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Fig. 2 | BMC Neurology

Fig. 2

From: Neuromyelitis optica spectrum disorder with massive basal ganglia involvement: a case report

Fig. 2

Neuropathology of the basal ganglia. a Coronal section of the brain after fixation with formalin. There is a large soft necrotic lesion involving the basal ganglia and a part of the internal capsule. A separate small necrotic focus is seen in the corpus callosum (arrowhead). In the right cerebral hemisphere, a large cystic lesion in the white matter lateral to the putamen (large arrow) and lesions in the subcortical white matter (small arrows) are seen. The optic chiasm appeared atrophic and there was a mild to moderate atherosclerotic changes in the basal arteries. b Klüver-Barrera myelin stain of the section approximately 1 cm posterior to. The necrotic area is well demarcated involving the globus pallidus extending to the internal capsule to the head of the caudate. c-f Serial sections stained immunohistochemically using the antibody for GFAP (c), AQP4 (d), CD138 for plasma cells (e) and CD8 for the marker of cytotoxic T cells (f). The necrotic lesions lacked immunostaining of both GFAP and AQP4 with a tendency to more preservation of the former (arrows in C). There are extensive CD138 and CD8 positive lymphocytic cell infiltrations in vasocentric patterns around small and medium sized vessels surrounding the area of necrosis. Bar = 200 μm. g-i Immunohistochemistry of the necrotic lesion stained for C9neo (g), fibrinogen (h), H.E. (i) and CD68 for macrophage (Inset of I). There were scattered foci of vasocentric complement deposition (g) and exudation of fibrinogen around the vessel wall (h). There are numerous macrophages containing corpora amylacea in the cytoplasm(I), as identified as such by the lack of immunostaining for CD68 (Inset of I). Bar = 100 μm (g, h), 20 μm (I, Inset). j-l Right basal ganglia lesions stained with Klüver-Barrera (j). There are well demarcated cystic lesions in the basolateral of the basal ganglia (*). k Enlarged area of (*) in (j). Microscopically, the lesion consisted of loosely associated fibrillary astrocytosis with few inflammatory cells. Klüver-Barrera myelin stain. l Enlarged area indicated by the arrow in (k). The neurons appeared relatively well preserved in the loosely arranged myelinated fibers. Arrows indicate axonal spheroid bodies. H&E. Bar = 20 μm

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