Lectin binding sites in the choroid plexus and choroid plexus papillomas

Invasive Streptococcus Pneumoniae Septicemia Complicated with Hemolytic Uremic Syndrome and Meningitis

Streptococcus pneumoniae-associated hemolytic uremic syndrome (SpHUS) is an uncommon cause of hemolytic uremic syndrome (HUS). The diagnosis and treatment of Streptococcus pneumoniae-associated HUS is often difficult and associated with high long-term morbidity and mortality. The authors report a five-year-old child who developed HUS following an invasive Streptococcus (S.) pneumoniae infection. The child initially presented with fever, cough, and difficulty in breathing for three days duration and was clinically and radiologically diagnosed as having right middle lobe pneumonia. Blood culture grew Streptococcus pneumoniae. The cerebrospinal fluid analysis also showed Streptococcus pneumoniae. He was initially treated with intravenous cefotaxime. As the child had a poor response to cefotaxime with ongoing fever, antibiotics were changed to ceftriaxone and vancomycin. Although fever started to subside subsequently, the child deteriorated with reduced urine output and developed generalized body swelling. The hematological and biochemical evaluation confirmed hemolytic uremic syndrome. He needed continuous renal replacement therapy for five days and antibiotics were given for 14 days. He had no long-term sequelae on follow-up.

Invasive Streptococcus pneumoniae infection causing hemolytic uremic syndrome in children: Two recent cases

INTRODUCTION

Streptococcus pneumoniae is an uncommon cause of hemolytic uremic syndrome (HUS) with a unique pathophysiology that differs from Shiga toxin-related HUS.

METHODS

Case descriptions for each patient are provided. Each strain of S pneumoniae was subjected to a pulsed-field gel electrophoresis (PFGE) analysis, Shiga toxin assay and polymerase chain reaction to detect Shiga toxin genes. A review of the current literature was conducted.

CASE PRESENTATIONS

Two patients with S pneumoniae-related HUS that presented to the Alberta Children's Hospital, Calgary, Alberta, within four weeks of each other in 2001 are described. Both presented with pneumonia and empyema with associated HUS. Both patients required dialysis, one patient for 10 days and the other for 18 days. Neither patient demonstrated evidence of Shiga toxin-related disease. S pneumoniae isolated from blood or pleural fluid was penicillin susceptible. One isolate was serotype 3 and the other was serotype 14. The two strains had different PFGE patterns. Both patients recovered well with no persistent renal dysfunction.

CONCLUSIONS

S pneumoniaecontinues to be an uncommon but important cause of HUS. Most cases can be confirmed or at least considered probable without performing a renal biopsy.

Pathology of choroid plexus papillomas: a review

Choroid plexus papillomas (CPPs) are rare, usually slow growing neoplasms. Their biological behaviour cannot be predicted in an individual case. Furthermore, the neuropathological diagnosis of these neoplasms is occasionally difficult because light and electron microscopical and immunohistochemical features may overlap with those of other neoplasms localising in the choroid plexus. The aim of this paper is to review the pathological literature (light and electron microscopy (EM) and immunocytochemistry), to provide guidance on current diagnostic tools and criteria and address the identification of 'atypical' CPPs, e.g. those CPPs with histological features indicative of aggressive behaviour, in an attempt to help bridge the diagnostic gap between benign CPPs on the one hand and choroid plexus carcinomas (CPCs) on the other.

Choroid plexus papillomas: consideration of a surgical series of 33 cases

With the aim of understanding better the behaviour of an uncommon lesion such as the choroid plexus papilloma, we have analysed a surgical series of 33 cases operated on at the Neurosurgical Department, University of Rome "La Sapienza", between 1955 and 1992 and have reviewed the relevant literature. Our results support the view that a radical resection of these lesions, which if removed entirely, carry a very good prognosis. The hydrocephalus should be treated only if persistent. Adjuvant treatment such as radiotherapy and chemotherapy should be reserved for specific cases.

Comprehensive lectin histochemistry of normal and neoplastic human choroid plexus cells: alternation of lectin-binding patterns through neoplastic transformation

Lectin histochemistry of the normal and neoplastic human choroid plexus cells [six choroid plexus papillomas (CPPs) and three choroid plexus carcinomas (CPCs)] was performed using eight representative lectins to study the development of sugar chain structures and also to determine whether lectins were useful for a histopathological diagnosis of choroid plexus neoplasms (CPNs). The normal choroid plexus cells reacted with Ricinus communis (RCA-I). Canavalia ensiformis (Con A), Limax flavus (LFA) and Triticum vulgaris (WGA), while Arachis hypoaea (PNA) stained them only after the removal of sialic acid. Human fetal choroid plexus cells at 8 weeks gestation already showed the same lectin-binding patterns as adult ones. All CPNs were stained by RCA-I and Con A in a similar manner as the normal choroid plexus cells. Although seven CPNs were positive for LFA, two CPCs were not stained by LFA, which bound to sialic acid. Two LFA-positive CPPs were stained by PNA before the removal of sialic acid. Moreover, unlike the normal choroid plexus cells, Ulex europaeus-, Glycine maximus- and Dolichos biflorus-binding sites often appeared, and WGA-binding sites of three CPNs remained even after sialic acid removal. In conclusion, the glycosialylation in normal choroid plexus cells was completed during the early embryonic stage. The lectin-binding patterns of CPNs were heterogenous in each case. The alternation of the glycosialylation and/or acquisition of binding sites for some lectins was sometimes observed through a neoplastic transformation.

Detection and mapping of endogenous receptors for carrier-immobilized constituents of glycoconjugates (lectins) by labelled (neo)glycoproteins and by affinity chromatography in human adult mesencephalon, pons, medulla oblongata and cerebellum

Different carrier-immobilized carbohydrate moieties were employed as tools to detect respective binding sites glycohistochemically and glycobiochemically. Besides ascertaining their presence the pattern of endogenous sugar receptors (lectins) in different regions of the human central nervous system was mapped to reveal any non-uniform expression. A strong and specific staining with biotinylated neoglycoproteins, exposing different sugar moieties as ligands, indicated the presence of sugar receptors in the nuclei, neuronal pathways and accessory structures such as ependyma cells, plexus chorioideus, intra- and extracerebral vessels and leptomeninges localized in the mesencephalon, in the pons, in the medulla oblongata and in the cerebellum. Significant differences were seen for various neuroanatomical regions like nerve cells in the basal and central regions of the nuclei pontis in the glycohistochemically detected level of expression of endogenous sugar receptors (lectins). The used approach with carbohydrate constituents of cellular glycoconjugates as ligands in search of specific receptors complemented studies on the localization of glycoconjugates with sugar-specific tools like plant lectins. Exemplary glycobiochemical investigations on the medulla oblongata and cerebellum were performed to investigate the molecular nature of sugar receptors detected glycohistochemically. Despite notable overall similarities, carbohydrate-binding proteins of differing molecular weight can be isolated from these two regions of the central nervous system, namely in the case of receptors with specificity to beta-galactoside termini, to N-acetyl-D-galactosamine and N-acetyl-D-glucosamine and to D-xylose. These combined glycohistochemical and glycobiochemical results serve as a guideline for exploring the physiological relevance of the detected regional differences.

(Neo)glycoproteins as tools in neuropathology: histochemical patterns of the extent of expression of endogenous carbohydrate-binding receptors, like lectins, in meningiomas

Biotinylated (neo)glycoproteins were used to specifically detect endogenous sugar receptors such as lectins in sections of formaldehydefixed, paraffin-embedded tissue from meningiomas. The histochemical methods used consisted of the application of a carrier protein and various covalently linked sugar moieties, available mainly through chemical synthesis, in an optimized standard protocol. They proved valuable in elucidating differential binding patterns within the various meningioma subtypes. alpha-Fucoside-, beta-galactoside-, alpha-mannoside- and beta-xyloside-specific carbohydrate-binding receptors were detected in all the tumor subclasses examined, although the levels of expression exhibited pronounced quantitative differences. In addition, differences in the extent of histochemical staining were observed, using a labelled carrier protein, derived from N-acetylglucosamine and mannose-6-phosphate moieties, respectively. Quantitative differences in the reaction intensity were also measured in the respective subtypes. Receptors for N-acetyl-D-galactosamine were detected only in the analplastic forms, while glucuronic acid-specific receptors were only present in the meningotheliomatous meningioma. In contrast to the other types, malignant meningiomas failed to show cytoplasmic staining with the alpha-glucoside-specific maltose-(BSA-biotin). Distinct differences in the pattern of expression of endogenous sugar receptors, evaluated by a standard protocol, provided further evidence for a possible additional subtype of meningioma, the submalignant meningioma. Our results suggest that labelled (neo)glycoproteins could be used routinely as tools for assessing the expression of endogenous sugar receptors in diagnostic neuro-oncology.