Journal of Pathology and Translational Medicine

Case Studies

Intravascular schwannoma as an extremely unusual cause of vein obstruction: a case report: Luis Miguel Chinchilla-Tábora, Beatriz Segovia Blázquez, José María Sayagués, Marta Rodríguez González, Joaquín González-Rivero, José Antonio Muñoz León, Andrea Beatriz Jiménez Pérez, Idalia González Morais, Diego Bueno-Sacristán, María Dolores Ludeña; J Pathol Transl Med. 2024;58(5):249-254. Published online July 3, 2024; DOI: https://doi.org/10.4132/jptm.2024.05.15

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Abstract PDF: The blood vessel lumen is an extremely rare location for a benign peripheral nerve sheath tumor like schwannoma. Less than 10 cases have been previously reported. In this report, we present a case of a 68-year-old woman who had a soft tissue nodule at the posterior calf of her left leg during a physical examination. Pathological examination was performed after complete surgical excision. The patient underwent follow-up for 12 months after surgery without evidence of recurrence or any other complication. This is the first case of intravascular schwannoma reported as a cause of vein obstruction. Microscopically, the tumor was composed of Schwann spindle cells that were immunoreactive for S100 protein and SOX10. This tumor was surrounded by a well-defined vascular smooth muscle wall. Prospective series are required to improve the knowledge on the underlying mechanisms of intravascular schwannoma development.

Benign Triton Tumor: A Rare Entity in Head and Neck Region: Krishnappa Amita, S. Vijay Shankar, Kuchangi C. Nischal, Haleuoor B. Basavaraj; Korean J Pathol. 2013;47(1):74-76. Published online February 25, 2013; DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.1.74

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Benign triton tumors (BTT) are very rare lesions composed of mature skeletal muscle and neural tissue. We report a case of a 14-year-old boy who presented with asymptomatic swelling of the chin over an 18-month duration which increased gradually to involve the left side of the lower lip. Clinically, a diagnosis of neurofibroma was made. Excisional biopsy confirmed the diagnosis of a BTT. Having an affinity for large nerve trunks like the brachial and sciatic, these tumors rarely occur in the head and neck region. When they do, they may involve the large central cranial nerve trunk and present as intracranial masses or involve the smaller peripheral nerve twigs and present as asymptomatic skin nodules, of which only four cases involving peripheral nerves are reported in the English literature. Here, we report the fifth documented case of a BTT involving the mental branch of the trigeminal nerve. A brief review of the literature is also provided.

Citations

Citations to this article as recorded by

Update on MR Imaging of Soft Tissue Tumors of Head and Neck
Justin D. Rodriguez, A. Morgan Selleck, Ahmed Abdel Khalek Abdel Razek, Benjamin Y. Huang
Magnetic Resonance Imaging Clinics of North America.2022; 30(1): 151. CrossRef
Pediatric benign triton tumor of trigeminal nerve: a case report and literature review
Sophia Peng, Mandana Behbahani, Shelly Sharma, Stacy Speck, Nitin R. Wadhwani, Jeff C. Rastatter, Tord D. Alden
Child's Nervous System.2022; 38(11): 2055. CrossRef
Rhabdomyomatous mesenchymal hamartoma presenting as a chin nodule in a 15‐year‐old male
Lisa M. Marinelli, Wendi E. Wohltmann, Kevin D. Myers, Geoffrey T. Sasaki
Journal of Cutaneous Pathology.2021; 48(2): 322. CrossRef
Pediatric Benign Tumors With a Skeletal Muscle Component: Myogenin Expression, Diagnostic Pitfalls, and New Molecular Insights
Lara Berklite, John Ozolek, Larry Wang, Luisa Santoro, Vittoria Donofrio, Alessandra Stracuzzi, Ivy John, Rita Alaggio
Pediatric and Developmental Pathology.2021; 24(3): 213. CrossRef
Incidental Hamartoma in an elderly patient: a case report
Tae-Sung Joo, Hyejee Kim, In-Ki Park, Jae-Ho Shin
BMC Ophthalmology.2020;[Epub] CrossRef
Peripheral Nerve Sheath Tumors of Head and Neck: Imaging-Based Review of World Health Organization Classification
Ahmed Abdel Khalek Abdel Razek, Omneya A. Gamaleldin, Nermeen A. Elsebaie
Journal of Computer Assisted Tomography.2020; 44(6): 928. CrossRef
Benign peripheral nerve tumors
Zinon T. Kokkalis, Nikolaos A. Stavropoulos, Andreas F. Mavrogenis, Andreas Panagopoulos, Panayotis N. Soucacos
Injury.2019; 50: S77. CrossRef
Tumor de tritón benigno: reporte de un caso en órbita
Tatiana Urrea Victoria, Luis Alberto Ruíz Robles, Ana María Vanegas Monroy, Humberto Quintana Muñoz
Universitas Médica.2017;[Epub] CrossRef
Benign Triton Tumor: Multidisciplinary Approach to Diagnosis and Treatment
Raj Thakrar, Caroline D. Robson, Sara O. Vargas, John G. Meara, Reza Rahbar, Edward R. Smith
Pediatric and Developmental Pathology.2014; 17(5): 400. CrossRef
Ectomesenchymoma with Embryonal Rhabdomyosarcoma and Ganglioneuroma, Arising in Association with Benign Triton Tumor of the Tongue
Katherine A. VandenHeuvel, David F. Carpentieri, Jie Chen, Kar-Ming Fung, David M. Parham
Pediatric and Developmental Pathology.2014; 17(3): 226. CrossRef
Adulthood Benign Triton Tumor Developed in the Orbit
Dong Hyeon Bae, Choong Hyun Kim, Jin Hwan Cheong, Jae Min Kim
Journal of Korean Neurosurgical Society.2014; 56(2): 146. CrossRef

Case Report

A Soft Tissue Perineurioma and a Hybrid Tumor of Perineurioma and Schwannoma: Ji Young Park, Nam Jo Park, Sang Pyo Kim, Kun Young Kwon, Sang Sook Lee; Korean J Pathol. 2012;46(1):75-78. Published online February 23, 2012; DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.1.75

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Abstract PDF

Perineuriomas are composed of differentiated perineurial cells. Perineuriomas have been recently recognized by the immunoreactivity for epithelial membrane antigen (EMA). Microscopically, perineuriomas show proliferation of spindle cells with wavy nuclei and delicate elongated bipolar cytoplasmic processes. The tumor cells are usually negative for the S-100 protein. Ultrastructurally, perineurial cells reveal slender, nontapered processes containing pinocytic vesicles and discontinuous basal lamina. Interestingly, hybrid tumors of benign peripheral nerve sheath tumor (PNST) have been recently reported by using immunohistochemical and ultrastructural investigations. Herein, we report a case of soft tissue perineurioma arising in the skin of a 56-year-old female; another case of a hybrid tumor of perineurioma and schwannoma in the posterior mediastinum occurred in a 53-year-old male, which is the first case of the hybrid PNST tumor reported in Korea.

Citations

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Neurogenic tumours of the posterior mediastinum and differential diagnosis considerations
Michael A den Bakker, Annikka Weissferdt
Histopathology.2024; 84(1): 238. CrossRef
Hybrid tumors with perineurioma components: a systematic review of the literature and illustrative case
Karina A. Lenartowicz, Dileep D. Monie, Kimberly K. Amrami, Christopher J. Klein, Caterina Giannini, Robert J. Spinner
Acta Neurochirurgica.2022; 165(4): 935. CrossRef
Hybrid Schwannoma/Perineurioma: Morphologic Variations and Genetic Profiles
Takanori Hirose, Anna Kobayashi, Sumihito Nobusawa, Naoe Jimbo
Applied Immunohistochemistry & Molecular Morphology.2021; 29(6): 433. CrossRef
Mesenchymal Tumors of the Mediastinum: An Update on Diagnostic Approach
Joon Hyuk Choi, Jae Y. Ro
Advances in Anatomic Pathology.2021; 28(5): 351. CrossRef
Neurogenic Tumors of the Mediastinum
Erika F. Rodriguez, Robert Jones, Daniel Miller, Fausto J. Rodriguez
Seminars in Diagnostic Pathology.2020; 37(4): 179. CrossRef
A Rare Perineurioma/Granular Cell Tumor Hybrid Peripheral Nerve Sheath Tumor
Koorosh Haghayeghi, Gladys Telang, Sonja Chen, Jack Bevivino, Shamlal Mangray, Yiang Hui, Leslie Robinson-Bostom
The American Journal of Dermatopathology.2020; 42(10): 762. CrossRef
Hybrid peripheral nerve sheath tumors
Emine KILIÇ BAĞIR, Arbil AÇIKALIN, Gülfiliz GÖNLÜŞEN, Suzan ZORLUDEMİR, Mehmet Ali DEVECİ
Cukurova Medical Journal.2019; 44(3): 804. CrossRef
Primary intraosseous hybrid epithelioid schwannoma/perineurioma in the proximal tibia: a case report of benign hybrid neoplasm with local hypercellularity
Yuejiao Lang, Dawei Liu, Pei Xiang, Jilin Wang, Yang Li
Diagnostic Pathology.2019;[Epub] CrossRef
Hybrid peripheral nerve sheath tumors: report of five cases and detailed review of literature
Nasir Ud Din, Zubair Ahmad, Jamshid Abdul-Ghafar, Rashida Ahmed
BMC Cancer.2017;[Epub] CrossRef
Primary intraosseous hybrid nerve sheath tumor of femur: A hitherto undescribed occurrence in bone with secondary aneurysmal bone cyst formation resulting in pathological fracture
Louis Tsun Cheung Chow
Pathology - Research and Practice.2015; 211(5): 409. CrossRef
Mesenchymal tumours of the mediastinum—part II
Michael A. den Bakker, Alexander Marx, Kiyoshi Mukai, Philipp Ströbel
Virchows Archiv.2015; 467(5): 501. CrossRef
Primary pleural hybrid cellular schwannoma/perineurioma: A case report
Danny Soria-Céspedes, Carlos Robles-Vidal, Arturo Gómez-González, Rosalinda Peñaloza-Ramírez, Carlos Ortiz-Hidalgo
Respiratory Investigation.2014; 52(4): 269. CrossRef
Hybrid peripheral nerve sheath tumour with intermingled perineuriomatous and schwannomatous areas reflected in skin ultrasonography image
H. Saeki, K. Ito, Y. Nobeyama, T. Ishiji, M. Fukunaga, H. Nakagawa
Clinical and Experimental Dermatology.2014; 39(6): 747. CrossRef
Périneuriome extraneural des tissus mous localisé au nez
A. Zaouak, R. Benmously, M. Belhadj Salah, W. Koubaa, A. Debbiche, I. Mokhtar
Annales de Dermatologie et de Vénéréologie.2013; 140(8-9): 540. CrossRef

Original Article

The Expressions of Nerve Growth Factor and Its Receptor p75NGFR in Hepatocellular Carcinoma: Their Relation with the Clinicopathologic Factors.: Woo Sung Moon, Kyu Yun Jang, Myoung Ja Chung, Myoung Jae Kang, Dong Geun Lee, Ho Lee, Ho Sung Park; Korean J Pathol. 2009;43(2):145-151.; DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.2.145

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Abstract PDF

BACKGROUND
Nerve growth factor (NGF) has been suggested to participate in tumor progression and it can interact with its receptor p75NGFR. In the present study, we investigated the expressions of NGF and p75NGFR in hepatocellular carcinoma (HCC).
METHODS
We performed immunohistochemistry for NGF, p75NGFR and PCNA in 45 cases of HCCs, and examined the relationships between the clinicopathologic factors and the immunohistochemical results.
RESULTS
NGF was detected in 84.4% (38/45) of the tumor cells and in 64.4% (29/45) of the non-tumorous hepatocytes. Furthermore, a NGF expression was present in 28.9% (13/45) of the endothelial cells in the HCCs, but in 80% (36/45) of the endothelial cells in the non-tumor liver tissue. The tumor cells were negative for p75NGFR in all the HCCs. Although a p75NGFR expression was present in all the nerve fibers in the non-tumor liver tissues, it was markedly reduced (42.2%; 19/45) in the HCCs and a p75NGFR expression was observed at the sinusoids or around the large vessels. The HCCs expressing NGF, either in the tumor cells or the endothelial cells, showed a larger size than those HCCs that didn't express NGF. The NGF positive tumors showed a tendency toward a higher PCNA-labeling index than did the negative tumors.
CONCLUSIONS
The changed localization of the NGF expression and the decreased expression of p75NGFR are associated with hepatic carcinogenesis. We suggest that a NGF expression may contribute to the progression of HCC.

Citations

Citations to this article as recorded by

Expression of nerve growth factor and heme oxygenase-1 predict poor survival of breast carcinoma patients
Sang Jae Noh, Jun Sang Bae, Urangoo Jamiyandorj, Ho Sung Park, Keun Sang Kwon, Sung Hoo Jung, Hyun Jo Youn, Ho Lee, Byung-Hyun Park, Myoung Ja Chung, Woo Sung Moon, Myoung Jae Kang, Kyu Yun Jang
BMC Cancer.2013;[Epub] CrossRef

Case Reports

Cellular Schwannoma Arising in a Facial Nerve.: Mee Joo, Hye Sung Kim, Yun Kyung Kang, Hye Kyung Lee, Jae Young Park; Korean J Pathol. 1997;31(7):688-691.

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Abstract PDF: Cellular schwaninoma is a variant of schwannoma, which is characterized by predominance of cellular Antoni A area, presence of mitotic activity, nuclear hyperchromasia, pleomorphism, and absence of Verocay body. These pathologic features often prompted a misdiagnosis of malignancy. However, the clinical outcome has indicated the benignity of the tumor. We have experienced a case of cellular schwannoma arising from right facial nerve with right hemifacial weakness and erosion of mastoid process. Grossly, it was a 3.5 x 3 cm sized and relatively well encapsulated mass with yellowish, friable cut surface. Microscopically, cellular growth with moderate cellular pleomorphism and some mitotic activity (5/40 HPFS, up to 2/HPF) were noted. Immunostaining for S-100 protein showed diffuse strong positive reaction.

Ultrastructural Findings of Hereditary Sensory and Autonomic Neuropathies, Type IV and II.: Jai Hyang Go, Yeon Lim Suh; Korean J Pathol. 1998;32(7):535-539.

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Abstract: Hereditary sensory and autonomic neuropathies (HSAN) are disorders of hereditary neuropathy mainly affecting sensation and also accompanying autonomic nervous system dysfunction. They are divided into five subtypes based on inheritance pattern and clinical manifestation. Among HSAN, type II is characterized by autosomal recessive inheritance, presentation at later stage of life, slow progression and mainly sensation abnormalities. The main pathology of the peripheral nerve is the absence of myelinated nerve fibers. Type IV is very rare disorder and only a few cases have been reported. It is characterized by autosomal recessive inheritance, presentation at birth as failure to thrive, retarded motor development, unexplained pyrexia and rapidly progressive and severe clinical course. The main pathology of the peripheral nerve is a loss of unmyelinated and small myelinated nerve fibers. We report two cases of type IV and one case of type II especially focusing on ultrastructural findings, which are characteristic of and diagnostic for HSAN.

Soft Tissue Perineurioma.: Yoon La Choi, Dae Soo Kim, Jai Hyang Go, Yeon Lim Suh; Korean J Pathol. 1998;32(11):1028-1031.

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Abstract: Perineurial cells, which normally surround the nerve fascicles within a nerve, can be distinguished from Schwann cells by their immunoreactivity for epithelial membrane antigen (EMA) and lack of reactivity for S-100 protein. Perineurioma is a form of benign peripheral nerve sheath tumor (PNST) almost exclusively composed of perineurial cells. It is often difficult to differentiate this tumor from the other benign PNSTs or ectopic meningioma by histology alone. Immunohistochemical and electron microscopic studies are helpful for differential diagnosis. We recently experienced a case of soft tissue perineurioma in a 14-year-old girl. This tumor was presented as a 5.6 cm sized subcutaneous movable mass in the elbow. The well encapsulated soft tissue tumor consisted of spindle cells which have whorling and storiform patterns within the collagenous stroma. The spindle cells were stained positive for EMA but negative for S-100 protein, chromogranin, neuron-specific enolase or Leu-7. Ultrastructurally, they possessed long cytoplasmic processes with incomplete basal lamina, primitive intercellular junction and occasional pinocytotic vesicles.

Malignant Peripheral Nerve Sheath Tumor in Descending Colon: A Case Report.: Young S Park, Sung Jing Lim, Woo Ho Kim, Eui Keun Ham; Korean J Pathol. 2002;36(3):179-183.

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Abstract PDF: We report a unique case of malignant peripheral nerve sheath tumor (MPNST) of colon, not associated with neurofibromatosis or parasite infection. The tumor presented as an encircling mass in descending colon causing obstruction with nuberous metastatic lesions in a 43-year-old man. The tumor was largely composed of spindle cells which showed strong positivity for vimemtin, S-100 protein and Leu-7. The tumor often exhibited epithelioid feature where tumor cells were weakly positive for cytokeratin.

Intraneural Perineurioma in the Tongue: A Case Report.: Jun Kang, Shin Kwang Khang, Jene Choi, Jeong Won Kim, Eul Ju Seo, Bu kyu Lee, Eunsil Yu; Korean J Pathol. 2007;41(1):51-54.

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Abstract PDF: We report a case of an intraneural perineurioma that developed in an unusual location, the tongue. A 16-year-old male presented with a 1 cm sized protruding submucosal mass in his tongue without any sensory or motor signs or symptoms. The mass was excised. The mucosa was intact, with an ill-defined firm mass measuring 1.0 x 0.8 x 0.6 cm in the submucosa and muscle. The cut surface of the mass was pinkish gray and fibrotic. Microscopically, the mass contained tortuous and thickened peripheral nerve bundles in the submucosa, showing onion bulb like structures. The onion bulb like structures consisted of centrally located S-100 protein positive Schwann cells surrounded by Glut-1 positive perineurial cells. The FISH study did not reveal any genetic aberrations in chromosome 22.

Neuromuscular Choristoma of the Sciatic Nerve: A Case Report.: Sun Young Kim, Hyuck Po Kwon, Kyoung Duck Kwak, Kee Baek Ahn; Korean J Pathol. 2005;39(3):192-196.

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Abstract PDF: Neuromuscular choristoma is a rare benign tumor of the peripheral nerves. To the best of our knowledge, 21 cases have been reported to date. We describe here a 20-day-old female infant who presented with a buttock mass (4.5 x 4.1 x 3.2 cm on MRI) arising from the left sciatic nerve. Microscopically, it was characterized by an intimately disorganized mixture of nerve fibers and striated muscle fibers that were occasionally surrounded by the perineurium and separated by fibrous bands of varying thickness. In some areas, there appeared to be some cells in transitional forms between nerve fibers and muscle fibers, revealing variously positive expressions for S-100 protein in the muscular components. These findings are consistent with the hypothesis that neuroectodermal-derived Schwann cells can give rise to mature skeletal muscle. It appears that the fibrosis may be related to the degeneration of the neural components. The size of the mass on MRI has been unchanged during the 3-year follow-up period.

Optic Nerve sheath Meningioma: A case report.: Yoon Jung Choi, Yong Hee Lee, Tai Seung Kim; Korean J Pathol. 1994;28(4):430-432.

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Abstract PDF: Optic nerve sheath meningioma arises from the arachnoid cap cell of optic nerve sheath and comprises most of primary orbital meningioma. We experienced a rare case of optic nerve sheath meningioma originating in the left orbit. A 44-year-old woman had suffered from visual disturbance in the left eye for 3 years and had only light perceptibility for the recent 6 months. The right eye was normal. Brain CT scan and MRI revealed a 2x0.8 cm sized fusiform solid mass in the left retrobulbar area. Under the impression of optic nerve tumor. excision of the mass including a small segment of the optic nerve was performed. The tumor was a yellowish firm, relatively well demarcated mass that encircled the optic nerve without infiltrating it. Microscopically it was a typical meningioma, meningothelial type. The recovery of visual acuity was impossible due to resection of optic nerve but there was no evidence of recurrence for u months.

Clear Cell Meningioma arising from Lumbar Nerve Root in a Child: A case report.: Eun Kyung Hong, Geun Shin Lyu, Moon Hyang Park; Korean J Pathol. 1994;28(2):179-184.

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Abstract PDF: Meningioma of unusual age of onset, location, histogenesis and histologic type is reported. The patient, 4 year-old girl, had an intradural spinal meningioma arising from lumbar nerve root with no dural attachement. The meningioma revealed glycogen-rich, clear cell type with extensive and blocky hyalinization of the stroma. The tumor shared common fibrous sheath with attached lumbar nerve, and nerve fibers were scattered within the tumor. Ultrastructurally, the tumor cells had abundant glycogen particles, intermediate filaments and intercellular desmosomes. Hyalinized material revealed large amianthoid collagen fibers.

Original Articles

Optic Nerve Glioma with Neurofibromatosis.: Na Hye Myong, Seung Sook Lee, Yun Lim Shu, Je G Chi; Korean J Pathol. 1993;27(5):524-530.

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Abstract PDF: Optic nerve gliomas manifest either as a solitary form or a component of von Recklinghausen's neurofibromatosis. The reported incidence of coexistence with neurofibromatosis varies from 12% to 70%. Usually there are no significant cytological differences between the gliomas that accomapny the disease and those that are deemed to be solitary manifestations. The only possible difference between them is the apparently more common association, with the former, of extensive arachnoid hyperplasia and of a more florid local gliomatous infiltration into the leptomeninges, altogether resulting in perineural thickening. Our cases were 8 and 6 years old girls, respectively, presented with slowly progressive proptosis for 4 years and visual disturbance for 2.5 months. There were multiple cafe au lait spots on their trunks, and case 2 showed Lisch nodules in the iris. MRI of brain revealed unilateral optic nerve thickening with involvement of chiasm or multiple intracranial lesions. Resection of optic nerve tumor was performed. Microscopically, variable degree of tumorous change was seen. Most typically enlarged area was composed of intraneural and perineural portions surrounded by a layer of intact dura. Intraneural tumor revealed proliferation of elongated, spindle-shaped pilocytic astrocytes in intertrabecular spaces and distention of the pial septa with fibrovascular thickening. Another segment had areas with reactive gliosis. Perineural tissue was considerably thickened and, associated with proliferation of meningothelial cells and fibroblasts intermingled with astrocytes and Rosenthal fibers. There were increase of the optic nerve diameter and distention of the overlying dura. Foci of arachnoid cell hyperplasia were noted in both cases, although differed in degree. Immunohistochemically, the tumor cells expressed glial fibrillary acidic protein in intraneural and perineural portions particularly in case 2.

Histopathologic Studies of Muscle and Peripheral Nerve Following Ingestion of L-tryptophan in Rats.: Tae Sik Yoon, Tai Seung Kim, In Joon Choi, Jung Soon Shin; Korean J Pathol. 1993;27(4):318-327.

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Abstract PDF: The eosinophilia-myalgia syndrome associated with ingestion of L-tryptophan in man is defined by the CDC(1989) as follows: 1) eosinophil count more than 1,000 cells per microliter; 2) generalized myaligia(at some point during the course of illness) of severity sufficient to affect a patient's ability to pursue his or her usual daily activities; 3) no evidence of any infection(e.g., trichinosis) or neoplasm that would explain either the eosinophila or the myalgia. The pathologic findings of the eosinophilia-myalgia syndrome varies according to the degree of severity and types of inflammatory cells in the skeletal muscle. In order to simulate this syndrome in animals and further determine its histopathogenesis, L-tryptophan was administered to rats in the laboratory at various doses(25 mg/kg, 50 mg/kg, 150 mg/kg) over a set period of time. In this study, positive histopathologic findings were designated according to the inflammatory cell infiltration of the epimysium and epineurium. Most of the pathologic findings in the positive group were that of inflammatory cell infiltration composed mainly of eosinophils in the epimysial, epineurial connective and surrounding adipose tissues. Only a few necrotic muscle fibers were seen, and there was absence of any evidence of inflammatory cell inflitration in endoneurium or axonal degenerations. Of 59 rats which were given L-tryptophan, 27 rats(45.8%) met the criteria and were designated as belongintg to the positive group. Only 2 rats ingested with L-tryptophan(150 mg/kg) for 2 months and 4 months showed an eosinophil count more than 1,000 cells/microliter. The eosinophil count in the positive group showed significantly different levels when compared to the the negative group and control group. On the other hand, there were no significant differences in the electrodiagnostic study and serum CK, SGOT, SGPT level between the positive, negative and control groups. In summary, histopathologic findings similar to the eosinophilia-myalgia syndrome were inducible in rats followign the administration of L-tryptophan.

The Effects of Localized X-ray Irradiation on the Peripheral Nerve.: Jong Gi Lee, Chong Ryong Lee, In Soo Suh; Korean J Pathol. 1989;23(1):122-131.

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Abstract PDF: The authors studied the early morphologic changes of peripheral nerve, which is known as relatively radioresistant tissue to the X-ray irradiation, but recently clamied by several clinician through development of neuropathies after radiotherapy of the malignacy. Rabbits were received 1,000 or 2,000 cGy of X-ray on the knee joint areas. Sciatic nerves were extracted out 30 minutes, 1, 2, 4, 24 hours, and 3 and 7 days after irradiation. The morphologic changes were observed by light and electron microscopes. The results were summarized as follows: Light microscopically, only mild edema is noted. Electron microscopically, irregular separation and folding of myelin sheath with spherical body formation are noted. Above features were more prominent at later stages and aggregated nests of fragmented myelin were scattered 16 hours after irradiation. Schwann cell necrosis is noted after 24 hours. But above degenerative changes were scarcely present 7 days after irradiation. There is no remarkable axonal changes. The interstitial tissue revealed swelling and irregularity of surface of endothelial cells, and edema. On the basis of the results, it may be concluded that the peripheral nerve is injured by irradiation in early stages, and the main target of irradiation injury is thought to be myelin sheath and Schwann cells, which would be reversible and could be recovered promptly.

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