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Clinicopathological study on multiple spongy necrosis of the pontine base
Author(s) -
Ujihira Nobuko,
Hashizume Yoshio
Publication year - 1996
Publication title -
neuropathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.701
H-Index - 61
eISSN - 1440-1789
pISSN - 0919-6544
DOI - 10.1111/j.1440-1789.1996.tb00176.x
Subject(s) - radiation therapy , pathology , malignancy , chemotherapy , medicine , lesion , gliosis , myelin , calcification , central nervous system , radiology
Eleven cases with multiple spongy necrosis of the pontine base are reported and their clinicopathologic characteristics discussed. Seven of the cases occurred in men and four in women; age ranged from 42 to 90 years old. Eight patients had various types of cancer as background disease. Three patients received central nervous system (CNS) radiotherapy and six received chemotherapy. No consistent clinical factor (e.g., malignancy, radiotherapy, chemotherapy, severe immunosuppressive state, specific laboratory data and infection) could be found among the cases. Neuropathological findings were characterized as multiple patchy spongy areas of the pontine base with loss of myelin and axons. There were few reactive gliosis or inflammatory changes. Many axonal swellings and a small number of macrophages were scattered in the lesions. Neurons and glial cells adjacent to these lesions were not affected, and calcification was not found. Almost all of the lesions existed in the transverse fibers of the basis pontis. In the literature, malignancy or toxicity due to CNS radiotherapy or chemotherapy was suspected to be the causative factor of these lesions. In our 11 cases, however, the lesions were also found in patients who had not received radiotherapy or chemotherapy. In contrast, the neuropathological findings of the lesions in our patients were similar in each case. Electronmicroscopically, the myelin sheath was seen to be swollen in the early stage of the lesion. Excluding malignancy, radiotherapy and chemotherapy, there may be an additional unknown causative factor. Metabolic disturbances or toxic agents for myelin were suspected as causative factors.