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Immunohistochemical Markers in the Diagnosis of Calcifying Pseudoneoplasm of the Neuraxis

Published online by Cambridge University Press:  17 August 2020

Kaiyun Yang
Affiliation:
Department of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
Kesava Reddy
Affiliation:
Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
Bill H. Wang
Affiliation:
Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
Aleksa Cenic
Affiliation:
Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
John Provias
Affiliation:
Neuropathology Section, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
Snezana Popovic
Affiliation:
Anatomic Pathology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
William H. Yong
Affiliation:
Division of Neuropathology, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
France Berthelet
Affiliation:
Department of Pathology and Cellular Biology, University of Montreal, Montreal, Quebec, Canada
Michel W. Bojanowski
Affiliation:
Division of Neurosurgery, Department of Surgery, University of Montreal, Montreal, Quebec, Canada
Robert Hammond
Affiliation:
Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada
Jian-Qiang Lu
Affiliation:
Neuropathology Section, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
Corresponding

Abstract:

Background:

Calcifying pseudoneoplasm of the neuraxis (CAPNON) is a rare tumor-like lesion with unknown pathogenesis. It is likely under-reported due to diagnostic challenges including the nonspecific radiographic features, lack of diagnostic markers, and often asymptomatic nature of the lesions.

Methods:

We performed detailed examination of 11 CAPNON specimens diagnosed by histopathology, with the help of electron microscopy and immunohistochemistry.

Results:

Electron microscopy revealed the presence of fibrillary materials consistent with neurofilaments. In addition to some entrapped axons at the periphery of CAPNONs, we discovered that all specimens stained positive for neurofilament-light (NF-L) within the granular amorphous cores, but not neurofilament-phosphorylated (NF-p). CAPNONs also showed variable infiltration of CD8+ T-cells and a decreased ratio of CD4/CD8+ T-cells, suggesting an immune-mediated process in the pathogenesis of CAPNON.

Conclusion:

NF-L and CD4/CD8 immunostains may serve as diagnostic markers for CAPNON and shed light on its pathogenesis.

Résumé :

RÉSUMÉ :

Recourir à des marqueurs immunohistochimiques pour le diagnostic de pseudo-tumeurs calcifiantes du névraxe.

Contexte :

Les pseudo-tumeurs calcifiantes du névraxe (PTCN) sont des lésions rares ressemblant à des tumeurs dont la pathogénèse reste inconnue. On a probablement tendance à moins les signaler en raison d’écueils diagnostiques, par exemple des caractéristiques radiographiques non-spécifiques, un manque de marqueurs diagnostiques et la nature fréquemment asymptomatique de ces lésions.

Méthodes :

C’est à l’occasion d’un examen histopathologique, plus précisément au moyen de la microscopie électronique et de marqueurs immunohistochimiques, que nous avons effectué une analyse approfondie de 11 échantillons de PTCN.

Résultats :

La microscopie électronique a révélé la présence de matériaux fibrillaires (fibrillary materials) compatibles avec des neurofilaments. Outre certains axones piégés à la périphérie des PTCN, nous avons découvert que tous les échantillons, une fois soumis à la lumière de neurofilament, se sont déclarés positifs à l’intérieur de noyaux amorphes granulaires, ce qui n’a pas été le cas avec des neurofilaments phosphorylés. Les PTCN ont également donné à voir des infiltrations variables de lymphocytes T cytotoxiques possédant la protéine CD8 (CD8 + T-cells) et une diminution du ratio de lymphocytes T cytotoxiques possédant les protéines CD4 et CD8, ce qui suggère un processus d’origine immunitaire dans la pathogénèse des PTCN.

Conclusion :

L’immunocoloration des neurofilaments et des lymphocytes T cytotoxiques possédant les protéines CD4 et CD8 pourrait servir de marqueurs diagnostiques pour les PTCN et permettre ainsi de faire la lumière sur leur pathogénèse.

Type
Original Article
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press on behalf of The Canadian Journal of Neurological Sciences Inc.

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