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Tuesday slide seminar, December 1st 2009
Hannu Kalimo
Division of Pathology, HUSLAB, University Central Hospital, Helsinki, Finland
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Case 1
72 M. In head MRI an incidental finding of an intracranial tumor attached to parietal dura. Radiologically a meningioma. H&E stained frozen section and main specimens from the tumor.
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Case 2
53 M. Psychiatric problems in 1970s. Has lived like an eremite by himself with minimal contacts with other people. For not exactly known reasons he was sent to hospital. Virtually impossible to make contact. Slurry speech, responded by only murmuring. Basic clinical and laboratory examinations non -contributory. In brain cutting suspected hemorrhagic necrotizing lesions in the walls of the III ventricle (mainly in thalamus) and in mamillary bodies. H&E stained section through the mamillary bodies and third ventricle.
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Case 3
63 F. 63-year-old female, who has elevated blood lipid values. Heavy smoker. 3/08 fluctuating fever, liver laboratory tests abnormal, liver and spleen were enlarged. 5/08 liver biopsy with suspected lymphoma. In repeat liver biopsy only reactive alterations. The patient contracted Epstein-Barr viremia, which was treated with Valavir and Kiovig. 10/2008 splenectomy in which the diagnosis of anaplastic T-cell lymphoma was confirmed. Treated with Dexabeam x 3. Before the second regimen 3.12.2008 the patient had cardiac flimmer and she got a stroke, which was treated with Marevan. After the second regimen of Dexabeam she got full right sided hemiplegia and aphasia developed. CT was compatible with a brain infarct. After the third regimen of Dexabeam 20.1.2009 onwards different infections during the cytopenia phase and thereafter continuous downhill course and patient died 4.2.2009. H&E and myelin (LFB-CV) stained sections from the left frontal lobe.
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Case 4
66 F. According to the clinical referral she had suffered from severe Parkinson´s disease for 10 years. X/2005 she was neurosurgically operated on to place a stimulator in her left thalamus. Postoperatively she got a severe intracerebral hemorrhage, evacuated 2x. Severe posthemorrhagic state with epileptic seizures developed. Became wheelchair-bound. Needed constant daily assistance, respiratory infections, continuous downhill course. Was found dead in her bed at the care center 02.10.2009 klo 03.00. Forensic autopsy, brain sent to Dr. Anders Paetau for the neuropathological examination with questions: Severity of the Parkinson´s disease?
Extent and significance of the neurosurgical complications?
Acute epileptic attack in association with her death?
Specimen H&E and a-synuclein stained sections from the left lentiform nucleus. Look especially at the small bundles (striae) of white matter within putamen in the alfa-synuclein stained sections (see annotation ROI 1 in Slide 1b).
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Case 5
75 M. Diabetes type II and hypertonia. During two past years progressive muscle weakness, predominantly distally. Muscle biopsy from lateral thigh muscle H&E stained section.
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Case 6
26 M. The eldest son in a family, in which the maternal grandfather and his brother had had a slowly progressive, but not until at later age more severely disabling muscle disease. This boy had learnt to walk normally but already in childhood he could not keep up with his companions in physical activities. He has two brothers from his mother´s first marriage, one with the same muscular symptoms, the other healthy and third half-brother with the same symptoms. Specimen: muscle biopsy from the eldest son´s lateral thigh muscle at the age of 26 years. H&E staining and immunostaining for dystrophin 2.
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