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] [What about the content of this article? (0)] [Affiliation(s)] [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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Edminster S, Wu TW, Van Speybroeck A, Chu J, Lapa DA, Chmait RH, Szymanski LJ. Neuropathology Evaluation of in Utero Correction of Myelomeningocele and Complications of Late-Onset GBS Infection. Fetal Pediatr Pathol 2022:1-10. [PMID: 36475417 DOI: 10.1080/15513815.2022.2150528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Myelomeningocele (MMC) causes significant morbidity and mortality. Efforts have been directed to correct this defect in utero. The neuropathology literature on antenatally repaired MMC and associated complications in humans is limited. Case report: A 12-day-old female, who underwent prenatal MMC repair via a two-layer closure (dural replacement patch, primary skin closure), was born at 34 weeks' gestation. Her group B streptococcus positive mother received appropriate antepartum prophylactic antibiotics. She remained stable until day 11 of life when she underwent rapid clinical deterioration. Despite aggressive intervention, she expired on day 12. Review of placental pathology showed maternal and fetal inflammatory response. Autopsy revealed Gram-positive cocci and inflammation within the basilar leptomeninges and lumbosacral region. Neural and dermal elements were present within the MMC repair. Conclusion: This case documents integration of the dermal matrix patch to neural elements, adhering the spinal cord to scar tissue, the clinical implications of which remain unclear.
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Affiliation(s)
- Sarah Edminster
- Department of Pathology, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Tai-Wei Wu
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Alexander Van Speybroeck
- Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jason Chu
- Department of Neurosurgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Denise A Lapa
- Hospital Israelita Albert Einstein, Fetal Surgery, Sao Paulo, Brazil
| | - Ramen H Chmait
- Department of Maternal and Fetal Medicine, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Linda J Szymanski
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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3
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Abstract
Central nervous system (CNS) tumors are now the most common type of solid tumor in individuals aged 0-19 years, with an incidence rate in the United States around 5 per 100,000, accounting for about 1 out of 4 childhood cancers. Pediatric pathologists encounter brain tumor cases with varying frequency, but many of these encounters begin in the context of intraoperative consultation or "frozen section." This review provides an overview of the technical aspects of intraoperative consultation specific to, or more helpful in, CNS tumors, emphasizing helpful cytologic and histologic features of the more commonly encountered pediatric CNS tumors, and illustrating some common diagnostic pitfalls and how these may be avoided.
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Affiliation(s)
- Jennifer A Cotter
- Department of Pathology and Laboratory Medicine, Keck School of Medicine of University of Southern California, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Linda J Szymanski
- Department of Pathology and Laboratory Medicine, Keck School of Medicine of University of Southern California, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Bruce R Pawel
- Department of Pathology and Laboratory Medicine, Keck School of Medicine of University of Southern California, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Alexander R Judkins
- Department of Pathology and Laboratory Medicine, Keck School of Medicine of University of Southern California, Children's Hospital Los Angeles, Los Angeles, CA, USA
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4
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Stokke JL, Szymanski LJ, Bankamp B, Pratt F, Martines R, Dien-Bard J, Mohandas S. MMR Vaccine-Associated Disseminated Measles in an Immunocompromised Adolescent. N Engl J Med 2021; 385:1246-1248. [PMID: 34551236 DOI: 10.1056/nejmc2103772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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5
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Alturkustani M, Gallant R, Raca G, Ranganathan S, Mahabir R, Biegel JA, Mascarenhas L, Moke D, Szymanski LJ. Pediatric Metastatic Hepatoblastoma With an ARID1A Mutation and Rhabdoid Cells. Int J Surg Pathol 2021; 30:307-312. [PMID: 34488461 DOI: 10.1177/10668969211042638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The small cell undifferentiated component of hepatoblastoma is an uncommon histologic component and is distinguished from small cell undifferentiated like pattern (originally called hepatoblastoma and now recognized to be malignant rhabdoid tumor) by the bi-allelic SMARCB1 mutations or copy number alterations in the latter. AT-rich interactive domain-containing protein 1A (ARID1A) is a part of the ATP-dependent switch/sucrose non-fermentable complex assembly, but mutations have not been reported as drivers of malignant rhabdoid tumor. ARID1A mutations in hepatocellular carcinoma are associated with poor prognosis but its significance in hepatoblastoma is unknown. We report a unique case of hepatoblastoma in a 19-month-old female with an unusual/atypical small cell undifferentiated component with ARID1A and beta-catenin mutations. It had an aggressive clinical course despite treatment, with metastases to the left psoas muscle, perihepatic and paratracheal lymph nodes, spinal cord, and leptomeninges. Leptomeningeal metastases resulted in diffuse cerebral edema and death. The initial diagnostic biopsy did not reveal rhabdoid cells while all metastatic foci showed cells with rhabdoid morphology in the autopsy specimens. Although this rhabdoid component resembled malignant rhabdoid tumor morphologically, molecular analyses failed to show mutations or deletions of SMARCB1.
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Affiliation(s)
- Murad Alturkustani
- Children's Hospital Los Angeles, Keck School of Medicine, 12223University of Southern California, Los Angeles, CA, USA.,37848King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rachel Gallant
- Children's Hospital Los Angeles, Keck School of Medicine, 12223University of Southern California, Los Angeles, CA, USA
| | - Gordana Raca
- Children's Hospital Los Angeles, Keck School of Medicine, 12223University of Southern California, Los Angeles, CA, USA
| | | | - Roshan Mahabir
- Children's Hospital Los Angeles, Keck School of Medicine, 12223University of Southern California, Los Angeles, CA, USA
| | - Jaclyn A Biegel
- Children's Hospital Los Angeles, Keck School of Medicine, 12223University of Southern California, Los Angeles, CA, USA
| | - Leo Mascarenhas
- Children's Hospital Los Angeles, Keck School of Medicine, 12223University of Southern California, Los Angeles, CA, USA
| | - Diana Moke
- Children's Hospital Los Angeles, Keck School of Medicine, 12223University of Southern California, Los Angeles, CA, USA
| | - Linda J Szymanski
- Children's Hospital Los Angeles, Keck School of Medicine, 12223University of Southern California, Los Angeles, CA, USA
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6
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Cohen-Cutler S, Szymanski LJ, Bockoven C, Miller JM, Moke D, Anselmo DM, Lee J, Luu M. Catastrophic congenital hemangioma with severe coagulopathy leading to fatal cardiac failure: Case report and review. Pediatr Dermatol 2021; 38:1276-1282. [PMID: 34595775 DOI: 10.1111/pde.14825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We present a complex case of a neonate, delivered urgently for hydrops fetalis, with a large vascular mass of the extremity, diagnosed postnatally as a congenital hemangioma. The patient suffered immediate cardiac compromise and severe coagulopathy atypical for the diagnosis and subsequently died from these complications. Treatment was imperative but challenging due to a lack of a standardized treatment approach and few historical reports of equally critically ill patients. In this report, we review potential medical and surgical interventions and discuss treatment considerations in similar, life-threatening cases of congenital hemangiomas.
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Affiliation(s)
- Sally Cohen-Cutler
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Linda J Szymanski
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Anatomic Pathology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Crystal Bockoven
- Department of Anatomic Pathology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Joseph M Miller
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Radiology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Diana Moke
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Dean M Anselmo
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Jessica Lee
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Division of Pediatric Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Minnelly Luu
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Dermatology, Children's Hospital Los Angeles, Los Angeles, CA, USA
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7
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Szymanski LJ, Kellis S, Liu CY, Jones KT, Andersen RA, Commins D, Lee B, McCreery DB, Miller CA. Neuropathological effects of chronically implanted, intracortical microelectrodes in a tetraplegic patient. J Neural Eng 2021; 18. [PMID: 34314384 DOI: 10.1088/1741-2552/ac127e] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/08/2021] [Indexed: 11/12/2022]
Abstract
Objective.Intracortical microelectrode arrays (MEA) can be used as part of a brain-machine interface system to provide sensory feedback control of an artificial limb to assist persons with tetraplegia. Variability in functionality of electrodes has been reported but few studies in humans have examined the impact of chronic brain tissue responses revealed postmortem on electrode performancein vivo. Approach.In a tetraplegic man, recording MEAs were implanted into the anterior intraparietal area and Brodmann's area 5 (BA5) of the posterior parietal cortex and a recording and stimulation array was implanted in BA1 of the primary somatosensory cortex (S1). The participant expired from unrelated causes seven months after MEA implantation. The underlying tissue of two of the three devices was processed for histology and electrophysiological recordings were assessed.Main results.Recordings of neuronal activity were obtained from all three MEAs despite meningeal encapsulation. However, the S1 array had a greater encapsulation, yielded lower signal quality than the other arrays and failed to elicit somatosensory percepts with electrical stimulation. Histological examination of tissues underlying S1 and BA5 implant sites revealed localized leptomeningeal proliferation and fibrosis, lymphocytic infiltrates, astrogliosis, and foreign body reaction around the electrodes. The BA5 recording site showed focal cerebral microhemorrhages and leptomeningeal vascular ectasia. The S1 site showed focal tissue damage including vascular recanalization, neuronal loss, and extensive subcortical white matter necrosis. The tissue response at the S1 site included hemorrhagic-induced injury suggesting a likely mechanism for reduced function of the S1 implant.Significance.Our findings are similar to those from animal studies with chronic intracortical implants and suggest that vascular disruption and microhemorrhage during device implantation are important contributors to overall array and individual electrode performance and should be a topic for future device development to mitigate tissue responses. Neurosurgical considerations are also discussed.
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Affiliation(s)
- Linda J Szymanski
- Department of Pathology, Keck USC School of Medicine, Los Angeles, CA, United States of America.,Department of Pathology and Laboratory Medicine, Children's Hospital of Los Angeles, Los Angeles, CA, United States of America
| | - Spencer Kellis
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, United States of America.,Tianqiao and Chrissy Chen Brain-Machine Interface Center, Chen Institute for Neuroscience, California Institute of Technology, Pasadena, CA, United States of America.,Department of Neurosurgery, Keck USC School of Medicine, Los Angeles, CA, United States of America.,USC Neurorestoration Center, Keck USC School of Medicine, Los Angeles, CA, United States of America
| | - Charles Y Liu
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, United States of America.,Department of Neurosurgery, Keck USC School of Medicine, Los Angeles, CA, United States of America.,USC Neurorestoration Center, Keck USC School of Medicine, Los Angeles, CA, United States of America
| | - Kymry T Jones
- Department of Pathology, Keck USC School of Medicine, Los Angeles, CA, United States of America
| | - Richard A Andersen
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, United States of America.,Tianqiao and Chrissy Chen Brain-Machine Interface Center, Chen Institute for Neuroscience, California Institute of Technology, Pasadena, CA, United States of America
| | - Deborah Commins
- Department of Pathology, Keck USC School of Medicine, Los Angeles, CA, United States of America
| | - Brian Lee
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, United States of America.,Department of Neurosurgery, Keck USC School of Medicine, Los Angeles, CA, United States of America.,USC Neurorestoration Center, Keck USC School of Medicine, Los Angeles, CA, United States of America
| | - Douglas B McCreery
- Huntington Medical Research Institute, Pasadena, CA, United States of America
| | - Carol A Miller
- Department of Pathology, Keck USC School of Medicine, Los Angeles, CA, United States of America
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8
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Alturkustani M, Cotter JA, Mahabir R, Hawes D, Koschmann C, Venneti S, Judkins AR, Szymanski LJ. Autopsy findings of previously described case of diffuse intrinsic pontine glioma-like tumor with EZHIP expression and molecular features of PFA ependymoma. Acta Neuropathol Commun 2021; 9:113. [PMID: 34162441 PMCID: PMC8220665 DOI: 10.1186/s40478-021-01215-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/08/2021] [Indexed: 11/23/2022] Open
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9
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Szymanski LJ, Hawes D, Gilles F. Corticospinal Wallerian Degeneration Before Myelination: A Case Report. Pediatr Dev Pathol 2020; 23:399-403. [PMID: 32406814 DOI: 10.1177/1093526620923452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Wallerian degeneration is defined as axonal fiber and myelin sheath degeneration that affects myelinated axons within the peripheral or central nervous system. Wallerian degeneration or anterograde axonal degeneration before myelination is rarely reported. Involvement of both corticospinal tracts (CSTs) is rarely documented in the literature. We present the postmortem neuropathologic findings of a 1-week-old male neonate born at 23 weeks of gestation with bilateral CST degeneration extending from the posterior limb of the internal capsule through the brainstem into the lumbar spinal cord. Abundant CD68- and CD163-positive macrophages were the prominent histopathology in both CSTs. The cerebrum, brainstem, and spinal cord were unmyelinated, as expected. In contrast, the spinal nerve roots demonstrated early myelination. This case illustrates that Wallerian degeneration occurs in unmyelinated axis cylinders.
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Affiliation(s)
- Linda J Szymanski
- Department of Pathology and Laboratory Medicine, Children's Hospital of Los Angeles, Los Angeles, California.,Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Debra Hawes
- Department of Pathology and Laboratory Medicine, Children's Hospital of Los Angeles, Los Angeles, California.,Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Floyd Gilles
- Department of Pathology and Laboratory Medicine, Children's Hospital of Los Angeles, Los Angeles, California.,Keck School of Medicine of the University of Southern California, Los Angeles, California
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10
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Szymanski LJ, Ernst LM. Cartilaginous Metaplasia Involving the Atrioventricular Node and Bundle of His Contributing to Sudden Early Neonatal Death. Pediatr Dev Pathol 2020; 23:312-316. [PMID: 31821773 DOI: 10.1177/1093526619892352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cartilaginous metaplasia involving the atrioventricular (AV) node is an uncommon entity that may cause sudden cardiac death secondary to dysrhythmias. We report 2 autopsy cases of full-term male newborns: 1 stillborn and 1 live-born, with antemortem bradycardia who died in the peripartum period. An examination of the cardiac conduction system in both cases demonstrated extensive cartilaginous metaplasia of the central fibrous body and involvement of the AV node and bundle of His. The cases highlight the recognition of cardiac conduction system anomalies as a cause of sudden perinatal death. In cases of perinatal death with preceding arrhythmia, postmortem sections of the cardiac conduction system are recommended to examine for cardiac conduction system anomaly.
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Affiliation(s)
- Linda J Szymanski
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California.,Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Linda M Ernst
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, Illinois.,The University of Chicago, Pritzker School of Medicine, Chicago, Illinois
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11
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Szymanski LJ, Huss-Bawab J, Ribe JK. Coronary Artery Aneurysms and Thrombosis in Kawasaki Disease. Acad Forensic Pathol 2019; 8:416-423. [PMID: 31240051 DOI: 10.1177/1925362118782083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/12/2018] [Indexed: 11/15/2022]
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12
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13
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Szymanski LJ, Molas-Torreblanca K, Bawab R, Kim E, Don D, Mascarenhas L, Stanley P, Zhou S, Shillingford N. Bronchial Mucoepidermoid Carcinoma With the Classic MAML2 Gene Rearrangement in a 2-year-old Boy. Pediatr Dev Pathol 2018; 21:480-485. [PMID: 28492094 DOI: 10.1177/1093526617707855] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pulmonary mucoepidermoid carcinoma (PMEC) is rare. To date, primary PMEC has not been reported in a child younger than 3 years of age. We report a case of a 2-year-old boy who presented with 3 episodes of wheezing, cough, and fever over a period of 1 month. Radiologic findings were consistent with foreign body aspiration with consequent bronchial obstruction. Bronchoscopy was performed and attempts to retrieve the foreign body resulted in a biopsy of a fleshy lesion. By histology, the lesion was an epithelial neoplasm comprising cells arranged in a nested pattern. The neoplastic cells were round with round nuclei and amphophilic, vacuolated cytoplasm. Our diagnosis was low-grade salivary gland-type carcinoma of the bronchus. The pneumonectomy specimen showed a well-circumscribed, polypoid intrabronchial mass measuring 2.1 cm in greatest dimension. Histologic examination of the tumor showed an admixture of intermediate cells which were predominant, a small number of mucus cells and rare foci of squamous cells. The final diagnosis rendered was a low-grade mucoepidermoid carcinoma of the bronchus. Accurate diagnosis of PMEC can be challenging on limited biopsy material as seen in the case reported here. The use of molecular studies such as MAML2 gene rearrangement may facilitate diagnosis in difficult cases. Increased awareness of this entity and further molecular studies are needed for a better understanding of the pathogenesis of PMEC. To date, the reported age range for primary bronchial mucoepidermoid carcinoma is between 3 years and 78 years. This case represents the youngest patient reported in the English literature.
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Affiliation(s)
- Linda J Szymanski
- 1 Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California
| | - Kira Molas-Torreblanca
- 2 Keck School of Medicine, University of Southern California, Los Angeles, California
- 3 Department of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California
| | - Ramzi Bawab
- 1 Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California
| | - Eugene Kim
- 2 Keck School of Medicine, University of Southern California, Los Angeles, California
- 4 General Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Debra Don
- 2 Keck School of Medicine, University of Southern California, Los Angeles, California
- 5 Division of Otolaryngology, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Leo Mascarenhas
- 2 Keck School of Medicine, University of Southern California, Los Angeles, California
- 6 Division of Hematology-Oncology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Phillip Stanley
- 2 Keck School of Medicine, University of Southern California, Los Angeles, California
- 7 Department of Radiology, Children's Hospital Los Angeles, Los Angeles, California
| | - Shengmei Zhou
- 1 Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California
- 2 Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Nick Shillingford
- 1 Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California
- 2 Keck School of Medicine, University of Southern California, Los Angeles, California
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14
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Tan SY, Szymanski LJ, Galliani C, Parham D, Zambrano E. Solitary Fibrous Tumors in Pediatric Patients: A Rare and Potentially Overdiagnosed Neoplasm, Confirmed by STAT6 Immunohistochemistry. Pediatr Dev Pathol 2018; 21:389-400. [PMID: 29228868 DOI: 10.1177/1093526617745431] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Pathological diagnosis of solitary fibrous tumor (SFT) in the pediatric population is challenging, as it occurs uncommonly in this age-group and resembles other spindle cell neoplasms. SFT contains a NAB2-STAT6 fusion gene, which can be reliably detected using STAT6 immunohistochemistry. Positive staining is highly sensitive and specific. We sought to investigate the utility of STAT6 immunohistochemistry, to show how commonly SFT was historically recognized at 3 academic pediatric institutions, to reclassify them when appropriate, and to demonstrate features of major mimics of SFT. Our series included cases with a previous diagnosis of SFT or for which SFT was among key considerations, from 3 major academic pediatric hospitals seen over the past 30 years. Of 18 tumors identified, only 3 tumors from 2 patients demonstrated positive STAT6 staining as well as the typical histology and immunophenotype seen in SFT. The remaining 15 tumors were reclassified based on morphology, additional immunohistochemistry and fluorescence in situ hybridization as desmoid-type fibromatosis (3 tumors), nerve sheath/neural tumors (3 tumors), low-grade fibromyxoid sarcoma, medallion-like dermal fibroma, poorly differentiated Sertoli cell tumor, nodular/proliferative fasciitis, calcifying fibrous tumor, aneurysmal bone cyst of soft tissue, STAT6-negative SFT with adipocytic differentiation, undifferentiated small round blue cell tumor, and scar (1 tumor each). Our study confirms that SFT is rare in the pediatric population and that it is potentially overdiagnosed. STAT6 immunohistochemistry is recommended to confirm the diagnosis of SFT in the pediatric population.
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Affiliation(s)
- Serena Y Tan
- 1 Department of Pathology, Stanford University Medical Center, Stanford, California
| | - Linda J Szymanski
- 2 Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California
| | - Carlos Galliani
- 3 Department of Pathology, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
| | - David Parham
- 2 Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California
| | - Eduardo Zambrano
- 1 Department of Pathology, Stanford University Medical Center, Stanford, California
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Szymanski LJ, Sibug Saber ME, Kim JW, Go JL, Zada G, Rao N, Hurth KM. Quadruple Neoplasms following Radiation Therapy for Congenital Bilateral Retinoblastoma. Ocul Oncol Pathol 2017; 4:33-37. [PMID: 29344496 DOI: 10.1159/000477410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/09/2017] [Indexed: 01/30/2023] Open
Abstract
Purpose The aim of this study was to describe a 34-year-old male with hereditary bilateral retinoblastoma treated with radiotherapy as a child who developed 4 distinct tumors within the radiation field. Methods A 34-year-old male with bilateral retinoblastoma status postradiation therapy and recurrence requiring enucleation presented with left-eye visual acuity changes. Magnetic resonance imaging demonstrated a left orbital mass and a right parasellar complex lobulated mass (right sphenoid and right cavernous sinus). Two weeks later, the patient underwent excision of the orbital mass and biopsy of an upper-lid nodule. This was followed by craniotomy for removal of the complex mass. Results Histology revealed 4 distinct tumors, including an undifferentiated pleomorphic sarcoma (left orbit), a radiation-induced meningioma (right sphenoid), a schwannoma (right cavernous sinus), and a basal-cell carcinoma (left lid). Conclusion Although occurrence of a second neoplasm is a well-known outcome following radiation treatment in patients with hereditary retinoblastoma, the diagnosis of 4 additional neoplasms is rare. Pleomorphic sarcoma, radiation-induced meningioma, and schwannoma are uncommon tumors and not well represented in the literature describing irradiated retinoblastoma patients. Secondary malignancies are a leading cause of early death in retinoblastoma survivors, and long-term follow-up is crucial for patient care.
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Affiliation(s)
- Linda J Szymanski
- Department of Pathology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Maria E Sibug Saber
- Department of Pathology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.,Department of Opthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Jonathan W Kim
- Department of Opthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - John L Go
- Department of Radiology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Gabriel Zada
- Department of Neurosurgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Narsing Rao
- Department of Opthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Kyle M Hurth
- Department of Pathology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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Szymanski LJ, Hurth K. "Pistachio" and "Avatar" Green-Blue Discoloration of the Brain. Acad Forensic Pathol 2016; 6:150-152. [PMID: 31239883 DOI: 10.23907/2016.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/10/2016] [Accepted: 02/07/2016] [Indexed: 12/29/2022]
Affiliation(s)
- Linda J Szymanski
- Los Angeles County University of Southern California Medical Center - Pathology
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Szymanski LJ, Aurelius MB, Szymanski SA, Lathrop SL. Suicidal Drug Overdoses in New Mexico: A 5-year Retrospective Review. J Forensic Sci 2016; 61:661-5. [DOI: 10.1111/1556-4029.13014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 05/26/2015] [Accepted: 06/07/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Linda J. Szymanski
- Department of Pathology; LAC + USC Medical Center; 1983 Marengo St Los Angeles CA 90033
| | | | | | - Sarah L. Lathrop
- Department of Pathology; Office of the Medical Investigator; 1 University of New Mexico; MSC07 4040 Albuquerque NX 87131
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Szymanski LJ, Ayyad H, Inamdar K. Chronic Myelogenous Leukemia in a 66-Year-Old Male with Concurrent Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma. Lab Med 2013. [DOI: 10.1309/lm5js4lsslx7uqyv] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Szymanski LJ, Szymanski JM, Muhletaler F, Alassi O. A 50-Year-old With Gross Hematuria. Urology 2012; 80:509-11. [DOI: 10.1016/j.urology.2012.04.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 03/13/2012] [Accepted: 04/13/2012] [Indexed: 10/28/2022]
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Szymanski LJ, Buekers TE, Alassi O, Zhang Z. Five-Year Cyto-Histo Correlations for the Papanicolaou Test With Suspicious or Positive Endometrial Adenocarcinoma Diagnosis. Am J Clin Pathol 2012. [DOI: 10.1093/ajcp/138.suppl1.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pimentel JD, Szymanski LJ, Samuel LP, Meier FA. Discordant Streptococcus agalactiae (Group B streptococcus) gestational infection in monochorionic/diamniotic and dichorionic/diamniotic twins. Fetal Pediatr Pathol 2012; 31:176-83. [PMID: 22414062 DOI: 10.3109/15513815.2012.659394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Infection due to Streptococcus agalactiae or Group B streptococcus may be acquired during parturition or gestation. Discordant twin gestational Group B streptococcus infections are rarely reported. We describe two cases of fatal discordant gestational Group B streptococcus infection in both a monochorionic/diamniotic pregnancy and in a dichorionic/diamniotic pregnancy. In both instances, cultures, examination of the placentae, and autopsy findings demonstrated infection by Group B streptococcus in only the presenting fetus. Despite the ubiquity of this organism, this is the first documented case of discordant gestational Group B streptococcus infection in monochorionic/diamniotic twins and only the third case documented in dichorionic/diamniotic twins.
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Affiliation(s)
- Jason D Pimentel
- Department of Pathology and Laboratory Medicine, Henry Ford Hospital, Detroit, Michigan 48202, USA.
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