Biomedical subjects

S Morgello

Publications and source records attributed to S Morgello.

60 records · Page 4Linked to original sources

PubMed1987

Cytomegalovirus encephalitis in patients with acquired immunodeficiency syndrome: an autopsy study of 30 cases and a review of the literature.

The pathology of cytomegalovirus (CMV) encephalitis was studied at autopsy in thirty patients with acquired immunodeficiency syndrome. Lesions could be segregated into five major categories: microglial nodules, isolated inclusion-bearing cells, focal parenchymal necrosis, necrotizing ventriculo-encephalitis, and necrotizing radiculo-myelitis. Microglial nodules and CMV inclusions were present in all brains. Microglial nodules were found with variable frequency and had greatest density in subcortical grey matter. Only a small percentage (average, 6.5 per cent) contained CMV inclusion-bearing cells. Isolated inclusion-bearing cells unaccompanied by microglial nodules or inflammatory infiltrates were seen in half the patients. CMV inclusions were identified in capillary endothelia, astrocytes, and neurons. Focal CMV necrosis, ventriculo-encephalitis, and radiculo-myelitis were less frequent. The presence of CMV inclusions in capillary endothelia suggests a vascular portal of entry for the virus into the central nervous system. The diffuse ependymal and/or subpial distribution of CMV in several patients suggests additional dissemination via the cerebrospinal fluid. Isolated inclusion-bearing cells may reflect the relative nonpermissiveness of surrounding central nervous system parenchyma for CMV infection.

Acquired Immunodeficiency Syndrome↗

PubMed1986

Craniotomy versus transsphenoidal excision of large pituitary tumors: the usefulness of magnetic resonance imaging in guiding the operative approach.

Fifteen patients with large pituitary tumors were studied with computed tomography (CT) and magnetic resonance imaging (MRI). CT was performed using General Electric 8800 and 9800 scanners (General Electric Co., Medical Systems Division, Milwaukee, Wisconsin). MRI was performed utilizing a Technicare superconducting scanner (Technicare, Cleveland, Ohio) at 0.5 tesla. Based on the operative findings, the tumors were divided into two groups. Tumors in Group 1 (n = 12) were described by the surgeon as soft or partially necrotic and easily removed by suction and curettage. Tumors in Group 2 (n = 3) were firm and required sharp dissection or the laser for removal. The tumors were divided into four categories based on MRI signal: (a) isointense with surrounding brain on spin echo (SE) 30 and SE 90, (b) increased signal intensity on SE 30 and SE 90, (c) decreased signal intensity on SE 30 and increased signal intensity on SE 90, and (d) isointense signal on SE 30 and increased signal intensity on SE 90. All three of the firm tumors were isointense with brain on MRI appearance. The tumor consistency (firm vs. soft) was not differentiable on CT scan. The transsphenoidal approach is less satisfactory than craniotomy in cases of firm, fibrous pituitary tumors. Based on our preliminary data, if the MRI signal in the tumor is isointense, then the surgeon should be prepared to deal with a fibrous tumor and might elect a transcranial rather than a transsphenoidal approach.

Adult↗

PubMedDate not supplied

Central nervous system lymphoma in the acquired immunodeficiency syndrome.

Primary central nervous system (CNS) lymphomas were studied in fifteen autopsied patients with the acquired immunodeficiency syndrome (AIDS). Using the working formulation for non-Hodgkin's lymphomas, the tumors were classified as large cell (7 patients), mixed large and small cell (6 patients), small cleaved cell (1 patient), and unclassifiable (1 patient). The mixed lymphomas displayed unusual features characterized by a high mitotic rate and the presence of numerous medium-sized cells (5 to 10 mus), not classifiable using the working formulation. Focal T cell and lymphoplasmacytoid B cell infiltrates accompanied lymphoma cells at the periphery of and remote from solid tumor masses in 9 cases. Immunohistochemical analysis of the lymphomas suggested B cell neoplasms. All of these patients had concurrent CNS and systemic cytomegalovirus (CMV) infections. The CNS infections were of both viral (CMV, human immunodeficiency virus (HIV), varicella zoster virus (VZV), progressive multifocal leukoencephalopathy (PML) and non-viral (toxoplasmosis, candidiasis) etiology. In the general AIDS population at our institution, the autopsy incidence of CNS infections and systemic CMV was 63% and 60%, respectively. In contrast, the incidence for both these entities was 0% in otherwise healthy, non-AIDS patients with CNS lymphoma supports the hypothesis that viral infection plays a role in the pathogenesis of CNS lymphoma in the immunocompromised. Polyclonal lymphoplasmacytoid B and T cell infiltrates accompanying lymphoma may produce diagnostic difficulties on surgical biopsy. As these infiltrates were a frequent feature in this study, we caution that their recognition does not argue against the presence of CNS lymphoma.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Differentiation between meningeal fibrosis and chronic subdural hematoma after ventricular shunting: value of enhanced CT and MR scans.

Unenhanced CT in four patients with long-standing ventricular shunts demonstrated bilateral low-density extraaxial collections that were indistinguishable from chronic subdural hematomas. After administration of contrast material, however, there was marked enhancement of the collections as well as prominent paratentorial and parafalcial enhancement. MR imaging, performed in three patients, demonstrated the extent and paradural location of the collections better than CT did, but, as with unenhanced CT, the collections could not be distinguished from chronic subdural hematomas. On follow-up CT and MR, there was no change in the size, enhancement, or intensity of the collections. Histologic examination of biopsies from two patients demonstrated fibrosis of the meninges characterized by granulation tissue and collagen deposition. Meningeal fibrosis is a rare postshunt phenomenon that may mimic chronic subdural hematoma on unenhanced CT and MR. Recognition of this entity is important, particularly if therapeutic intervention is being considered. Therefore, an enhanced CT or enhanced MR scan should be obtained in chronically shunted patients to differentiate between a drainable chronic subdural hematoma and meningeal fibrosis.

Adult↗

PubMedDate not supplied

Large Virchow-Robin spaces: MR-clinical correlation.

High-field MR scans frequently show Virchow-Robin spaces, which conform to the path of the penetrating arteries as they enter either the basal ganglia or the cortical gray matter over the high convexities. A retrospective review of 816 MR scans was undertaken to determine the clinical significance and associations (if any) of this finding. The Virchow-Robin spaces were graded, as were the nonspecific white-matter lesions. The presence of atrophy, infarction, hydrocephalus, and miscellaneous disease was noted. Large Virchow-Robin spaces were identified in 314 cases. A study sample was created consisting of a positive group containing all the larger grade 2 and 3 Virchow-Robin spaces (67 patients) and a negative or control group of 109 randomly selected patients from the original 502 who did not have large Virchow-Robin spaces. The charts of this study sample were reviewed and the following patient variables were noted: age, gender, incidental white-matter lesions, infarction, dementia, hypertension, and atrophy. For each variable, the proportion of patients who were positive for that variable was calculated for each of the two groups and compared across groups by using a Fisher exact test. Multiple logistic regression analysis was used to determine whether any of these variables were jointly associated with being "positive" or "negative" for large Virchow-Robin spaces. Some variables were strongly associated with being positive for large Virchow-Robin spaces: age, hypertension, dementia, and incidental white-matter lesions. Logistic regression analysis revealed that when all of these variables are considered jointly, only age remains significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMedDate not supplied

Epstein-Barr virus and AIDS-related primary central nervous system lymphoma. Viral detection by immunohistochemistry, RNA in situ hybridization, and polymerase chain reaction.

Epstein-Barr virus (EBV) has been implicated in the pathogenesis of acquired immunodeficiency syndrome- (AIDS) related primary central nervous system (CNS) lymphoma. Tumors from 16 patients with AIDS-related primary CNS lymphoma, and 1 with concurrent CNS and systemic lymphoma, were evaluated histologically and for the presence of EBV by immunohistochemistry for latent membrane protein, in situ hybridization for EBER1 RNA transcripts, polymerase chain reaction (PCR) for the single copy EBNA1 gene, and PCR for the multiple copy EBV internal repeat region. Histologically, 11 tumors displayed extremely large, bizarre, anaplastic immunoblasts, with prominent nucleoli and multilobated nuclei, resembling Reed-Sternberg (RS) cells and variants. The lymphomas displayed B cell phenotypes by immunohistochemistry. Latent membrane protein was detected in 88% (15/17) of tumors, EBNA1 sequences in 54% (6/11), EBV-internal repeat sequences in 100% (11/11), and EBER1 transcripts in 100% (17/17). All EBNA1-negative tumors lacked RS-like cells. Latent membrane protein immunohistochemical staining was limited to a minority of tumor cells, and was most often positive in RS-like, immunoblastic large cells. In situ hybridization for EBER1 message demonstrated EBV in the majority of tumor cells, which displayed a wide range of sizes and variable nuclear morphology. We conclude that EBV can be detected in all AIDS-related primary CNS lymphomas, and that EBER1 in situ hybridization is currently the best technique for detecting virus. The presence of atypical immunoblasts (RS-like cells) with high levels of latent membrane protein in many of these tumors may suggest the emergence of a common, virally-determined phenotype in AIDS-related lymphomas of brain.

Adult↗