1
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Magaki S, Haeri M, Szymanski LJ, Chen Z, Diaz R, Williams CK, Chang JW, Ao Y, Newell KL, Khanlou N, Yong WH, Fallah A, Salamon N, Daniel T, Cotter J, Hawes D, Sofroniew M, Vinters HV. Hyaline protoplasmic astrocytopathy in epilepsy. Neuropathology 2023; 43:441-456. [PMID: 37198977 DOI: 10.1111/neup.12909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/19/2023]
Abstract
Hyaline protoplasmic astrocytopathy (HPA) describes a rare histologic finding of eosinophilic, hyaline cytoplasmic inclusions in astrocytes, predominantly in the cerebral cortex. It has mainly been observed in children and adults with a history of developmental delay and epilepsy, frequently with focal cortical dysplasia (FCD), but the nature and significance of these inclusions are unclear. In this study, we review the clinical and pathologic features of HPA and characterize the inclusions and brain tissue in which they are seen in surgical resection specimens from five patients with intractable epilepsy and HPA compared to five patients with intractable epilepsy without HPA using immunohistochemistry for filamin A, previously shown to label these inclusions, and a variety of astrocytic markers including aldehyde dehydrogenase 1 family member L1 (ALDH1L1), SRY-Box Transcription Factor 9 (SOX9), and glutamate transporter 1/excitatory amino acid transporter 2 (GLT-1/EAAT2) proteins. The inclusions were positive for ALDH1L1 with increased ALDH1L1 expression in areas of gliosis. SOX9 was also positive in the inclusions, although to a lesser intensity than the astrocyte nuclei. Filamin A labeled the inclusions but also labeled reactive astrocytes in a subset of patients. The immunoreactivity of the inclusions for various astrocytic markers and filamin A as well as the positivity of filamin A in reactive astrocytes raise the possibility that these astrocytic inclusions may be the result of an uncommon reactive or degenerative phenomenon.
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Affiliation(s)
- Shino Magaki
- Division of Neuropathology, Department of Pathology & Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - Mohammad Haeri
- Division of Neuropathology, Department of Pathology & Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
- Department of Pathology & Laboratory Medicine and Alzheimer Disease Research Center, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Linda J Szymanski
- Department of Pathology & Laboratory Medicine, Keck School of Medicine of University of Southern California, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Zesheng Chen
- Division of Neuropathology, Department of Pathology & Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
- Centre Hospitalier Universitaire Sainte-Justine, Montréal, Quebec, Canada
| | - Ramiro Diaz
- Division of Neuropathology, Department of Pathology & Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - Christopher K Williams
- Division of Neuropathology, Department of Pathology & Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - Julia W Chang
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - Yan Ao
- Department of Neurobiology, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Kathy L Newell
- Department of Pathology & Laboratory Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Negar Khanlou
- Division of Neuropathology, Department of Pathology & Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - William H Yong
- Division of Neuropathology, Department of Pathology & Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
- Department of Pathology & Laboratory Medicine, UCI School of Medicine, Irvine, California, USA
| | - Aria Fallah
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - Noriko Salamon
- Department of Radiological Sciences, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
| | - Tarek Daniel
- Department of Pathology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
| | - Jennifer Cotter
- Department of Pathology & Laboratory Medicine, Keck School of Medicine of University of Southern California, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Debra Hawes
- Department of Pathology & Laboratory Medicine, Keck School of Medicine of University of Southern California, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Michael Sofroniew
- Department of Neurobiology, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Harry V Vinters
- Division of Neuropathology, Department of Pathology & Laboratory Medicine, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
- Department of Neurology, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
- Brain Research Institute, Ronald Reagan UCLA Medical Center and David Geffen School of Medicine, Los Angeles, California, USA
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2
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Miller KE, Rivaldi AC, Shinagawa N, Sran S, Navarro JB, Westfall JJ, Miller AR, Roberts RD, Akkari Y, Supinger R, Hester ME, Marhabaie M, Gade M, Lu J, Rodziyevska O, Bhattacharjee MB, Von Allmen GK, Yang E, Lidov HGW, Harini C, Shah MN, Leonard J, Pindrik J, Shaikhouni A, Goldman JE, Pierson CR, Thomas DL, Boué DR, Ostendorf AP, Mardis ER, Poduri A, Koboldt DC, Heinzen EL, Bedrosian TA. Post-zygotic rescue of meiotic errors causes brain mosaicism and focal epilepsy. Nat Genet 2023; 55:1920-1928. [PMID: 37872450 PMCID: PMC10714261 DOI: 10.1038/s41588-023-01547-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 09/21/2023] [Indexed: 10/25/2023]
Abstract
Somatic mosaicism is a known cause of neurological disorders, including developmental brain malformations and epilepsy. Brain mosaicism is traditionally attributed to post-zygotic genetic alterations arising in fetal development. Here we describe post-zygotic rescue of meiotic errors as an alternate origin of brain mosaicism in patients with focal epilepsy who have mosaic chromosome 1q copy number gains. Genomic analysis showed evidence of an extra parentally derived chromosome 1q allele in the resected brain tissue from five of six patients. This copy number gain is observed only in patient brain tissue, but not in blood or buccal cells, and is strongly enriched in astrocytes. Astrocytes carrying chromosome 1q gains exhibit distinct gene expression signatures and hyaline inclusions, supporting a novel genetic association for astrocytic inclusions in epilepsy. Further, these data demonstrate an alternate mechanism of brain chromosomal mosaicism, with parentally derived copy number gain isolated to brain, reflecting rescue in other tissues during development.
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Affiliation(s)
- Katherine E Miller
- Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Adithe C Rivaldi
- Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Noriyuki Shinagawa
- Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Sahib Sran
- Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jason B Navarro
- Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jesse J Westfall
- Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Anthony R Miller
- Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Ryan D Roberts
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Yassmine Akkari
- Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Rachel Supinger
- Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Mark E Hester
- Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Mohammad Marhabaie
- Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Meethila Gade
- Division of Pharmacotherapy and Experimental Therapeutics in the Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jinfeng Lu
- Division of Pharmacotherapy and Experimental Therapeutics in the Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Olga Rodziyevska
- Division of Child Neurology, Department of Pediatrics, McGovern Medical School, Houston, TX, USA
| | | | - Gretchen K Von Allmen
- Division of Child Neurology, Department of Pediatrics, McGovern Medical School, Houston, TX, USA
- Department of Neurology, McGovern Medical School, Houston, TX, USA
| | - Edward Yang
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Hart G W Lidov
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Chellamani Harini
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Manish N Shah
- Departments of Pediatric Surgery and Neurosurgery, McGovern Medical School, Houston, TX, USA
| | - Jeffrey Leonard
- Department of Neurosurgery, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Neurosurgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jonathan Pindrik
- Department of Neurosurgery, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Neurosurgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Ammar Shaikhouni
- Department of Neurosurgery, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Neurosurgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - James E Goldman
- Department of Pathology and Cell Biology, Columbia University, New York, NY, USA
| | - Christopher R Pierson
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pathology, The Ohio State University College of Medicine, Columbus, OH, USA
- Department of Biomedical Education & Anatomy, Division of Anatomy, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Diana L Thomas
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pathology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Daniel R Boué
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pathology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Adam P Ostendorf
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
- Division of Pediatric Neurology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Elaine R Mardis
- Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Neurosurgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Annapurna Poduri
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Daniel C Koboldt
- Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Erin L Heinzen
- Division of Pharmacotherapy and Experimental Therapeutics in the Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Department of Genetics in the School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Tracy A Bedrosian
- Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA.
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3
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Alzoubi H, Nobile G, d'Amati A, Nobili L, Giacomini T, Tortora D, Gaggero G, Gianno F, Giangaspero F, Antonelli M, Consales A. Hyaline Protoplasmic Astrocytopathy in the Setting of Epilepsy. Am J Clin Pathol 2023; 159:120-128. [PMID: 36495294 DOI: 10.1093/ajcp/aqac145] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 10/24/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Cerebral hyaline protoplasmic astrocytopathy (HPA) is a clinicopathologic entity characterized by eosinophilic cytoplasmic inclusions within astrocytes. It has been observed in a subset of patients with early-onset epilepsy, brain malformations, and developmental delay. The exact association of this entity with epilepsy is still unknown. This report, with its review of the literature, aims to summarize HPA features to raise awareness regarding this entity. METHODS We report on 2 HPA cases and critically review the literature. RESULTS Approximately 42 cases of HPA have been reported, including the 2 cases presented here, consisting of 23 female and 19 male patients. Patient age ranged from 3 to 39 years. All patients had early-onset seizures (3-20 months of age), ranging from partial to generalized, that were refractory despite treatment with antiepileptic drugs. Postoperative follow-up intervals ranged from 2 to 93 months, and the clinical outcome was graded according to the Engel classification, showing variable results. CONCLUSIONS Clinicians should consider HPA in differential diagnosis in patients with intractable seizures, especially when they are associated with developmental delay and brain malformations. Increasing awareness of this entity among pathologists may promote better understanding of this condition as well as better diagnosis and treatment for these patients.
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Affiliation(s)
- Hiba Alzoubi
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Giulia Nobile
- Unit of Child Neuropsychiatry, Department of Medical and Surgical Neuroscience and Rehabilitation, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Antonio d'Amati
- Anatomic Pathology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.,Department of Radiology, Oncology and Anatomic Pathology, University La Sapienza, Rome, Italy
| | - Lino Nobili
- Unit of Child Neuropsychiatry, Department of Medical and Surgical Neuroscience and Rehabilitation, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Thea Giacomini
- Unit of Child Neuropsychiatry, Department of Medical and Surgical Neuroscience and Rehabilitation, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Domenico Tortora
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Gabriele Gaggero
- Ospedale Policlinico, San Martino IRCCS, Anatomic Pathology Unit, Genoa, Italy
| | - Francesca Gianno
- Department of Radiology, Oncology and Anatomic Pathology, University La Sapienza, Rome, Italy
| | - Felice Giangaspero
- Department of Radiology, Oncology and Anatomic Pathology, University La Sapienza, Rome, Italy
| | - Manila Antonelli
- Department of Radiology, Oncology and Anatomic Pathology, University La Sapienza, Rome, Italy
| | - Alessandro Consales
- Division of Neurosurgery, IRCCS Giannini Gaslini Children's Hospital, Genoa, Italy
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Fischer GM, Vaziri Fard E, Shah MN, Patel RP, Von Allmen G, Ballester LY, Bhattacharjee MB. Filamin A-negative hyaline astrocytic inclusions in pediatric patients with intractable epilepsy: report of 2 cases. J Neurosurg Pediatr 2020; 26:38-44. [PMID: 32217802 DOI: 10.3171/2020.1.peds19706] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/27/2020] [Indexed: 11/06/2022]
Abstract
Although rare, hyaline cytoplasmic inclusions isolated to astrocytes of the cerebral cortex have been identified in a spectrum of diseases ranging from intractable epilepsy in pediatric patients with only mild to moderate developmental delays to Aicardi syndrome. These inclusions classically stain positive for filamin A, giving rise to the term "filaminopathies." The authors report on 2 pediatric patients with intractable epilepsy and developmental delay who uniquely displayed filamin A-negative hyaline astrocytic inclusions in resected brain tissues. Additionally, these inclusions stained positive for S100 and negative for glial fibrillary acidic protein, chromogranin, neurofilament, CD34, vimentin, periodic acid-Schiff (PAS), and Alcian blue. These are the first reported cases of filamin A-negative hyaline astrocytic inclusions, providing a novel variation on a previously reported entity and justification to further investigate the pathogenesis of these inclusions. The authors compare their findings with previously reported cases and review the literature on hyaline astrocytic inclusions in intractable pediatric epilepsy.
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Affiliation(s)
| | | | - Manish N Shah
- 2Neurosurgery
- 5Memorial Hermann Hospital-Texas Medical Center, Houston, Texas
| | - Rajan P Patel
- 3Diagnostic and Interventional Imaging, and
- 5Memorial Hermann Hospital-Texas Medical Center, Houston, Texas
| | - Gretchen Von Allmen
- 4Pediatrics, The University of Texas Health Science Center at Houston; and
- 5Memorial Hermann Hospital-Texas Medical Center, Houston, Texas
| | - Leomar Y Ballester
- Departments of1Pathology and Laboratory Medicine
- 2Neurosurgery
- 5Memorial Hermann Hospital-Texas Medical Center, Houston, Texas
| | - Meenakshi B Bhattacharjee
- Departments of1Pathology and Laboratory Medicine
- 5Memorial Hermann Hospital-Texas Medical Center, Houston, Texas
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5
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Whitney R, AlMehmadi S, McCoy B, Yau I, Ochi A, Otsubo H, Weiss SK, Rutka J, Hazrati LN, Snead OC, Go C. The Fault in Their Stars-Accumulating Astrocytic Inclusions Associated With Clusters of Epileptic Spasms in Children With Global Developmental Delay. Pediatr Neurol 2017; 73:92-97.e3. [PMID: 28549652 DOI: 10.1016/j.pediatrneurol.2017.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 04/09/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND The presence of cerebral astrocytic inclusions recently has been described in a subset of children with early-onset refractory epilepsy, with or without structural brain malformations, and varying degrees of developmental delay. METHODS We describe two new individuals with epilepsy with astrocytic inclusions and suggest that in some children this disorder may represent a unique hemispheric epilepsy. We review previously reported individuals with epilepsy with astrocytic inclusions. RESULTS Two children with early onset epilepsy with astrocytic inclusions had refractory clusters of epileptic spasms, developmental delay, abnormal neuroimaging, and hemispheric or diffuse interictal epileptiform discharges. In both children, the initial focal resection of the putative epileptogenic zone was unsuccessful and pathology failed to show astrocytic inclusions. Subsequently, both children underwent functional hemispherectomy due to ongoing clusters of epileptic spasms, and the presence of multilobar astrocytic inclusions was demonstrated. Postoperatively, both children have remained seizure free in the short-term with improved development. CONCLUSIONS We highlight that functional hemispherectomy may be required for seizure control in a select subset of children with clusters of epileptic spasms, astrocytic inclusions, and global developmental delay. Given the small number of documented patients, however, ongoing collaboration is needed to better understand the pathophysiology of this condition and determine the optimal way to diagnose and manage these children.
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Affiliation(s)
- Robyn Whitney
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Sameer AlMehmadi
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Bláthnaid McCoy
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ivanna Yau
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ayako Ochi
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hiroshi Otsubo
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shelly K Weiss
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - James Rutka
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lili-Naz Hazrati
- Division of Pathology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - O Carter Snead
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cristina Go
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
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6
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Abstract
OBJECTIVES Hyaline protoplasmic astrocytopathy is a rare condition marked by the accumulation of various proteins in the cytoplasm of protoplasmic astrocytes. METHODS This study retrospectively reviews the clinicopathologic features of 14 patients (nine females; mean age, 9.1 years) with hyaline protoplasmic astrocytopathy. RESULTS Patients had chronic seizures (mean duration, 101.1 months); mean age at seizure onset was 6.9 months. Three patients had Aicardi syndrome, and one patient had tuberous sclerosis. Associated focal cortical dysplasia was noted in all 14 cases. Patterns of dysplasia observed included International League Against Epilepsy (ILAE) type I Ib (n = 7), ILAE type Ib (n = 4), ILAE type Ic (n = 2), and ILAE type IIa (n = 1). Additional pathologic findings included evidence of contusional damage (n = 5), gray matter nodular heterotopias (n = 3), polymicrogygria (n = 2), hemimegalencephaly (n = 2), and hippocampal sclerosis (ILAE type II, CA1 sclerosis) (n = 1). Postoperative follow-up intervals ranged from two to 93 months (mean, 31.2 months). Seven patients were free of seizures or had only rare disabling seizures (Engel I/II) at most recent follow-up. Two patients had recurrent seizures with no worthwhile improvement (Engel IV) at follow-up. CONCLUSIONS The current series supports an association of Aicardi syndrome (21% of cases) and focal cortical dysplasia (100% of cases) and hyaline protoplasmic astrocytopathy.
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Affiliation(s)
- Richard A Prayson
- From the Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH.
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7
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Alshafai L, Ochi A, Go C, McCoy B, Hawkins C, Otsubo H, Snead OC, Rutka J, Widjaja E. Clinical, EEG, MRI, MEG, and surgical outcomes of pediatric epilepsy with astrocytic inclusions versus focal cortical dysplasia. Epilepsia 2014; 55:1568-75. [PMID: 25169867 DOI: 10.1111/epi.12756] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Astrocytic inclusions (AIs) have been identified on histologic specimens of patients with early onset seizures, and the proteomic contents have been described. The aim of this study was to compare the clinical, electroencephalography (EEG), magnetoencephalography (MEG), magnetic resonance imaging (MRI), and surgical outcomes of AIs relative to focal cortical dysplasia (FCD). METHODS We assessed the clinical manifestations, semiology, ictal and interictal features on video-EEG, MEG, MRI features, and surgical outcomes of children with histologically proven AIs compared to FCD. RESULTS Six children had AIs and 27 had FCD. Children with AIs had an earlier age at seizure onset, periodic spasms (all children), and interictal epileptiform discharges consisting of a mixture of generalized or diffuse hemispheric slow waves, sharp waves, spikes and polyspikes. Children with FCD were less likely to have spasms (4/27 [15%]), and the morphology of the diffuse hemispheric or generalized discharges were different from those of AI, consisting of spike-and-waves, polyspike-and-waves, sharp-and-slow waves, and paroxysmal fast activity. Patients with AIs were less likely to have tightly clustered MEG spike sources (3/6 [50%] vs. 23/27 [85%]), and more likely to demonstrate abnormal sulcation and gyration pattern (4/6 [67%] vs. 2/27 [7%]) and gray matter heterotopia (2/6 [33%] vs. 0/27 [0%]) than patients with FCD. Four children with AIs had resection and two had biopsy but did not undergo resection. Children with AIs had lower rates of seizure freedom after surgery compared to FCD (1/4 [25%] vs. 15/27 [56%], respectively). SIGNIFICANCE Although there were some similarities between AIs and FCD, patients with AIs were more likely to present with early onset periodic spasms, have unusual interictal epileptiform discharges, abnormal sulcation, gyration pattern, and gray matter heterotopia, and were less likely to be seizure free following surgical resection relative to FCD. Further study with a larger sample size is needed to validate our findings.
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Affiliation(s)
- Laila Alshafai
- Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
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8
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Wong JC, O'Neill B, Hawkins CE, Kleinschmidt-DeMasters BK, Hazrati LN. Child Neurology: Pediatric seizures with hyaline astrocytic inclusions. Neurology 2013; 81:e14-6. [PMID: 23858415 DOI: 10.1212/wnl.0b013e31829bfe54] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Janice C Wong
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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9
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Barnett BP, Bressler J, Chen T, Hutchins GM, Crain BJ, Kaufmann WE. αB-crystallin negative astrocytic inclusions. Brain Dev 2011; 33:349-52. [PMID: 20621427 DOI: 10.1016/j.braindev.2010.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2009] [Revised: 06/20/2010] [Accepted: 06/21/2010] [Indexed: 10/19/2022]
Abstract
We report on an unusual pathological finding of astrocytes, observed in the brain of a 16-year-old African-American male with severe intellectual disability and spastic quadriplegia. The brain showed bilateral pericentral, perisylvian polymicrogyria and pachygyria, in conjunction with a large number of hypertrophic astrocytes with eosinophilic granular cytoplasmic inclusions. The astrocytic abnormality was more severe in the dysgenetic area but present throughout the cerebral cortex. Astrocytic inclusions stained with acid fuchsin, azocarmine and Holzer's stain, and were immunoreactive for GFAP, S-100, and ubiquitin, but not for αB-crystallin, filamin, vimentin, nestin, tau or α-synuclein. Based on the case and a review of the literature, the authors postulate that these astrocytic inclusions in the cerebral cortex reflect abnormalities in radial glial developmental processes, such as migration, differentiation, or glial-neuronal interaction function during neuronal migration.
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Affiliation(s)
- Brad P Barnett
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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10
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Buchino JJ, Nicol KK, Parker JC. Aicardi Syndrome: A Morphologic Description with Particular Reference to Intracytoplasmic Inclusions in Cortical Astrocytes. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/15513819609169290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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11
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Abstract
Eosinophilic inclusions in the cytoplasm of protoplasmic astrocytes of the neocortex, usually in the clinical setting of epilepsy and/or psychomotor retardation, were first recognized and illustrated by Alois Alzheimer in 1910. Traditional special stains have failed to elucidate the specific nature of these inclusions. Ultrastructurally, the material was composed predominantly of highly electron-dense, non-membrane-bound, granular material distinct from Rosenthal fibers. Immunohistochemical examination has been informative but also sometimes inconsistent; it has recently been suggested that they may represent a filaminopathy (filamin A). We examined 5 cases with neocortical eosinophilic inclusions (3 autopsies, 2 surgical resections) using a standardized immunohistochemical protocol at a single institution. The specimens were immunostained with 32 antibodies to 30 potentially relevant proteins using several antigen retrieval protocols. We confirmed the presence of filamin A in these inclusions, but several additional proteins, particularly cytoglobin and glutamate transporter 1, were also identified. By electron microscopy in 2 cases, the granular fine structure of the inclusions was confirmed; mitochondria adjacent to, and perhaps within, the inclusions that contained many pleomorphic vesicular and membranous elements were also noted in 1 case. The pathophysiologic relevance of these proteins and the clinical significance of the hyaline inclusions are discussed.
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Van den Veyver IB, Panichkul PP, Antalffy BA, Sun Y, Hunter JV, Armstrong DD. Presence of filamin in the astrocytic inclusions of Aicardi syndrome. Pediatr Neurol 2004; 30:7-15. [PMID: 14738943 DOI: 10.1016/s0887-8994(03)00311-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Aicardi syndrome affects only females and has been hypothesized to be an X-linked dominant male-lethal disorder. Because no familial cases can be studied for genetic linkage analysis, the mutated gene has remained elusive. With the goal of selecting genes for mutation analysis by a functional candidate approach, a detailed pathologic analysis of two brains from deceased Aicardi syndrome patients was performed. The presence of micrencephaly, absent or hypoplastic corpus callosum, polymicrogyria, heterotopia, ventriculomegaly, intracerebral cyst, and intracytoplasmic eosinophilic inclusions was confirmed in glial fibrillary acidic protein-positive astrocytes in the cortex and heterotopias, but not in white matter. The inclusions demonstrated strong immunolabeling with antibodies to filamin and vimentin but weak labeling with antibodies to proteins S100 and microtubule-associated protein 1. These findings suggested that an underlying defect in the cytoskeleton, which involves filamin, may cause this condition. Because the filamin A gene in Xq28 is mutated in another disorder with heterotopia, familial bilateral periventricular heterotopia, mutation analysis of filamin A in Aicardi syndrome patients was pursued. No mutations were found, and the full-length protein was expressed in both brain samples. Future studies will focus on investigation of X-linked genes that may affect function of filamin or other cytoskeletal proteins.
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Affiliation(s)
- Ignatia B Van den Veyver
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas 77030, USA
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Sasaki K, Doh-ura K, Furuta A, Nakashima S, Morisada Y, Tateishi J, Iwaki T. Neuropathological features of a case with schizophrenia and prion protein gene P102L mutation before onset of Gerstmann-Sträussler-Scheinker disease. Acta Neuropathol 2003; 106:92-6. [PMID: 12682740 DOI: 10.1007/s00401-003-0697-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2002] [Revised: 02/03/2003] [Accepted: 02/03/2003] [Indexed: 10/25/2022]
Abstract
Gerstmann-Sträussler-Scheinker disease (GSS) is a hereditary transmissible spongiform encephalopathy associated with prion protein gene mutation P102L. The age of onset is roughly restricted to around the sixth decade; however, it is unclear whether the disease-specific pathology of GSS is already evident in the pre-clinical stage. We had a chance to examine an autopsy case with PRNP P102L mutation. The patient had died at 50 years of age before the clinical symptoms of GSS had appeared; neither neuronal loss, gliosis nor spongiform change was found anywhere in the brain. Immunohistochemistry failed to detect any deposition of prion protein. It is thus considered that amyloid plaque formation in GSS probably develops in a relatively rapid fashion compared with Alzheimer's disease. Although the patient suffered from schizophrenia, no significant pathological changes were detected except for astrocytic inclusion bodies in the cerebral cortex. The nature and significance of the inclusion bodies, which are not observed in patients with GSS, remain unclear.
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Affiliation(s)
- Kensuke Sasaki
- Department of Neuropathology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 812-8582 Fukuoka, Japan.
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Horoupian DS, Hattab EM, Heit G. Astrocytic cytoplasmic inclusions within an epileptic focus in an otherwise neurologically intact patient. Hum Pathol 2003; 34:714-6. [PMID: 12874769 DOI: 10.1016/s0046-8177(03)00182-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A 17-year-old woman with intractable seizures since infancy underwent resection of an epileptic focus in the left frontal cortex. The cytoplasm of many cortical astrocytes contained amorphous eosinophilic inclusions, which ultrastructurally were non-membrane bound and consisted of densely packed osmiophilic material. Similar inclusions have previously been observed, at autopsy, in patients with unspecified mental retardation and various brain malformations. The present report is unique in that the inclusions were detected in the resected specimen of an epileptic focus. The patient is neurologically intact except for the seizures that presently are totally controlled by the surgery. The pathogenesis of these inclusions is unclear. The fact they occurred in an epileptic focus raises the possibility that prolonged seizures or its underlying precipitating factors may cause conglutination of an indeterminate element of the protoplasmic astrocytes resulting in inclusion formation.
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Affiliation(s)
- Dikran S Horoupian
- Department of Pathology, Stanford University Medical Center, CA 94305, USA
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Yamamoto T, Armstrong D, Shibata N, Kato Y, Kobayashi M. Unique astrocytic inclusion in a 2 month-old baby showing Leigh-like brain lesions with lactic acidosis. Brain Dev 2000; 22:234-8. [PMID: 10838110 DOI: 10.1016/s0387-7604(00)00117-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
An unique cytoplasmic inclusion was found in astrocytes of a 2-month-old female baby who showed Leigh-like brain lesions with lactic acidosis, hypoglycemia and hepatomegaly. Although a defective enzyme was not determined, a metabolic disorder was suggested from clinicopathological observations. Symmetrically distributed lesions consisting of marked gliosis and proliferation of capillaries were observed in the basal ganglia, thalami and tegmentum. The astrocytic cytoplasmic inclusion was exclusively found in the cerebral and cerebellar white matter, where myelination was immature. The inclusion was round and eosinophilic, and positive for glial fibrillary acidic protein, vimentin, alphaB-crystallin, S-100 protein and microtubule associated protein 1B, immunohistochemically. An electron microscopic examination revealed an accumulation of intermediate filaments, ribosome and rough endoplasmic reticulum in the inclusion. The characteristic of this inclusion is different from that of other reported inclusions. The inclusion showed positive immunoreaction against CuZn superoxide dismutase, catalase, advanced glycation end-product and 4-hydroxy-2-nonenal antibodies, which suggest that oxidative stress is involved in the genesis of the inclusion.
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Affiliation(s)
- T Yamamoto
- Department of Pathology, Tokyo Women's Medical University, Japan
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Spacek J, Nozicka Z. Cytoplasmic inclusions in neocortical astrocytes associated with arteriopathic encephalopathy and dementia. Hum Pathol 1994; 25:1366-70. [PMID: 7528165 DOI: 10.1016/0046-8177(94)90099-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We describe what we believe to be the fifth case of a degenerative condition of the brain characterized by unusual intracytoplasmic inclusions in neocortical astrocytes, and we review four previous reports of what appears to be the same condition. Whereas these previous cases were characterized by prolonged clinical mental and psychomotor retardation, our case describes a rapid onset in a previously fit and mentally able patient in whom the astrocytic inclusions showed a close association with fibrohyaline vascular degeneration and changes resembling those of Alzheimer's disease. The inclusions, which were most frequent in the second to fourth layers of the frontal, temporal, and occipital cortices but absent from subcortical regions, consisted of large, irregular hyaline bodies surrounding the nucleus and extending into the proximal parts of cell processes. Ultrastructurally they consisted of free ribosomes in a granular and filamentous matrix. They were not bound by a membrane. Lipofuscin granules were associated with them. It is suggested that the inclusions might result from a disturbance of protein metabolism in protoplasmic astrocytes, but their true significance is unknown.
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Affiliation(s)
- J Spacek
- Department of Pathology, Charles University Faculty of Medicine, Hradec Kralove, Czech Republic
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Minamitani M, Tanaka J, Maekawa K. Peculiar eosinophilic inclusions within astrocytes in a patient with malformed brain. Brain Dev 1994; 16:309-14. [PMID: 7818027 DOI: 10.1016/0387-7604(94)90029-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
At autopsy, we observed eosinophilic inclusions within the astrocytic cytoplasm in areas of polymicrogyria and heterotopic gray matter in a 17-year-old female with severe mental retardation and physical handicaps who had died of respiratory failure. The inclusions stained with acid fuchsin, azocarmine, Holzer's stain and phosphotungstic acid hematoxylin (PTAH). They reacted with anti-S-100 protein antibody. The cytoplasm of the astrocytes containing the inclusions reacted with antibody to GFAP. The inclusions were amorphous masses that consisted of aggregated clusters of osmiophilic coarse granules about 30 nm in diameter. Some rough endoplasmic reticulum was observed on the inside and outside of the inclusions and in the cytoplasm of the astrocytes lacking such inclusions. We suggest that these inclusions resulted from an abnormality at or near the rough endoplasmic reticulum.
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Affiliation(s)
- M Minamitani
- Division of Neuropathology, Jikei University School of Medicine, Tokyo, Japan
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Wegiel J, Wisniewski HM. Rosenthal fibers, eosinophilic inclusions, and anchorage densities with desmosome-like structures in astrocytes in Alzheimer's disease. Acta Neuropathol 1994; 87:355-61. [PMID: 8017171 DOI: 10.1007/bf00313604] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Ultrastructural study of the cerebral cortex of nine brains of individuals with Alzheimer's disease (AD) revealed four types of pathological changes of astrocytes. Rosenthal fibers were found in three cases, eosinophilic inclusions in one, anchoraged densities with desmosome-like structures in two, and corpora amylacea in four. In two biopsies, Rosenthal fibers were seen in less than 5% astrocytes, but in a third biopsy with numerous plaques, tangles, and severe neuronal loss, they were present in about 40% of astrocytes. In one case with severe AD pathology and numerous Rosenthal fibers, the cytoplasm of some astrocytes was occupied by inclusions composed of electron-dense granules 3-6 microns in diameter or aggregates of inclusions greater than 12 microns in diameter. Ultrastructurally, they were similar to eosinophilic inclusions observed in Aicardi syndrome and brain malformations. The presence of eosinophilic inclusions in the brain of elderly persons with Alzheimer's disease does not confirm the previous suggestion that this form of astrocyte pathology is typical for protoplasmic astrocytes and developmental brain malformations. Development anchorage densities associated with hemidesmosome-like structures, which reinforce astrocyte cell membranes facing the perivascular space, may reflect adaptation of astrocytes to the complex of changes that occurs in atrophic brain. Morphological changes in astrocytes in areas with numerous plaques and massive infiltration of intercellular space with beta-amyloid fibrils and remnants of neurons and ghost tangles suggest that astrocyte pathology is a late unspecific reaction to the cascade of changes induced by beta-amyloid deposition that causes neuronal degeneration and brain atrophy.
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Affiliation(s)
- J Wegiel
- Department of Pathological Neurobiology, New York State Institute for Basic Research in Developmental Disabilities, Staten Island 10314
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Del Bigio MR, Deck JH. Rosenthal fibers producing a granular cell appearance in a glioblastoma. Acta Neuropathol 1993; 86:100-4. [PMID: 8396834 DOI: 10.1007/bf00454907] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
In this report we describe a glioblastoma multiforme with focal granular cell change. In most astroglial tumors with granular cells, the granular appearance is due to the presence of periodic acid-Schiff-positive, membrane-bound cellular debris. In the present case the granular appearance was due to the presence of many small Rosenthal fibers, which were immunoreactive for glial fibrillary acidic protein, vimentin, ubiquitin, and heat-shock protein 27, but not for alpha-B crystallin. The ultrastructural characteristics are described. These findings demonstrate that granulofilamentous inclusions with the appearance of Rosenthal fibers in glial tumors are a structurally heterogeneous feature.
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Affiliation(s)
- M R Del Bigio
- Division of Neuropathology, Toronto Hospital, University of Toronto, Canada
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Twiss JL, Anderson LJ, Horoupian DS. Globular glial fibrillary acidic protein-reactive cytoplasmic inclusions in ependymoma: an immunoelectron-microscopic study. Acta Neuropathol 1993; 85:658-62. [PMID: 8393263 DOI: 10.1007/bf00334677] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
We report of a 27-month-old boy with a recurrent infratentorial ependymoma; the initial resection was at 14 months of age. Both resection specimens were histologically similar. In addition to neoplastic ependymal cells forming perivascular pseudo-rosettes, a second population of cells with identical nuclear morphology displayed large hyaline, refractile cytoplasmic inclusion, causing these cells to superficially resemble gemistocytic astrocytes. These inclusions demonstrated strong glial fibrillary acidic protein (GFAP) immunoreactivity. Ultrastructurally, the inclusions appeared as fenestrated irregular-shaped bodies with jagged edges and were made up of electron-dense granular material. Although these inclusions superficially resembled Rosenthal fibers, immunoperoxidase stains for ubiquitin and alpha B-crystallin were negative. Immunoelectron microscopy showed that these unusual non-filamentous inclusions were diffusely GFAP positive.
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Affiliation(s)
- J L Twiss
- Department of Pathology (Neuropathology), Stanford University Medical Center, CA 94305
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