[Brain vasculitis associated with drugs]. / Vasculitis cerebral asociada a drogas.

INTRODUCTION: Vasculitis or angiitis is the term used to define the inflammation of the vessels, either blood or lymphatic, which causes may be primary related to immunological disorders, or secondary, with great variety of causal factors. CASE REPORT: We present a very uncommon case of a 36 year old man with brain vasculitis associated with drugs with very peculiar characteristics in the imaging studies and with definite diagnosis through histopathology obtained by biopsy, which differs from the few reports in the literature until our days. CONCLUSIONS: Our report is an uncommon case of cerebral vasculitis whose clinical features were confusing with impressing neuroimaging studies that showed possible lesions due to vasculitis that was confirmed through a cerebral biopsy and considering that the immunological tests were negative for a primary vasculitic process, we concluded that it was a vasculitis secondary to drug abuse which represents a special interest in view of the few existing reports in literature with definite diagnostic methods, such as cerebral biopsy or autopsy.

Vasculitis cerebral asociada a drogas / Brain Vasculitis associated with drugs

Introduction. Vasculitis or angiitis is the term used to define the inflammation of the vessels, either blood or lymphatic, which causes may be primary related to immunological disorders, or secondary, with great variety of causal factors. Case report. We present a very uncommon case of a 36 year old man with brain vasculitis associated with drugs with very peculiar characteristics in the imaging studies and with definite diagnosis through histopathology obtained by biopsy, which differs from the few reports in the literature until our days. Conclusions. Our report is an uncommon case of cerebral vasculitis whose clinical features were confusing with impressing neuroimaging studies that showed possible lesions due to vasculitis that was confirmed through a cerebral biopsy and considering that the immunological tests were negative for a primary vasculitic process, we concluded that it was a vasculitis secondary to drug abuse which represents a special interest in view of the few existing reports in literature with definite diagnostic methods, such as cerebral biopsy or autopsy (AU)

Introducción. Vasculitis, o angeítis, es el término que se emplea para definir la inflamación de los vasos, ya sean sanguíneos o linfáticos, cuyas causas pueden ser primarias, relacionada más con alteraciones inmunológicas, o secundarias, con una gran heterogeneidad de factores causales. Caso clínico. Presentamos el caso poco común de un hombre de 36 años de edad con vasculitis cerebral asociada a la utilización de drogas, el cual cuenta con estudios de imagen peculiares, pero con confirmación histopatológica de una muestra obtenida mediante biopsia cerebral, la cual difiere de los pocos informes similares que existen en la literatura hasta la actualidad. Conclusiones. Este comunicado corresponde a un caso poco común de vasculitis cerebral cuyas manifestaciones iniciales eran confusas, con estudios de neuroimagen que mostraron posibles lesiones por vasculitis, lo que se corroboró mediante biopsia cerebral; considerando que las pruebas inmunológicas resultaron negativas para un proceso vasculítico primario, concluimos, por los antecedentes del paciente, que se trataba de una vasculitis secundaria a abuso de drogas; esto tiene un interés especial, dados los escasos comunicados existentes en la literatura con métodos diagnósticos definitivos, como la biopsia cerebral o la necropsia (AU)

[120 biopsies of pituitary adenomas studied by immunohistochemistry and electron microscopy. A clinico-pathological correlation]. / Estudio de 120 biopsias de adenomas pituitarios con inmunohistoquímica y microscopía electrónica. Correlación clínico-patológica.

Study of biopsies from 120 pituitary adenomas from the Hospital de Especialidades, Centro Médico Nacional, and the Hospital 20 de Noviembre, ISSSTE, were studied over a period of 55 months. 70 cases were female and 50 male. Ages varied between 18 and 67 years of age (with an average of 31 years). Histologically 41 tumors were chromophobes, 34 acidophilic, 37 mixed and 8 basophilic. 101 patients were operated by trans-sphenoidal (84.5%) and 19 were operated (15.5%) by trans-cranial approaches. 99 tumors were macroadenomas (81.1%) and 21 were microadenomas (18.9%). More than one hormone was found in the cytoplasm of 69 adenomas, although only 20 fulfilled the criteria of being plurihormonal. Those adenomas classified as "non-functional", mostly produced glycoprotein hormones corresponding to oncocytomas and null cell adenomas, from an ultrastructural point of view. 85 patients developed different degrees of visual impairment, with 30 tumoral relapses, of which 10 received radiotherapy. 40 adenomas produced prolactin, although only 29 patients developed clinical signs of hyperprolactinemia; 38 tumors contained growth hormone, of which only 25 had acromegaly; 8 tumors contained ACTH in the cytoplasm, although only 7 developed Cushing's Syndrome and 57 patients (47.5%) were classified as nonfunctional and did not show any endocrinological data. All the cases are studied with a light microscope, electron microscope, and they were all submitted to a complete set of adenohypophyseal hormone with immunoperoxidase technique.

Pathology of the neurohypophysis.

Neurohypophysis is composed of nerve fibers and has an intimate morphologic and functional contact with the hypothalamus. Pathology of the posterior lobe of the pituitary gland may develop several clinical features such as diabetes insipidus, which is caused by infections, vascular events, surgical complications and benign and malignant tumors as well as metastasis. Inappropriate secretion of vasopressin (Schwartzbartter syndrome) is due to excessive vasopressin release from the posterior pituitary or the ectopic production by various tumors, mainly carcinoid of the lung.

Mammosomatotroph adenoma of the pituitary associated with gigantism and hyperprolactinemia. A morphological study including immunoelectron microscopy.

A 29-year old giantess with growth hormone excess and hyperprolactinemia underwent transsphenoidal surgery to remove her pituitary tumor. Electron microscopy revealed a mammosomatotroph adenoma composed of one cell type. Immunoelectron microscopy, using the immunogold technique, demonstrated predominantly growth hormone or prolactin or a varying mixture of both growth hormone and prolactin in the adenoma cells. The presence of growth hormone and prolactin was found not only in the cytoplasm of the same adenoma cells but also in the same secretory granules. In the nontumorous adenohypophysis, somatotrophs and lactotrophs showed ultrastructural signs of hyperactivity. This finding is in contrast with the presence of suppressed somatotrophs and lactotrophs seen in nontumorous portions of adult pituitaries harboring growth hormone or prolactin-secreting adenomas. Our morphological study reinforces the view that growth hormone-producing pituitary tumors, originating in childhood, are different from those of the adult gland.

The effect of tetraphenylporphinesulfonate (TPPS) on muscle end-plates in mice. An ultrastructural and quantitative study.

Motor end-plates were studied in mice at various intervals after a single injection of a synthetic porphyrin, tetraphenylporphinesulfonate (TPPS). Ultrastructurally, excess accumulation of neurofilaments constituted the earliest abnormality. These were followed by atrophy of many nerve terminals and their separation from the postsynaptic area by interposed Schwann cells. Five to 8 months after the injection some postsynaptic areas showed denervation and atrophy. These progressive changes in the nerve terminals were accompanied by secondary changes in the subneural apparatus. Morphometric analysis revealed marked atrophy of the end-plates and significant swelling of preterminal axons. The present findings are suggestive of partial denervation of muscle, occurring after the injection of a synthetic porphyrin.

Massive Crooke's hyalinization in corticotroph cell adenomas of the human pituitary. A histological, immunocytological, and electron microscopic study of three cases.

Three women with Cushing's disease caused by ACTH-producing adenoma, underwent transsphenoidal tumour resection. Many adenoma cells showed massive accumulation of microfilaments indistinguishable from Crooke's hyalin material by light and electron microscopy. We believe that these tumours represent variants of ACTH-producing adenomas, and the accumulation of microfilaments is due to cortisol dependency.