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Multiple intra-axial lesions in a 57-year-old male with a history of B-cell chronic lymphocytic leukemia 一名曾患 B 细胞慢性淋巴细胞白血病的 57 岁男性的多发性轴内病变。
IF 5.8 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-08-07 DOI: 10.1111/bpa.13296
Sofia Asioli, Lina Cardisciani, Matteo Martinoni, Caterina Tonon, Rocco Liguori, Pierluigi Zinzani, Luisa Di Sciascio, Elena Sabattini
<p>A 57-year-old male with a recent history of B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma (BCLL/SLL), developed a persistent left-frontal headache. One month after the onset of headache and 2 days after the second dose of anti-SARS-CoV2 mRNA vaccine, he developed a persistent high fever. He was monitored for the following days and 20 days later, he experienced tonic–clonic seizures with post-critical coma (Day 1). CT and MRI scans showed multiple sub and supra-tentorial intra-axial edematous lesions with contrast enhancement and without mass effect, as shown in Figure 1. He started dexamethasone and levetiracetam with subsequent total recovery of vigilance on Day 3 (Box 1).</p><p>On Day 6, a stereotactic biopsy of the major frontal lesion showed the presence of necrotic tissue. Following clinical improvement, on Day 9 he was discharged, with dexamethasone taping from Day 20. On Day 40 a control RMI showed edema reduction, but new nodules appeared. He was admitted again and underwent CSF analysis, lymphocyte characterization, blood culture, and total body <sup>18</sup>FDG-PET-CT, all non-contributive.</p><p>Still, under steroid tapering, the patient became unresponsive and febrile again, so corticosteroid dosing was increased. After initial improvement he went into hyponatremic coma, consistent with inappropriate ADH secretion syndrome. A new MRI showed a further increase in the lesions and expanded edema. On Day 67 a new open biopsy of the left frontal lesion was performed. After histologic diagnosis, the patient was referred to the Onco-Hematology department where a bone marrow biopsy confirmed a modest infiltration by BCLL/SLL (10% of cellularity). Chemotherapy with MATRix regimen was started with only mild improvement. He ultimately succumbed to the disease on Day 98.</p><p>On hematoxylin–eosin the lesion showed extensive necrosis with predominantly medium-sized, atypical lymphoid cells with irregular nuclei, moderate amount of pale cytoplasm with vascular proliferation and histiocytic elements (Figure 2A–C). The neoplastic cells displayed angiocentric growth, mitoses, and apoptotic bodies. CD3 (Figure 2D) and CD2 were positive in neoplastic cells (Figure 2E) as well as Beta-F1 for the αβ T-cell receptor (TCR) dimer; CD20, PAX5, CD5, CD7, CD4, CD8, TdT, CD56, Tia-1, and TCR-γ dimer were negative. Epstein–Barr virus-encoded small RNAs were not detected at in situ hybridization. TCR Gamma rearrangement (TRG) was analyzed by GeneScanning and two distinct reproducible peaks were detected (Figure 2E) interpreted as either a biallelic or biclonal rearrangement.</p><p>Peripheral T cell lymphoma, Not Otherwise Specified (NOS) consistent with Primary CNS T cell lymphoma.</p><p>Peripheral T-cell lymphoma (PTCLs) accounts for 2%–4% of primary CNS lymphomas in Europe. Immunodeficiency might play a role in the etiology of the disease in a subset of patients. Involved sites include the frontal and temporal lobes, cerebellum, pituitary, a
一名 57 岁的男性近期曾患 B 细胞慢性淋巴细胞白血病/小淋巴细胞淋巴瘤(BCLL/SLL),后来出现持续性左额头痛。头痛发生一个月后,在接种第二剂抗 SARS-CoV2 mRNA 疫苗两天后,他出现了持续高烧。随后几天他一直接受监测,20 天后,他出现强直阵挛发作,并伴有重症后昏迷(第 1 天)。如图 1 所示,CT 和 MRI 扫描显示多发幕下和幕上轴内水肿性病变,造影剂增强,无肿块效应。他开始服用地塞米松和左乙拉西坦,随后在第 3 天完全恢复了警觉(方框 1)。第 6 天,对额叶主要病灶进行的立体定向活检显示存在坏死组织。随着临床症状的改善,第 9 天他出院了,从第 20 天起开始使用地塞米松。第 40 天,对照组 RMI 显示水肿减轻,但出现了新的结节。他再次入院并接受了脑脊液分析、淋巴细胞定性、血液培养和全身 18FDG-PET-CT 检查,结果均无影响。在病情初步好转后,他又陷入了低钠血症昏迷,这与不适当的 ADH 分泌综合征一致。新的核磁共振成像显示病灶进一步增加,水肿扩大。第 67 天,对左额叶病灶进行了新的开放性活检。经组织学诊断后,患者被转诊至肿瘤血液科,骨髓活检证实有轻微的 BCLL/SLL 浸润(10% 的细胞)。患者开始接受 MATRix 方案化疗,但病情仅有轻微好转。在苏木精-伊红染色下,病变组织广泛坏死,主要为中等大小的非典型淋巴细胞,细胞核不规则,有适量的苍白细胞质,伴有血管增生和组织细胞成分(图 2A-C)。肿瘤细胞呈血管中心生长、有丝分裂和凋亡体。肿瘤细胞中的 CD3(图 2D)和 CD2 呈阳性(图 2E),αβ T 细胞受体(TCR)二聚体的 Beta-F1 也呈阳性;CD20、PAX5、CD5、CD7、CD4、CD8、TdT、CD56、Tia-1 和 TCR-γ 二聚体呈阴性。原位杂交未检测到 Epstein-Barr 病毒编码的小 RNA。外周T细胞淋巴瘤,未另作说明(NOS)与原发性中枢神经系统T细胞淋巴瘤一致。在欧洲,外周T细胞淋巴瘤(PTCLs)占原发性中枢神经系统淋巴瘤的2%-4%。在欧洲,外周T细胞淋巴瘤(PTCLs)占原发性中枢神经系统淋巴瘤的2%-4%。免疫缺陷可能是部分患者的病因之一。受累部位包括额叶和颞叶、小脑、垂体和(极少)脑膜。克隆性增殖、广泛坏死、突出的血管中心性生长、组织学和基因组异质性、表型异常和细胞毒性表型是活检证实的 PTCL 的典型特征,而症状和神经放射学检查往往没有特异性。主要的鉴别诊断是其他中大细胞原发性中枢神经系统淋巴瘤,包括原发性中枢神经系统弥漫大B细胞淋巴瘤(CNS-DLBLC)、伯基特淋巴瘤和EBV+大B细胞淋巴瘤。其他结节或结节外 B 细胞和 T 细胞淋巴瘤也可累及中枢神经系统,如无弹性 T 细胞淋巴瘤,多见于难治性/晚期患者。免疫表型至关重要,形态学或克隆性分析的作用微乎其微(只有50%的原发性中枢神经系统T细胞淋巴瘤能检测到TCR-γδ)。Elena Sabattini、Rocco Liguori 和 Caterina Tonon:修改手稿。Sofia Asioli、Luisa Di Sciascio 和 Lina Cardisciani:研究设计、起草设计、解释病理结果、修改手稿。
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引用次数: 0
Microtubule-associated NAV3 regulates invasive phenotypes in glioblastoma cells 微管相关 NAV3 调节胶质母细胞瘤细胞的侵袭表型。
IF 5.8 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-08-03 DOI: 10.1111/bpa.13294
Aneta Škarková, Markéta Pelantová, Ondřej Tolde, Anna Legátová, Rosana Mateu, Petr Bušek, Elena Garcia-Borja, Aleksi Šedo, Sandrine Etienne-Manneville, Daniel Rösel, Jan Brábek

Glioblastomas are aggressive brain tumors for which effective therapy is still lacking, resulting in dismal survival rates. These tumors display significant phenotypic plasticity, harboring diverse cell populations ranging from tumor core cells to dispersed, highly invasive cells. Neuron navigator 3 (NAV3), a microtubule-associated protein affecting microtubule growth and dynamics, is downregulated in various cancers, including glioblastoma, and has thus been considered a tumor suppressor. In this study, we challenge this designation and unveil distinct expression patterns of NAV3 across different invasion phenotypes. Using glioblastoma cell lines and patient-derived glioma stem-like cell cultures, we disclose an upregulation of NAV3 in invading glioblastoma cells, contrasting with its lower expression in cells residing in tumor spheroid cores. Furthermore, we establish an association between low and high NAV3 expression and the amoeboid and mesenchymal invasive phenotype, respectively, and demonstrate that overexpression of NAV3 directly stimulates glioblastoma invasive behavior in both 2D and 3D environments. Consistently, we observed increased NAV3 expression in cells migrating along blood vessels in mouse xenografts. Overall, our results shed light on the role of NAV3 in glioblastoma invasion, providing insights into this lethal aspect of glioblastoma behavior.

胶质母细胞瘤是一种侵袭性脑肿瘤,目前仍缺乏有效的治疗方法,导致存活率极低。这些肿瘤具有明显的表型可塑性,其细胞群多种多样,既有肿瘤核心细胞,也有分散的高侵袭性细胞。神经元领航员3(NAV3)是一种影响微管生长和动态的微管相关蛋白,在包括胶质母细胞瘤在内的多种癌症中被下调,因此被认为是一种肿瘤抑制因子。在本研究中,我们对这一说法提出了质疑,并揭示了NAV3在不同侵袭表型中的不同表达模式。通过使用胶质母细胞瘤细胞系和源自患者的胶质瘤干样细胞培养物,我们发现NAV3在侵袭性胶质母细胞瘤细胞中上调,而在肿瘤球核细胞中表达较低。此外,我们还建立了 NAV3 低表达和高表达分别与变形体和间质侵袭表型之间的联系,并证明了在二维和三维环境中,NAV3 的过表达会直接刺激胶质母细胞瘤的侵袭行为。同样,我们在小鼠异种移植中观察到沿血管迁移的细胞中 NAV3 表达增加。总之,我们的研究结果揭示了 NAV3 在胶质母细胞瘤侵袭中的作用,为了解胶质母细胞瘤的这一致命行为提供了思路。
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引用次数: 0
A pituitary mass in a 46-year-old woman 一名 46 岁女性的垂体肿块。
IF 5.8 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-08-01 DOI: 10.1111/bpa.13295
Francesco E. Emiliani, Donald C. Green, Edward G. Hughes, Wahab A. Khan, George J. Zanazzi, Chun-Chieh Lin
<p>A 46-year-old woman presented to the clinic with a 6-week history of left retro-orbital headaches. In recent weeks, she had developed increased thirst, a salty taste, and diplopia with blurry vision in the left eye. On examination, left cranial nerve six palsy was noted. Magnetic resonance imaging (MRI) revealed a 2.7 cm heterogeneously enhancing pituitary mass (Figure 1). Laboratory findings showed slightly elevated prolactin (83.8 ng/mL; reference: 4.8–23.3 ng/mL). There were no other findings associated with hypo/hyperpituitarism. During transsphenoidal resection, the tumor appeared to be adherent and firm with indistinct boundary with the pituitary gland. A portion of the tumor infiltrating the cavernous sinus was left behind to prevent damage to the cavernous segment of the carotid artery.</p><p>Intraoperative cytological smears showed pleomorphic tumor cells with prominent nucleoli and minimal cytoplasm (Figure 2A and Box 1). Histological examination of formalin-fixed paraffin-embedded (FFPE) tissue showed a poorly differentiated neoplasm with high mitotic counts (up to five per high-power field), forming a sheet-like architecture. Tumor cells exhibited prominent nucleoli and vesicular chromatin with cytoplasmic vacuolation. Occasional intracytoplasmic globular eosinophilic inclusions were noted (Figure 2B). Immunohistochemical study showed that the tumor was negative for CK (AE1/AE3), GFAP, synaptophysin, LCA, Melan A, HMB-45, Oct3/4, PLAP, and brachyury. Notably, the tumor showed loss of nuclear SMARCB1/INI1 staining (Figure 2C). Ki67 index was elevated (70%).</p><p>Chromosomal microarray analysis (CMA) demonstrated copy neutral loss of heterozygosity (cnLOH) in nearly the entire chromosome 22 that includes the <i>SMARCB1</i> locus at 22q11.2 (Figure 2D). Next-generation sequencing (NGS) detected a frameshift deletion in the 3′ end of <i>SMARCB1</i> (p. P383Rfs c.1148del; VAF = 74.2%) (Figure 2E). No other mutation was identified. Brain tumor methylation profiling from National Cancer Institute classified this tumor as an AT/RT subclass MYC (calibrated score of 0.95).</p><p>Adult sellar atypical teratoid/rhabdoid tumor, CNS WHO grade 4.</p><p>Adult sellar AT/RT is a rare, aggressive CNS embryonal tumor, with less than 50 cases reported to date. By definition, it occurs in the sellar/suprasellar region of adults, displays variable polyphenotypic differentiation and demonstrates characteristic <i>SMARCB1</i> mutations. Notably, there is a strong female predominance (95%) and middle age distribution (mean = 44 ± 3 years) [<span>1-3</span> and current case]. This contrasts with pediatric AT/RT, which shows a slight male predominance and has not been reported in the sellar region.</p><p>On MRI, adult sellar AT/RT is frequently described as a heterogeneously enhancing pituitary mass with invasion of adjacent structures. Due to its rarity and non-specific histological findings, the differential diagnosis is usually broad [<span>1-3</span>]. A
最后,根据黑色素体基因(TYR)、声波刺猬通路(SHH)以及 MYC 和 HOX 簇的过度表达,小儿 ATRT 的甲基化分析确定了三种不同的亚型。最近的研究发现,有七种成人沽状AT/RT被归为ATRT-MYC亚型[2],与此相一致,我们的病例也被NIH分类器归为ATRT-MYC亚型。DCG、EGH和WAK分析了数据。CCL和GJZ进行了组织学和免疫组化分析。所有作者都审阅并批准了手稿的最终版本。作者声明没有利益冲突。
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引用次数: 0
Transmembrane and coiled-coil 2 associates with Alzheimer's disease pathology in the human brain 跨膜和盘绕线圈 2 与人脑中阿尔茨海默病的病理变化有关。
IF 5.8 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-07-31 DOI: 10.1111/bpa.13290
Paul C. R. Hopkins, Claire Troakes, Andrew King, Guy Tear

Transmembrane and coiled-coil 2 (TMCC2) is a human orthologue of the Drosophila gene dementin, mutant alleles of which cause neurodegeneration with features of Alzheimer's disease (AD). TMCC2 and Dementin further have an evolutionarily conserved interaction with the amyloid protein precursor (APP), a protein central to AD pathogenesis. To investigate if human TMCC2 might also participate in mechanisms of neurodegeneration, we examined TMCC2 expression in late onset AD human brain and age-matched controls, familial AD cases bearing a mutation in APP Val717, and Down syndrome AD. Consistent with previous observations of complex formation between TMCC2 and APP in the rat brain, the dual immunocytochemistry of control human temporal cortex showed highly similar distributions of TMCC2 and APP. In late onset AD cases stratified by APOE genotype, TMCC2 immunoreactivity was associated with dense core senile plaques and adjacent neuronal dystrophies, but not with Aβ surrounding the core, diffuse Aβ plaques or tauopathy. In Down syndrome AD, we observed in addition TMCC2-immunoreactive and methoxy-X04-positive pathological features that were morphologically distinct from those seen in the late onset and familial AD cases, suggesting enhanced pathological alteration of TMCC2 in Down syndrome AD. At the protein level, western blots of human brain extracts revealed that human brain-derived TMCC2 exists as at least three isoforms, the relative abundance of which varied between the temporal gyrus and cerebellum and was influenced by APOE and/or dementia status. Our findings thus implicate human TMCC2 in AD via its interactions with APP, its association with dense core plaques, as well as its alteration in Down syndrome AD.

跨膜和盘卷2(TMCC2)是果蝇基因Dementin的人类直系同源物,其突变等位基因会导致具有阿尔茨海默病(AD)特征的神经变性。TMCC2和Dementin还与淀粉样蛋白前体(APP)有进化上一致的相互作用,APP是导致阿尔茨海默病发病的核心蛋白。为了研究人类 TMCC2 是否也可能参与神经退行性变的机制,我们检测了 TMCC2 在晚发性 AD 人脑和年龄匹配的对照组、APP Val717 突变的家族性 AD 病例以及唐氏综合征 AD 中的表达。与之前在大鼠大脑中观察到的 TMCC2 和 APP 之间形成复合物的情况一致,对照组人类颞叶皮层的双重免疫细胞化学显示 TMCC2 和 APP 的分布高度相似。在按 APOE 基因型分层的晚发性注意力缺失症病例中,TMCC2 免疫反应与致密的核心衰老斑块和邻近的神经元萎缩有关,但与核心周围的 Aβ、弥漫性 Aβ 斑块或 tauopathy 无关。在唐氏综合征AD中,我们还观察到了TMCC2-免疫反应性和甲氧基-X04阳性病理特征,这些病理特征在形态上与晚发性和家族性AD病例中的病理特征不同,这表明唐氏综合征AD中TMCC2的病理改变增强。在蛋白质水平上,人脑提取物的Western印迹显示,人脑来源的TMCC2至少存在三种同工酶,其相对丰度在颞回和小脑之间存在差异,并受APOE和/或痴呆状态的影响。因此,我们的研究结果表明,人类TMCC2通过与APP的相互作用、与致密核心斑块的关联以及在唐氏综合征AD中的改变与AD有关。
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引用次数: 0
The historical background of hereditary cystatin C amyloid angiopathy: Genealogical, pathological, and clinical manifestations 遗传性胱抑素 C 淀粉样血管病的历史背景:谱系、病理和临床表现。
IF 5.8 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-07-25 DOI: 10.1111/bpa.13291
Asbjorg Osk Snorradottir, Hakon Hakonarson, Astridur Palsdottir

Hereditary cystatin C amyloid angiopathy (HCCAA) is an Icelandic disease that belongs to a disease class called cerebral amyloid angiopathy, a group of heterogenous diseases presenting with aggregation of amyloid complexes and deposition predominantly in the central nervous system. HCCAA is dominantly inherited, caused by L68Q mutation in the cystatin C gene, leading to aggregation of the cystatin C protein. HCCAA is a very progressive and severe disease, with widespread cerebral and parenchymal cystatin C and collagen IV deposition within the central nervous system (CNS) but also in other organs in the body, for example, in the skin. Most L68Q carriers have clinical symptoms characterized by recurrent hemorrhages and dementia, between the age of 20–30 years. If the carriers survive the first hemorrhage, the frequency and severity of the hemorrhages tend to increase, resulting in death at average of 30 years with mean number of major hemorrhages ranging from 3.2 to 3.9 over a 5-year average life span. The pathogenesis of the disease in carriers is very similar in the CNS and in the skin based on autopsy studies, thus skin biopsies can be used to monitor the progression of the disease by quantifying the cystatin C immunoreactivity. The cystatin C deposition always colocalizes with collagen IV and fibroblasts in the skin are found to be the main cell type responsible for the deposition of both proteins. No therapy is available for this devastating disease.

遗传性胱抑素 C 淀粉样血管病(HCCAA)是冰岛的一种疾病,属于脑淀粉样血管病,是一组主要表现为淀粉样复合物聚集并沉积于中枢神经系统的异质性疾病。HCCAA 为显性遗传,由胱抑素 C 基因的 L68Q 突变引起,导致胱抑素 C 蛋白聚集。HCCAA 是一种非常进展性的严重疾病,在中枢神经系统(CNS)内有广泛的脑和实质胱抑素 C 和胶原蛋白 IV 沉积,但也会在身体的其他器官(如皮肤)中出现。大多数 L68Q 携带者的临床症状以反复出血和痴呆为特征,年龄在 20-30 岁之间。如果携带者在第一次出血后存活下来,出血的频率和严重程度就会增加,导致平均 30 岁时死亡,平均 5 年的寿命中大出血的平均次数为 3.2 至 3.9 次。根据尸检研究,该病携带者中枢神经系统和皮肤的发病机制非常相似,因此可以通过皮肤活检来量化胱抑素 C 免疫反应,从而监测疾病的进展。胱抑素 C 沉积总是与胶原蛋白 IV 共聚焦,皮肤中的成纤维细胞是导致这两种蛋白质沉积的主要细胞类型。目前还没有治疗这种毁灭性疾病的方法。
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引用次数: 0
Foxq1 activates CB2R with oleamide to alleviate POCD Foxq1 通过油酰胺激活 CB2R,从而缓解 POCD。
IF 5.8 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-07-24 DOI: 10.1111/bpa.13289
Xiaoying Wu, Yuming Wu, Fudong Tang, Yangyang Wang, Chenxi Li, Su Wu, Guangzhi Wang, Jiaqiang Zhang

Postoperative cognitive dysfunction (POCD) is a major concern, particularly among older adults. This study used social isolation (ISO) and multiomics analyses in aged mice to investigate potential mechanisms underlying POCD development. Aged mice were divided into two groups: ISO and paired housing (PH). Oleamide and the cannabinoid receptor type 2 (CB2R) antagonist AM630 were administered intraperitoneally, while Foxq1 adeno-associated viral (AAV) vector was injected directly into the hippocampus. Intramedullary tibial surgeries were subsequently performed to establish the POCD models. Behavioral tests comprising the Y-maze, open field test, and novel object recognition were conducted 2 days after surgery. Hippocampal and serum inflammatory cytokines were assessed. Following surgery, ISO mice demonstrated intensified cognitive impairments and escalated inflammatory markers. Integrative transcriptomic and metabolomic analysis revealed elevated oleamide concentrations in the hippocampus and serum of PH mice, with associative investigations indicating a close relationship between the Foxq1 gene and oleamide levels. While oleamide administration and Foxq1 gene overexpression substantially ameliorated postoperative cognitive performance and systemic inflammation in mice, CB2R antagonist AM630 impeded these enhancements. The Foxq1 gene and oleamide may be crucial in alleviating POCD. While potentially acting through CB2R-mediated pathways, these factors may modulate neuroinflammation and attenuate proinflammatory cytokine levels within the hippocampus, substantially improving cognitive performance postsurgery. This study lays the groundwork for future research into therapeutic approaches targeting the Foxq1-oleamide-CB2R axis, with the ultimate goal of preventing or mitigating POCD.

术后认知功能障碍(POCD)是一个备受关注的问题,尤其是在老年人中。本研究利用社会隔离(ISO)和多组学分析对老年小鼠进行了研究,以探讨POCD发生的潜在机制。老年小鼠分为两组:ISO组和配对饲养组(PH组)。腹腔注射油胺和大麻素受体2型(CB2R)拮抗剂AM630,同时将Foxq1腺相关病毒(AAV)载体直接注入海马。随后进行胫骨髓内手术,以建立POCD模型。术后2天进行行为测试,包括Y迷宫、开阔地测试和新物体识别。对海马和血清中的炎性细胞因子进行了评估。手术后,ISO小鼠的认知障碍加剧,炎症标志物升高。综合转录组和代谢组分析显示,PH小鼠海马和血清中的油酰胺浓度升高,关联研究表明Foxq1基因与油酰胺水平之间存在密切关系。服用油酰胺和过表达 Foxq1 基因大大改善了小鼠术后的认知能力和全身炎症,而 CB2R 拮抗剂 AM630 则阻碍了这些改善。Foxq1 基因和油胺可能是缓解 POCD 的关键。这些因子可能通过 CB2R 介导的途径发挥作用,从而调节神经炎症并减轻海马内的促炎细胞因子水平,从而大大改善手术后的认知能力。这项研究为今后研究针对 Foxq1-oleamide-CB2R 轴的治疗方法奠定了基础,其最终目标是预防或减轻 POCD。
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引用次数: 0
Assessment of Ki-67 and mitoses in pituitary neuroendocrine tumours—Consistency counts 垂体神经内分泌肿瘤中 Ki-67 和有丝分裂的评估--一致性计数。
IF 5.8 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-07-15 DOI: 10.1111/bpa.13285
Paul Benjamin Loughrey, Christine Greene, Kris D. McCombe, Fatima Abdullahi Sidi, Stephen McQuaid, Stephen Cooke, Steven J. Hunter, Brian Herron, Márta Korbonits, Stephanie G. Craig, Jacqueline A. James

Pituitary neuroendocrine tumour Ki-67 proliferation index varies according to the number of tumour cells assessed. Consistent Ki-67 scoring approaches and re-evaluation of the recommended Ki-67 3% cut-off are required to clarify controversies in pituitary neuroendocrine tumour Ki-67 proliferation index assessment.

垂体神经内分泌肿瘤的Ki-67增殖指数因评估的肿瘤细胞数量而异。为澄清垂体神经内分泌肿瘤 Ki-67 增殖指数评估中的争议,需要采用一致的 Ki-67 评分方法并重新评估推荐的 Ki-67 3% 临界值。
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引用次数: 0
Clinicopathological analysis of NEK1 variants in amyotrophic lateral sclerosis 肌萎缩性脊髓侧索硬化症中 NEK1 变体的临床病理分析。
IF 5.8 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-07-10 DOI: 10.1111/bpa.13287
Olivia M. Rifai, Fergal M. Waldron, Danah Sleibi, Judi O'Shaughnessy, Danielle J. Leighton, Jenna M. Gregory

Many genes have been linked to amyotrophic lateral sclerosis (ALS), including never in mitosis A (NIMA)-related kinase 1 (NEK1), a serine/threonine kinase that plays a key role in several cellular functions, such as DNA damage response and cell cycle regulation. Whole-exome sequencing studies have shown that NEK1 mutations are associated with an increased risk for ALS, where a significant enrichment of NEK1 loss-of-function (LOF) variants were found in individuals with ALS compared to controls. In particular, the p.Arg261His missense variant was associated with significantly increased disease susceptibility. This case series aims to understand the neuropathological phenotypes resulting from NEK1 mutations in ALS. We examined a cohort of three Scottish patients with a mutation in the NEK1 gene and evaluated the distribution and cellular expression of NEK1, as well as the abundance of phosphorylated TDP-43 (pTDP-43) aggregates, in the motor cortex compared to age- and sex-matched control tissue. We show pathological, cytoplasmic TDP-43 aggregates in all three NEK1-ALS cases. NEK1 protein staining revealed no immunoreactivity in two of the NEK1-ALS cases, indicating a LOF and corresponding to a reduction in NEK1 mRNA as detected by in situ hybridisation. However, the p.Arg261His missense mutation resulted in an increase in NEK1 mRNA molecules and abundant NEK1-positive cytoplasmic aggregates, with the same morphologic appearance, and within the same cells as co-occurring TDP-43 aggregates. Here we show the first neuropathological assessment of a series of ALS cases carrying mutations in the NEK1 gene. Specifically, we show that TDP-43 pathology is present in these cases and that potential NEK1 LOF can either be mediated through loss of NEK1 translation or through aggregation of NEK1 protein as in the case with p.Arg261His mutation, a potential novel pathological feature of NEK1-ALS.

许多基因都与肌萎缩性脊髓侧索硬化症(ALS)有关,其中包括有丝分裂 A(NIMA)相关激酶 1(NEK1),这是一种丝氨酸/苏氨酸激酶,在 DNA 损伤反应和细胞周期调控等多种细胞功能中发挥着关键作用。全外显子组测序研究表明,NEK1 基因突变与 ALS 风险增加有关,与对照组相比,在 ALS 患者中发现的 NEK1 功能缺失(LOF)变异显著增多。特别是,p.Arg261His 错义变异与疾病易感性的显著增加有关。本病例系列旨在了解 ALS 中 NEK1 突变导致的神经病理表型。我们研究了三位NEK1基因突变的苏格兰患者,并与年龄和性别匹配的对照组织相比,评估了NEK1在运动皮层中的分布和细胞表达以及磷酸化TDP-43(pTDP-43)聚集体的丰度。我们在所有三个NEK1-ALS病例中都发现了病理性的细胞质TDP-43聚集体。在两个 NEK1-ALS 病例中,NEK1 蛋白染色显示无免疫反应,表明存在 LOF,并与原位杂交检测到的 NEK1 mRNA 减少相对应。然而,p.Arg261His 错义突变导致 NEK1 mRNA 分子增加,并出现大量 NEK1 阳性胞质聚集体,其形态外观与 TDP-43 聚集体相同,且在同一细胞内。在这里,我们首次对一系列携带 NEK1 基因突变的 ALS 病例进行了神经病理学评估。具体而言,我们发现这些病例中存在 TDP-43 病理变化,而且潜在的 NEK1 LOF 可通过 NEK1 翻译损失或 NEK1 蛋白聚集(如 p.Arg261His 突变的病例)来介导,这是 NEK1-ALS 的潜在新病理特征。
{"title":"Clinicopathological analysis of NEK1 variants in amyotrophic lateral sclerosis","authors":"Olivia M. Rifai,&nbsp;Fergal M. Waldron,&nbsp;Danah Sleibi,&nbsp;Judi O'Shaughnessy,&nbsp;Danielle J. Leighton,&nbsp;Jenna M. Gregory","doi":"10.1111/bpa.13287","DOIUrl":"10.1111/bpa.13287","url":null,"abstract":"<p>Many genes have been linked to amyotrophic lateral sclerosis (ALS), including never in mitosis A (NIMA)-related kinase 1 (NEK1), a serine/threonine kinase that plays a key role in several cellular functions, such as DNA damage response and cell cycle regulation. Whole-exome sequencing studies have shown that <i>NEK1</i> mutations are associated with an increased risk for ALS, where a significant enrichment of <i>NEK1</i> loss-of-function (LOF) variants were found in individuals with ALS compared to controls. In particular, the p.Arg261His missense variant was associated with significantly increased disease susceptibility. This case series aims to understand the neuropathological phenotypes resulting from <i>NEK1</i> mutations in ALS. We examined a cohort of three Scottish patients with a mutation in the <i>NEK1</i> gene and evaluated the distribution and cellular expression of <i>NEK1</i>, as well as the abundance of phosphorylated TDP-43 (pTDP-43) aggregates, in the motor cortex compared to age- and sex-matched control tissue. We show pathological, cytoplasmic TDP-43 aggregates in all three <i>NEK1</i>-ALS cases. NEK1 protein staining revealed no immunoreactivity in two of the <i>NEK1</i>-ALS cases, indicating a LOF and corresponding to a reduction in <i>NEK1</i> mRNA as detected by in situ hybridisation. However, the p.Arg261His missense mutation resulted in an increase in <i>NEK1</i> mRNA molecules and abundant NEK1-positive cytoplasmic aggregates, with the same morphologic appearance, and within the same cells as co-occurring TDP-43 aggregates. Here we show the first neuropathological assessment of a series of ALS cases carrying mutations in the <i>NEK1</i> gene. Specifically, we show that TDP-43 pathology is present in these cases and that potential NEK1 LOF can either be mediated through loss of <i>NEK1</i> translation or through aggregation of NEK1 protein as in the case with p.Arg261His mutation, a potential novel pathological feature of NEK1-ALS.</p>","PeriodicalId":9290,"journal":{"name":"Brain Pathology","volume":"35 1","pages":""},"PeriodicalIF":5.8,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11669413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141579021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Upper motor neuron-predominant motor neuron disease presenting as atypical parkinsonism: A clinicopathological study 表现为非典型帕金森病的上运动神经元为主的运动神经元病:临床病理学研究。
IF 5.8 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-07-10 DOI: 10.1111/bpa.13286
Aya Murakami, Shunsuke Koga, Shinsuke Fujioka, Adrianna E. White, Kevin F. Bieniek, Hiroaki Sekiya, Mariely DeJesus-Hernandez, NiCole A. Finch, Marka van Blitterswijk, Masataka Nakamura, Yoshio Tsuboi, Melissa E. Murray, Zbigniew K. Wszolek, Dennis W. Dickson

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder characterized by upper and lower motor neuron signs. There are, however, cases where upper motor neurons (UMNs) are predominantly affected, leading to clinical presentations of UMN-dominant ALS or primary lateral sclerosis. Furthermore, cases exhibiting an UMN-predominant pattern of motor neuron disease (MND) presenting with corticobasal syndrome (CBS) have been sparsely reported. This study aims to clarify the clinicopathological features of patients with UMN-predominant MND. We reviewed 24 patients with UMN-predominant MND with TDP-43 pathology in the presence or absence of frontotemporal lobar degeneration. Additionally, we reviewed the medical records of patients with pathologically-confirmed corticobasal degeneration (CBD) who received a final clinical diagnosis of CBS (n = 10) and patients with pathologically-confirmed progressive supranuclear palsy (PSP) who received a final clinical diagnosis of PSP syndrome (n = 10). Of 24 UMN-predominant MND patients, 20 had a clinical diagnosis of an atypical parkinsonian disorder, including CBS (n = 11) and PSP syndrome (n = 8). Only two patients had antemortem diagnoses of motor neuron disease. UMN-predominant MND patients with CBS less frequently exhibited apraxia than those with CBD, and they were less likely to meet clinical criteria for possible or probable CBS. Similarly, UMN-predominant MND patients with PSP syndrome less often met clinical criteria for probable PSP than PSP patients with PSP syndrome. Our findings suggest that UMN-predominant MND can mimic atypical parkinsonism, and should be considered in the differential diagnosis of CBS and PSP syndrome, in particular when criteria are not met.

肌萎缩侧索硬化症(ALS)是一种神经退行性疾病,以上下运动神经元症状为特征。然而,在有些病例中,上运动神经元(UMN)主要受累,导致临床表现为 UMN 主导型 ALS 或原发性侧索硬化症。此外,表现出以 UMN 为主导的运动神经元病(MND)模式并伴有皮质基底综合征(CBS)的病例也鲜有报道。本研究旨在阐明 UMN 显性 MND 患者的临床病理特征。我们回顾了 24 例伴有或不伴有额颞叶变性的 TDP-43 病变的 UMN 显性 MND 患者。此外,我们还查阅了病理确诊为皮质基底节变性(CBD)且最终临床诊断为CBS的患者(n = 10)和病理确诊为进行性核上麻痹(PSP)且最终临床诊断为PSP综合征的患者(n = 10)的病历。在24名以UMN为主的MND患者中,20人被临床诊断为非典型帕金森病,包括CBS(11人)和PSP综合征(8人)。只有两名患者在死前被诊断为运动神经元疾病。与CBD患者相比,以UMN为主的CBS MND患者较少表现出失语,他们也较少符合可能或疑似CBS的临床标准。同样,与患有 PSP 综合征的 PSP 患者相比,患有 PSP 综合征的 UMN 型 MND 患者较少符合可能患有 PSP 的临床标准。我们的研究结果表明,UMN为主的MND可模拟非典型帕金森病,在CBS和PSP综合征的鉴别诊断中应加以考虑,尤其是在不符合标准的情况下。
{"title":"Upper motor neuron-predominant motor neuron disease presenting as atypical parkinsonism: A clinicopathological study","authors":"Aya Murakami,&nbsp;Shunsuke Koga,&nbsp;Shinsuke Fujioka,&nbsp;Adrianna E. White,&nbsp;Kevin F. Bieniek,&nbsp;Hiroaki Sekiya,&nbsp;Mariely DeJesus-Hernandez,&nbsp;NiCole A. Finch,&nbsp;Marka van Blitterswijk,&nbsp;Masataka Nakamura,&nbsp;Yoshio Tsuboi,&nbsp;Melissa E. Murray,&nbsp;Zbigniew K. Wszolek,&nbsp;Dennis W. Dickson","doi":"10.1111/bpa.13286","DOIUrl":"10.1111/bpa.13286","url":null,"abstract":"<p>Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder characterized by upper and lower motor neuron signs. There are, however, cases where upper motor neurons (UMNs) are predominantly affected, leading to clinical presentations of UMN-dominant ALS or primary lateral sclerosis. Furthermore, cases exhibiting an UMN-predominant pattern of motor neuron disease (MND) presenting with corticobasal syndrome (CBS) have been sparsely reported. This study aims to clarify the clinicopathological features of patients with UMN-predominant MND. We reviewed 24 patients with UMN-predominant MND with TDP-43 pathology in the presence or absence of frontotemporal lobar degeneration. Additionally, we reviewed the medical records of patients with pathologically-confirmed corticobasal degeneration (CBD) who received a final clinical diagnosis of CBS (<i>n</i> = 10) and patients with pathologically-confirmed progressive supranuclear palsy (PSP) who received a final clinical diagnosis of PSP syndrome (<i>n</i> = 10). Of 24 UMN-predominant MND patients, 20 had a clinical diagnosis of an atypical parkinsonian disorder, including CBS (<i>n =</i> 11) and PSP syndrome (<i>n =</i> 8). Only two patients had antemortem diagnoses of motor neuron disease. UMN-predominant MND patients with CBS less frequently exhibited apraxia than those with CBD, and they were less likely to meet clinical criteria for possible or probable CBS. Similarly, UMN-predominant MND patients with PSP syndrome less often met clinical criteria for probable PSP than PSP patients with PSP syndrome. Our findings suggest that UMN-predominant MND can mimic atypical parkinsonism, and should be considered in the differential diagnosis of CBS and PSP syndrome, in particular when criteria are not met.</p>","PeriodicalId":9290,"journal":{"name":"Brain Pathology","volume":"35 1","pages":""},"PeriodicalIF":5.8,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11669411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141579033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Visualizing alpha-synuclein and iron deposition in M83 mouse model of Parkinson's disease in vivo 在帕金森病 M83 小鼠模型体内观察α-突触核蛋白和铁沉积。
IF 5.8 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-07-09 DOI: 10.1111/bpa.13288
Nadja Straumann, Benjamin F. Combes, Xose Luis Dean Ben, Rebecca Sternke-Hoffmann, Juan A. Gerez, Ines Dias, Zhenyue Chen, Benjamin Watts, Iman Rostami, Kuangyu Shi, Axel Rominger, Christian R. Baumann, Jinghui Luo, Daniela Noain, Roger M. Nitsch, Nobuyuki Okamura, Daniel Razansky, Ruiqing Ni

Abnormal alpha-synuclein (αSyn) and iron accumulation in the brain play an important role in Parkinson's disease (PD). Herein, we aim to visualize αSyn inclusions and iron deposition in the brains of M83 (A53T) mouse models of PD in vivo. The fluorescent pyrimidoindole derivative THK-565 probe was characterized by means of recombinant fibrils and brains from 10- to 11-month-old M83 mice. Concurrent wide-field fluorescence and volumetric multispectral optoacoustic tomography (vMSOT) imaging were subsequently performed in vivo. Structural and susceptibility weighted imaging (SWI) magnetic resonance imaging (MRI) at 9.4 T as well as scanning transmission x-ray microscopy (STXM) were performed to characterize the iron deposits in the perfused brains. Immunofluorescence and Prussian blue staining were further performed on brain slices to validate the detection of αSyn inclusions and iron deposition. THK-565 showed increased fluorescence upon binding to recombinant αSyn fibrils and αSyn inclusions in post-mortem brain slices from patients with PD and M83 mice. Administration of THK-565 in M83 mice showed higher cerebral retention at 20 and 40 min post-intravenous injection by wide-field fluorescence compared to nontransgenic littermate mice, in congruence with the vMSOT findings. SWI/phase images and Prussian blue indicated the accumulation of iron deposits in the brains of M83 mice, presumably in the Fe3+ form, as evinced by the STXM results. In conclusion, we demonstrated in vivo mapping of αSyn by means of noninvasive epifluorescence and vMSOT imaging and validated the results by targeting the THK-565 label and SWI/STXM identification of iron deposits in M83 mouse brains ex vivo.

大脑中异常的α-突触核蛋白(αSyn)和铁积聚在帕金森病(PD)中起着重要作用。在此,我们旨在观察 M83(A53T)帕金森病模型小鼠脑内的αSyn包涵体和铁沉积。荧光嘧啶吲哚衍生物 THK-565 探针通过重组纤维和 10 到 11 个月大的 M83 小鼠大脑进行表征。随后在体内同时进行了宽场荧光和容积多谱段光声断层成像(vMSOT)。为确定灌注大脑中铁沉积的特征,还进行了 9.4 T 结构和感性加权成像(SWI)磁共振成像(MRI)以及扫描透射 X 射线显微镜(STXM)检查。对脑切片进一步进行了免疫荧光和普鲁士蓝染色,以验证αSyn包涵体和铁沉积的检测结果。在帕金森病患者和M83小鼠的尸检脑片上,THK-565与重组αSyn纤维和αSyn包涵体结合后显示出更强的荧光。与非转基因同系小鼠相比,给 M83 小鼠注射 THK-565 在静脉注射后 20 分钟和 40 分钟的广域荧光中显示出更高的脑保留率,这与 vMSOT 的研究结果一致。SWI/相位图像和普鲁士蓝显示 M83 小鼠大脑中铁沉积物的积累,推测为 Fe3+ 形式,这与 STXM 的结果一致。总之,我们通过非侵入性的外荧光和 vMSOT 成像展示了 αSyn 的体内图谱,并通过靶向 THK-565 标记和 SWI/STXM 鉴定 M83 小鼠大脑体内外的铁沉积验证了结果。
{"title":"Visualizing alpha-synuclein and iron deposition in M83 mouse model of Parkinson's disease in vivo","authors":"Nadja Straumann,&nbsp;Benjamin F. Combes,&nbsp;Xose Luis Dean Ben,&nbsp;Rebecca Sternke-Hoffmann,&nbsp;Juan A. Gerez,&nbsp;Ines Dias,&nbsp;Zhenyue Chen,&nbsp;Benjamin Watts,&nbsp;Iman Rostami,&nbsp;Kuangyu Shi,&nbsp;Axel Rominger,&nbsp;Christian R. Baumann,&nbsp;Jinghui Luo,&nbsp;Daniela Noain,&nbsp;Roger M. Nitsch,&nbsp;Nobuyuki Okamura,&nbsp;Daniel Razansky,&nbsp;Ruiqing Ni","doi":"10.1111/bpa.13288","DOIUrl":"10.1111/bpa.13288","url":null,"abstract":"<p>Abnormal alpha-synuclein (αSyn) and iron accumulation in the brain play an important role in Parkinson's disease (PD). Herein, we aim to visualize αSyn inclusions and iron deposition in the brains of M83 (A53T) mouse models of PD in vivo. The fluorescent pyrimidoindole derivative THK-565 probe was characterized by means of recombinant fibrils and brains from 10- to 11-month-old M83 mice. Concurrent wide-field fluorescence and volumetric multispectral optoacoustic tomography (vMSOT) imaging were subsequently performed in vivo. Structural and susceptibility weighted imaging (SWI) magnetic resonance imaging (MRI) at 9.4 T as well as scanning transmission x-ray microscopy (STXM) were performed to characterize the iron deposits in the perfused brains. Immunofluorescence and Prussian blue staining were further performed on brain slices to validate the detection of αSyn inclusions and iron deposition. THK-565 showed increased fluorescence upon binding to recombinant αSyn fibrils and αSyn inclusions in post-mortem brain slices from patients with PD and M83 mice. Administration of THK-565 in M83 mice showed higher cerebral retention at 20 and 40 min post-intravenous injection by wide-field fluorescence compared to nontransgenic littermate mice, in congruence with the vMSOT findings. SWI/phase images and Prussian blue indicated the accumulation of iron deposits in the brains of M83 mice, presumably in the Fe<sup>3+</sup> form, as evinced by the STXM results. In conclusion, we demonstrated in vivo mapping of αSyn by means of noninvasive epifluorescence and vMSOT imaging and validated the results by targeting the THK-565 label and SWI/STXM identification of iron deposits in M83 mouse brains ex vivo.</p>","PeriodicalId":9290,"journal":{"name":"Brain Pathology","volume":"34 6","pages":""},"PeriodicalIF":5.8,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bpa.13288","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141562732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Brain Pathology
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