A case of Farber disease

We report a case of Farber disease (Farber lipogranulomatosis). The main features were a shrill voice, joint swelling, subcutaneous nodules and retarded psychomotor development. Cytological investigation revealed intracytoplasmic inclusion bodies characteristic of Farber disease. Lipid analysis of liver tissue indicated an accumulation of ceramide containing non-hydroxy fatty acids. It was found that the acid ceramidase activity in the liver was reduced to 31% of the control value. In this patient there was also persistent diarrhea, cholelithiasis, transient proteinuria and increased urinary total sialic acids. These features have not been noted in previously reported cases.

Feline sphingolipidosis resembling Niemann-Pick disease type C

A 9-week old domestic short-hair kitten with progressive neurological dysfunction had histopathological lesions consistent with a lysosomal storage disease. Light microscopy of the brain, spinal cord, and ganglia revealed distention and vacuolation of many neuronal populations, and extensive neuroaxonal dystrophy. Large numbers of foamy macrophages were observed in the liver, spleen, lymph nodes, and lung. Hepatocytes appeared pale and swollen. Ultrastructural examination of all affected tissues and organs revealed heterogeneous membranous inclusions. Lipid analysis of liver revealed an excess of cholesterol, glucosylceramide, lactosylceramide and phospholipids including sphingomyelin. There was some increase in the levels of brain GM2 and GM3 gangliosides. Sphingomyelinase activity in liver was partially deficient or low normal. Skin fibroblasts were cultured from two affected cats from the colony established with littermates of the subject of this report. The cultured skin fibroblasts had partially decreased sphingomyelinase activity and a greatly decreased ability to esterify exogenous cholesterol. Clinical, morphological, and biochemical findings suggest that this cat had sphingolipidosis similar to human Niemann-Pick disease type C, a disease not previously described in the cat. The feline form of this storage disease may provide a useful model for studies on the human disease.

Farber's lipogranulomatosis in siblings: light and electron microscopic studies

Two cases of Farber's lipogranulomatosis in siblings are reported. The clinical features included contractures of the limbs with swelling of the joints and subcutaneous nodules and erythematous infiltrated plaques. On histology there were many large foam cells in the dermis, and electron microscopy showed numerous large cells with round cytoplasmic lamellar and microtubular bodies.

Neurovisceral sphingomyelinosis in a Siamese cat

This report presents the clinical, morphological and biochemical findings on an 11-month-old female Siamese cat with neurovisceral sphingomyelinosis. Gross pathological features and histochemical findings are compared with the human disease counterpart and the previously described animal models. Hepatomegaly was observed while splenomegaly was not. Although sphingomyelin in liver and spleen was biochemically elevated, histochemical results in this case were slightly different from those previously recorded in human and feline Niemann-Pick disease. These results suggest that this feline case might be a different type of animal Niemann-Pick disease to that reported previously.

The contribution of pathology to the study of storage disorders

Our purpose is to illustrate some contributions of pathology to a better knowledge of metabolic disorders affecting the brain and visceral organs. Four groups of diseases are used to that effect. A comparative study of pre- and postnatal examples of mucopolysaccharidoses I, II and III reveals for example that severe neuronal lesions are already found in fetuses and that a rough parallelism exists between the maturation of neurons and the progressive intralysosomal accumulation of undigested metabolites. The study of four patients with I-cell disease shows that the intralysosomal storage occurs nearly exclusively in fibroblasts. Since the enzyme defect has also been found in non-mesenchymal cells, other mechanisms for a proper processing of lysosomal enzymes must be available in the intact cells. Adrenoleukomyeloneuropathy is used to demonstrate that the morphological features witnessing the accumulation of the very long chain fatty acids can be different in the central and in the peripheral nervous system. Finally, juvenile dystonic lipidosis illustrate the heterogeneity of the conditions grouped under the denomination of sphingomyelinoses. These few examples confirm the role of pathology in the diagnosis of metabolic disorders and in the study of their physiopathogenesis.

Cerebellar involvement in murine sphingomyelinosis: a new model of Niemann-Pick disease

Mice with sphingomyelinosis (spm) with a C57BL/KsJ inbred background showed hepatosplenomegaly as early as four weeks (wk) of age and cerebellar signs around seven wk. Almost all animals died by 14 wk. Sudanophilic lipid accumulated in the liver, spleen, and lymph nodes as well as in the brain. The striking neuropathological change was a marked atrophy of the cerebellum, where Purkinje cells were predominantly involved. Loss of Purkinje cells started at the age of six wk before the cerebellar signs had become evident clinically. The cell loss appeared to be more marked in the vermis than in the hemispheres. Cytoplasmic inclusions in most cells consisted of myelin figures composed of concentric membranous lamellae. These inclusions were found mainly in the Purkinje cells at an early stage; thereafter, they were widely distributed in the granule cells, Golgi cells, some glial cells, macrophages and endothelial cells. The neuronal inclusions were frequently located in the vicinity of the Golgi apparatus; there were no unusual mitochondrial configurations. The clinicopathological characteristics of the mutant mice are similar to those of the human Niemann-Pick disease type C.

Lipid storage disease: Part III. Ultrastructural evaluation of cultured fibroblasts in sphingolipidoses

For the purpose of evaluating electron microscopy of tissue culture in making the diagnosis of sphingolipidoses, an ultrastructural study was made on the cultured fibroblasts from 23 patients with the disorders. The characteristic cytoplasmic inclusions were observed in the cultured cells of Fabry disease, Tay-Sachs disease, Sandhoff disease, generalized gangliosidosis, Niemann-Pick disease, metachromatic leukodystrophy, and multiple sulfatase deficiency, and differ in fine structure with these diseases. All these cytoplasmic inclusions were surrounded by a single limiting membrane and enzyme cytochemically showed acid phosphatase activity, indicating their lysosomal origin. Ultrastructurally, the cytoplasmic inclusions showed pleomorphic osmiophilic inclusions in Fabry disease, membranous cytoplasmic bodies (MCB) in Tay-Sachs disease and Sandhoff disease, MCB and vacuolar inclusions containing finely reticulogranular materials in generalized gangliosidosis, myelin-like inclusions in Niemann-Pick disease, concentric lamellar inclusions in metachromatic leukodystrophy, and polymorphic cytoplasmic inclusions in multiple sulfatase deficiency. In the heterozygous carriers of Fabry disease, pleomorphic osmiophilic inclusions were also detected. However, any specific inclusions were not detectable in the cultured fibroblasts of Gaucher disease and Krabbe disease. Availability of electron microscopy in the cultured fibroblasts of sphingolipidoses is discussed.

Farber's disease: a fine structural study

A 1-week-old baby boy presented with hepatosplenomegaly, coarse facial features, and cloudy corneas. A metabolic storage disease was considered and he underwent cutaneous and liver biopsy. By light microscopy the skin was normal. Kupffer cells were enlarged and had foamy cytoplasm. Ultrastructural examination of skin and liver demonstrated features compatible with Farber's disease: curvilinear and "banana" bodies, zebra-like structures, and concentric lamellar bodies. A deficiency of lysosomal acid ceramidase was subsequently demonstrated in cultured fibroblasts and in liver tissue corroborating the ultrastructural findings.

Sphingomyelin lipidosis variant with cirrhosis in the pediatric age group

Two children with a variant of sphingomyelin lipidosis had otherwise unexplained cirrhosis that was histologically inactive and appeared to run an indolent course. The primary clinical problems involved the central nervous system, with vertical supranuclear ophthalmoplegia being the most distinctive feature. Biochemical analysis of cultured skin fibroblasts obtained from one of the children revealed that sphingomyelinase activity was 42% of control values. The typical inconspicuous hepatic storage and cirrhosis, coupled with the important morphologic finding of sea-blue histiocytes in the marrow, suggested that in cases of unexplained infantile or childhood cirrhosis the marrow should be closely examined for such histiocytes. Likewise, in cases of sea-blue histiocytes without evident etiology, with or without cirrhosis, this disease should be considered.

Farber's disease in two siblings, sural nerve and subcutaneous biopsies by light and electron microscopy

Two siblings born from consanguineous tunisian parents are reported. They showed a severe form of Farber's disease with prominent involvement of the central and peripheral nervous system: low conduction velocity was noticed in both children. Macular cherry red spots were observed in one of them. The diagnosis for the girl investigated was confirmed by evidence of ceramidase deficiency in cultured fibroblasts. Here we report the pathological findings in the subcutaneous nodules using light and electron microscopy (one case), and in sural nerves using morphometric studies (both cases). Varying morphological aspects of intracellular inclusions, depending on the tissues involved, are described and discussed. A review of all cases reported since Farber's first paper in 1952 is given.

[Farber's lipogranulomatosis. Apropos of a case]

A case of Farber's lipogranulomatosis is described in an 18 month-old girl. There was clinical evidence for diagnosis, which was confirmed by a ceramidase activity assay on cultured fibroblasts. A study of the conjunctiva by electron microscopy was performed. The authors emphasize the clinical and biological characteristics of such cases.

Heritable metabolic storage diseases

During the last decade, examinations of skin biopsies have gained increasing importance in the search for a better understanding and facilitated diagnosis of metabolic storage diseases. In addition to biochemical and tissue culture techniques, light- and electron-microscopic investigations have been recommended in a number of such disorders (1-6). There are, however, a large number of different and inhomogeneous conditions to be identified in this group. At present, approximately 300 diseases can be identified as inborn errors of metabolism by the determination of a biochemically well-established underlying defect. Moreover, a yet undetermined number of pathological conditions is accompanied by the deposition of more or less defined storage materials in cutaneous tissue elements. It appears, therefore, premature to propose a systematic dermatopathology of metabolic storage diseases, and the following contribution should be understood as an attempt to indicate possibilities and chances by quoting some representative examples.

Farber's disease. Light and electron microscopic study of the eye

A 35-month-old girl had Farber's disease (disseminated lipogranulomatosis) manifested clinically by macular cherry-red spots. The pathologic changes consisted of intracellular inclusions of varying morphologic features and density. The most frequently encountered inclusion was 1.2 micron wide and consisted of flattened stacks of osmophilic lamellae (2.1 to 2.3 nm thick, with 4.4-nm periodicity) oriented in parallel or oblique array ("zebra-body" configuration) and enclosed by a focally discontinuous unit membrane. Some of the inclusions contained curved tubular profiles resembling curvilinear tubular bodies. The retinal ganglion cells were grossly distended with inclusions and showed the greatest pathologic changes.

[Generalized GM1 gangliosidosis. Report of a case and review of the literature]

Authors present the case of a child, daughter of non related parents with neurologic progressive affectation, retina and visceral implication with certain pseudogargolic clinical aspect without near familiar antecedents suggestive of this disease. Biochemistry and histologic studies revealed a B-galactosidase enzyme deficiency and lipidic intracellular increase in different viscera. Biochemistry, hystological and clinical aspects exposed are fundamentally differential of another causes of pseudo-Hurler syndrome.

Sphingomyelin lipidosis in a cat: Golgi studies

Alterations in neuronal geometry in a feline model of sphingomyelin lipidosis were evaluated using Golgi staining. Neurons in cerebral cortex, basal ganglia, amygdala, thalamus, and cerebellum were impregnated and many were found to possess conspicuous enlargements at the axon hillock-initial segment region (meganeurites) and/or to sprout secondary neuritic processes from this same area. The latter were sometimes well developed and resembled small dendrites. These changes were cell type specific with distribution limited to certain types of neurons in select brain regions, while others remained normal, or underwent only simple somatic enlargement or generalized degenerative changes. Occasional cortical pyramidal neurons also displayed thinning of dendrites and extensive loss of dendritic spines. These observations add sphingomyelin lipidosis to other neuronal storage disorders in which aberrant neurite growth and meganeurite formation accompany lysosomal enzyme deficiency and the associated metabolic alterations and storage. Although meganeurite-like expansions have been reported to occur in many storage disorders, the appearance of axon hillock-associated neurite growth on morphologically mature neurons has been identified heretofore only in the gangliosidoses, and in feline models of alpha-mannosidosis and mucopolysaccharidosis type 1.

Abnormalities of lysosomes in human diploid fibroblasts from patients with Farber's disease

An accumulation of ceramide associated with the deficiency of acid ceramidase has been demonstrated in cultured diploid skin fibroblasts from a patient with Farber's disease. We extend this observation to investigate the lysosomal localization of accumulated ceramide and the abnormalities of lysosomes caused by this ceramide accumulation in Farber's diseased fibroblasts. We have found that the lysosomal fraction isolated from Farber's diseased fibroblasts by a subcellular fractionation procedure is markedly low in density compared with that of normal fibroblasts and is separated from other subcellular organelles. Ultrastructural studies of the isolated lysosomal fraction from Farber's diseased fibroblasts showed a mixed population of intact and swollen vesicles with a lysosomal appearance. Examination under high magnification clearly demonstrated lysosomal inclusions which contain lamellar and curvilinear membranes and resembled those seen in the intact fibroblasts. Subcellular localization of Farber's fibroblasts showed that the accumulated [3H]ceramide from the culture medium was predominantly localized in the lysosomal fraction with a markedly low density and very little was found to be associated with other cellular membranes. Our finding that ceramide is accumulated in the lysosomal fraction of Farber's fibroblasts and that these cells also show membranous inclusions strongly suggests that the accumulation of ceramide is directly involved in the formation of lysosomal inclusions.

Ovine ceroid-lipofuscinosis: a model of Batten's disease

An inherited neurological disease of sheep was characterized by the intracellular accumulation of autofluorescent lipopigments in neurones and a wide variety of other cells within the body. The staining, fluorescent, ultrastructural and physical characteristics of the storage material were similar to those found in a heterogeneous group of storage diseases of children known as Batten's disease or the ceroid-lipofuscinoses. The ovine disease did not exactly fit any of the main human entities, but had features in common with both the late infantile and juvenile forms. It was concluded that this was a useful model for studying the pathogenesis of this type of storage disease and for therapeutic trials. A flock of sheep is maintained for this purpose.

[Interest of ultrastructural study of skin and muscle biopsies in inborn storage diseases. A report of 18 cases (author's transl)]

Skin and muscle biopsies were performed in 18 patients affected by various inborn storage disorders: mucopolysaccharidosis (MPS), sphingolipidosis, GM1 gangliosidosis, I-cell disease, ceroid-lipofuscinosis (CLF), adrenoleucodystrophy (ALD) and glycogenosis. In most cases, cutaneous and muscle biopsies demonstrate clearly the presence of storage inclusions in different cell types with great reproducibility and sometimes a specificity for a particular disease. Thus, electron microscopic examinations of skin and muscle, often complementary, can given valuable informations at two levels: - either a morphological confirmation depending on the type of the storage disease: e. g. clear, granular and fuzzy inclusions identified with mucopolysaccharidic material, lamellar and pseudomyelinic figures corresponding to lipidic structures are found in different cell types in MPS, gangliosidosis and sphingolipidosis; - or a diagnostic proof of some lysosomal diseases where there are very specific ultrastructural features such as the curvilinear bodies and fingerprint profiles in CLF or the spicular inclusions in ALD. These informations are the more important as the enzymatic defect is unknown in these inherited disorders. We conclude that the ultrastructural examination of a skin and muscle biopsy are an important tool for the diagnosis of a lysosomal storage disease which avoids any more difficult biopsies as brain, kidney, liver.

Electron microscopy of skin and peripheral blood lymphocytes in infantile (Santavuori) neuronal ceroid lipofuscinosis

Skin punch biopsies and peripheral blood lymphocyte preparations from two siblings with early infantile (Santavuori) neuronal ceroid lipofuscinosis have been examined by electron microscopy. In both cases characteristic osmiophilic inclusion bodies were found in various cells in the skin and in lymphocytes. In one case, lymphocyte inclusions were detected before the onset of any symptoms as a result of a family study. This indicates the possibility of screening lymphocytes of siblings of affected patients as a result of a family study. This indicates the possibility of screening lymphocytes of siblings of affected patients with a view to early detection of the disorder.