellar liponeurocytoma as a distinct tumor entity that is genetically different from medulloblastoma. Furthermore, the cDNA expression array data suggest a relationship to central neurocytomas, but the presence of TP53 mutations, which are absent in central neurocytomas, suggests that their genetic pathways are different.

Adult↗

Clinical, electroneuromyographic and morphological studies of pure neural leprosy in a Brazilian referral centre.

Nineteen patients with pure neural leprosy were analysed with clinical examination, electroneuromyography and histopathology of nerve biopsies. Clinical examination showed sensory loss (78.9%), paresis (78.9%), nerve enlargement (68.4%) and nerve pain (42.1%). Electroneuromyographic study revealed an axonal pattern in 18 patients (94.7%) and a demyelinating pattern in one (0.5%). Mononeuropathy multiplex was the most frequent presentation (78.9%), followed by mononeuropathy simplex (10.5%) and polyneuropathy (10.5%). The histopathological study showed the presence of inflammatory infiltrate composed of epithelioid granuloma (42.1%), mononuclear infiltrate (36.8%) or macrophages positive for bacilli (21%). Fibrosis was present in 78.9% of the biopsies. Examination of semithin sections revealed, besides inflammatory infiltrate, myelinated fibre loss (94.7%), remyelination (42%), axonal degeneration (10%) as well as regeneration (31.5%). Based on these results, the pathogenesis of leprosy neuropathy in this group of patients is briefly discussed.

Adult↗

The effects of aging on biceps brachii muscle fibers: a morphometrical study from biopsies and autopsies.

OBJECTIVES: In order to study the morphology and size of muscle fibers, cross sections of biceps brachii samples from autopsies, up to 9 hours after death, and biopsies of 72 subjects were compared. The subjects aged 13 to 84 years in both sexes. METHODS: The samples obtained from autopsies (n=47) were from subjects with sudden death, or who died after acute disease without evidence of neuromuscular involvement. The biopsies (n=25) were from patients with symptoms suggestive of inflammatory or metabolic myopathy, not confirmed morphologically. The lesser diameter of muscle fibers was measured using the ATPase reaction. RESULTS: Morphological analysis showed that aging changes were present from the sixth decade in autopsies, and consisted of atrophy and/or type-grouping. The statistical models adjusted for females in both autopsies and biopsies were linear straight with no variation in fiber size with increasing age. The models adjusted for males in both groups were quadratic, indicating that age influenced the size of different type fibers. In males type 2 were larger than type 1 fibers, and than fibers in females. CONCLUSIONS: These values might be useful as controls, helping interpretation of changes in fiber size in samples obtained from biopsies and autopsies.

Adolescent↗

Lumbosacral angiolipoma: case report.

We present a case of a 46-year old woman with a ventral epidural angiolipoma at the lumbosacral level with erosion of the sacrum. About ninety cases of spinal angiolipomas have been previously described in the literature, most of them situated on the thoracic region, dorsal to the dural sac. Angiolipomas can be radically excised with a good prognosis even in the presence of bone erosion. We did not find any other angiolipoma at the sacral level surgically explored in the review of the literature.

Angiolipoma↗

Pathological and virological assessment of acute HTLV-I-associated myelopathy complicated with encephalopathy and systemic inflammation.

HTLV-I-associated myelopathy, also known as tropical spastic paraparesis (HAM/TSP), is a chronic inflammatory disease of the spinal cord. Acute cases are uncommon. We report the case of a 41-year-old woman with acute HAM/TSP complicated with encephalitis, an intense inflammatory reaction of the nervous system and lymphocytic infiltration of skeletal muscles, liver, salivary, adrenal and pituitary glands. The immunohistochemical studies of the lymphocytes surrounding blood vessels showed both B- and T-lymphocytes, in similar proportion, with both CD4- and CD8-positive cells. In addition, many perivascular and scattered macrophages were observed. Adult T-cell leukemia/lymphoma (ATL) was ruled out. The marrow aspirate was normal. Serial cerebrospinal fluid (CSF) analysis showed presence of HTLV-I antibodies, but without intrathecal synthesis of specific antibodies. Determination of HTLV-I viral loads demonstrated increased levels in the CSF relative to the peripheral blood and may be associated with widespread inflammation. The pathological and immunological findings may help understand the role of immune-reactive cells in the pathogenesis of HTLV-I-associated myelopathy.

Acute Disease↗

Criteria for diagnosis of pure neural leprosy.

The clinical diagnosis of pure neural leprosy (PNL) remains a public health care problem mainly because skin lesions-the cardinal features of leprosy-are always absent.Moreover, the identification of the leprosy bacillus is not easily achieved even when a nerve biopsy can be performed. In an attempt to reach a reliable PNL diagnosis in patients referred to our Leprosy Outpatient Clinic, this study employed a variety of criteria. The nerve biopsies performed on the 67 individuals whose clinical, neurological, and electrophysiological examination findings strongly suggested peripheral neuropathy were submitted to M. leprae identification via a polymerase chain reaction (PCR). Mononeuropathy multiplex was the most frequent clinical and electrophysiological pattern of nerve dysfunction, while sensory impairment occurred in 89% of all cases and motor dysfunction in 81%. Axonal neuropathy was the predominant electrophysiological finding, while the histopathological nerve study showed epithelioid granuloma in 14% of the patients, acid fast bacilli in 16%, and nonspecific inflammatory infiltrate and/or fibrosis in 39%. PCR for M. leprae was positive in 47% of the nerve biopsy samples (n=23). PCR, in conjunction with clinical and neurological examination results, can be a powerful tool in attempting to identify and confirm a PNL diagnosis.

Adolescent↗

Optic pathways tuberculoma mimicking glioma: case report.

BACKGROUND: Optochiasmatic tuberculomas are very rare lesions. They can occur with concomitant tuberculous meningitis, and pulmonary tuberculosis or as the only manifestation of the disease. The authors present a case of optic pathways tuberculoma with radiologic appearance simulating an optic pathways glioma. CASE DESCRIPTION: We report a case of a 20-year-old man with mental retardation due to anoxic encephalopathy who developed a sudden bilateral amaurosis. He also presented with diabetes insipidus, panhypopituitarism, right proptosis, and chemosis. Computed tomography (CT) and magnetic resonance imaging (MRI) showed an enhancing lesion in the optochiasmatic region extending to both optic nerves, with a mass in the right orbit, mimicking an optic pathways glioma. There was no other evidence of systemic involvement of the tuberculosis. The lesion was explored through a right pterional transylvian approach with opening of the optic canal and orbital roof, and a biopsy and an internal decompression were performed. Histopathological studies demonstrated a granulomatous lesion with central caseous necrosis with acid-fast bacilli. The patient improved after treatment with tuberculostatic drugs, but vision recovery could not be achieved. CONCLUSIONS: Visual compromise in tuberculosis is associated with hydrocephalus, optical neuritis or tuberculomas involving the optic pathways. Reviewing the literature on tuberculomas of the optochiasmatic area, we could not find any other case with such extensive involvement of the optic pathways that was radiologically suggestive of an infiltrating glioma. Histopathological studies remain crucial in the diagnosis of intrinsic expansive processes of the optochiasmatic region.

Adult↗

Sclerosing Cavernous Hemangioma in the Cavernous Sinus: Case Report.

Cavernous hemangiomas of the cavernous sinus belong to a well-distinguished entity of extra-axial cavernous hemangiomas located in the cavernous sinus and have a typical appearance on magnetic resonance imaging (MRI). Severe intraoperative bleeding has been described during the excision of these lesions that is probably associated with their pathological features. An atypical case of a sclerosing lesion with distinct MRI features is described. In these particular cases, especially with giant hemangiomas where en bloc excision would be difficult, safe internal decompression and resection can be achieved.

Case Reports↗

Pituitary tuberculoma: an unusual lesion of sellar region.

Pituitary tuberculomas are extremely rare lesions, with only few cases described in the literature, usually mistaken as pituitary tumors. Its heterogeneous clinical and imaging profile preclude preoperative diagnosis which ultimately relies on the histopathological examination. We describe a 46 years old woman who presented with an episode of confusion and hypopituitarism with no evidence of systemic tuberculosis. Computed tomography (CT) showed a central calcified and enhancing sellar mass. Magnetic resonance imaging (MRI) showed a sellar mass with suprasellar extension and associated optic chiasm compression. She was submitted a craniotomy for biopsy and resection. A caseous material was found at the center of the lesion involved by a thick wall. Due to the wall adherence to the optic chiasm and the inflammatory aspects of the lesion, subtotal removal was achieved and the patient followed on anti-tuberculous and hormonal replacement therapy. Sellar tuberculomas should be considered in the differential diagnosis of sellar tumors in order to offer appropriate treatment.

Female↗

[Myelopathy due to vitamin B12 deficiency presenting as transverse myelitis].

Vitamin B12 deficiency may induce neuropathy, myelopathy, dementia and optic neuropathy. The diagnosis is established by vitamin B12, homocysteine and methylmalonic acid measurements. Myelin and axon destruction in the white matter of the spinal cord are observed. The posterior column of the cervical and thoracic level is the most common involved area. The involvement of the anterior column is restricted to advanced and relatively severe cases. Treatment is based on vitamin B12 injections, and the prognosis depends on the stage of vitamin deficiency and deterioration at treatment onset. We report a case with transverse myelitis due to vitamin B12 deficiency. This picture is relatively uncommon, however, we believe patients with transverse myelitis should have vitamin B12 studies as part of the diagnosis work up.

Anemia, Pernicious↗

Immunohistological analysis of CD59 and membrane attack complex of complement in muscle in juvenile dermatomyositis.

OBJECTIVE: To assess the presence of CD59 and the deposition of membrane attack complex (MAC) of complement system in skeletal muscle from patients with juvenile dermatomyositis (JDM), in comparison to patients with muscular dystrophies (MD) and children with normal muscle biopsies. METHODS: Muscle specimens obtained for diagnostic purposes from 10 patients with JDM, 6 with MD, and 7 children whose biopsies showed normal histology were analyzed. Immunohistological staining was performed using Mab against CD59 (YTH 53.1) and MAC (WU 7.2). RESULTS: Immunohistochemical staining for CD59 was weak and irregularly distributed on muscle fibers of all patients with JDM. Two of the 9 biopsies that allowed analysis of vessels showed negative CD59 staining in all vessels; in the remaining 7 patients, there was weak staining in a proportion of the vessels. In contrast, uniform and strong or moderate immunoreactivity was detected on the sarcolemma and in intramuscular endothelium in all normal and MD samples. Immunostaining for MAC was strong in JDM muscle vessels, and weak in normal or MD muscle. An inverse relation was found between MAC deposition and presence of CD59 in vessels in 6/9 JDM biopsies and in all normal and MD samples. CONCLUSION: Decreased CD59 expression in JDM muscle fibers and vessels may be associated with muscle lesions mediated by deposition of MAC of complement in JDM.

Biomarkers↗

[Influence of hyperprolactinemia and tumoral size in the postoperative pituitary function in clinically nonfunctioning pituitary macroadenomas].

OBJECTIVE: To study the influence of hyperprolactinemia and tumoral size in the pituitary function in clinically nonfunctioning pituitary macroadenomas. METHODS: Twenty three patients with clinically nonfunctioning pituitary macroadenomas were evaluated by image studies (computed tomography or magnetic resonance) and basal hormonal level; 16 had preoperative hypothalamus-hypophysial function tests (megatests). All tumors had histological diagnosis and in seventeen immunohistochemical study for adenohypophysial hormones was also performed. Student's t test, chi square test, exact test of Fisher and Mc Neman test were used for the statistics analysis. The level of significance adopted was 5% (p<0.05). RESULTS: Tumoral diameter varied of 1.1 to 4.7 cm (average=2.99 cm +/- 1.04). In the preoperative, 5 (21.7%) patients did not show laboratorial hormonal deficit, 9 (39.1%) developed hyperprolactinemia, 13 (56,5%) normal levels of prolactin (PRL) and 1 (4.3%) subnormal; 18 (78.3%) patients developed hypopituitarism (4 pan-hypopituitarism). Nineteen patients (82.6%) underwent transsfenoidal approach, 3 (13%) craniotomy and 1 (4.4%) combined access. Only 6 patients had total tumoral resection. Of the 17 immunohistochemical studies, 5 tumours were immunonegatives, 1 compound, 1 LH+, 1 FSH +, 1 alpha sub-unit and 8 focal or isolated immunorreactivity for one of the pituitary hormones or sub-units; of the other six tumours, 5 were chromophobe and 1 chromophobe/acidophile. No significant statistic difference was noted between tumoral size and preoperative PRL levels (p=0.82), nor between tumoral size and postoperative hormonal state, except in the GH and gonadal axis. Significant statistic was noted: between tumoral size and preoperative hormonal state (except in the gonadal axis); between normal PRL levels, associated to none or little preoperative hypophysial disfunction, and recovery of postoperative pituitary function. CONCLUSION: Isolated preoperative hyperprolactinemia and tumoral size have not been predictable for the recovery of postoperative pituitary function.

Adenoma↗