CPC #2: 38 year old woman with HIV/AIDS and altered mental status October 9, 2007.

Slides:



Advertisements
Similar presentations
AM Report May 4, 2009 Amy Auerbach  Severe demyelinating disease of the central nervous system caused by reactivation of the polyomavirus JC  Occurs.
Advertisements

Pathologic Basis of Disease Neuropathology - 1. Major cells of the CNS Neurons Glial cells: -astrocytes -oligodendrocytes -ependymal cells -microglial.
Case Study 5 Gabrielle Yeaney, M.D.. Question 1 63-year-old female with progressive weakness of upper and lower extremities, in additiona to confusion,
OPPORTUNISTIC FUNGAL INFECTIONS
Approach to Pulmonary Manifestations of HIV/AIDS
HIV 101 Review Evaluation Center for HIV and Oral Health Boston University School of Public Health Health & Disability Working Group.
Ois generalPCPCryptococcus-Toxoplasma
Usefulness of the multimodality imaging for the diagnosis of an atypical lymphoma of the brainstem ATTIA M, KOUKI S, LANDOULSI M,BOUGUERRA S,AROUS Y, BOUJEMAA.
62 years old man Main complaint: Back pain at night but not during the day Loss of appettite Weight loss.
Immune deficiency Diseases (2). Immune Deficiency Disorders Immunodeficiencies can be divided into primary immunodeficiency disorders, and secondary immunodeficiency.
Pediatric Brain Tumors
Diagnostic Slide Session Case DS Miguel A. Guzman, MD 1 Zissimos Mourelatos, MD 2 1 Neuropathology Fellow 2 Director, Neuropathology Department.
Progressive Multifocal Leukoencephalopathy July 31, 2007 Margo Smith, M.D. Department of Medicine Washington Hospital Center.
N ORTHWEST A IDS E DUCATION AND T RAINING C ENTER HIV and Non Hodgkin Lymphoma Virginia C. Broudy, MD September 25, 2014 Presentation prepared by: Presenter.
LYMPHOMA.
Lymphoma DR: Gehan Mohamed.
HIV dementia and HIV-related brain impairment (HRBI) Jeanette Meadway FRCP Consultant Physician Mildmay Hospital UK Hackney Road, London E2 7NA.
First description of high grade NHL in 90 homosexual men with AIDS in 1984.
Tumors of the CNS can be: Primary Secondary
CNS Neoplasm Dr. Raid Jastania, FRCPC Assistant Professor, Faculty of Medicine, Umm Alqura University Vice Dean, Faculty of Dentistry.
Extranodal Lymphoma: Waldeyer’s Ring Lymphomas, primary Muscle Lymphoma Sinus Lymphomas , Bone.
Diagnostic Challenge Pathology for Neurosurgery & Neurology Residents Department of Pathology University of Oklahoma Health Sciences Center, Oklahoma City,
Central nervous system block Neuropathology practical Dr Shaesta Naseem
CPC:38 year-old AIDS patient with brain and pulmonary lesions
ENCEPHALITIS. Selected Viral causes of acute encephalitis/myelitis Herpesvirus: Herpes simplex virus, Varicella–zoster virus, Herpes B virus, Epstein–Barr.
The Immune System u Widely dispersed system u Review of structure and function F located in marrow cavities of bones F yellow vs. red marrow F hematopoiesis.
By: Anna Gooden. Medulloblastoma Medulloblastoma is a type of brain tumor. It is also known as PNET. It occurs in children and teenagers.
Clinical Care of HIV, AIDS and Opportunistic Infections
CNS Malignancies for internists
1 Copyright © 2014 Elsevier Inc. All rights reserved. Chapter 43 Nervous System Complications of Systemic Viral Infections John E. Greenlee.
Brain Abscess. What is brain abscess? Focal collection within brain parenchyma.
CPC #5 Pathology. CD3 CD20 Ki-67 Diagnosis Intravascular Large B-Cell Lymphoma.
General Aspects of Lymphoid Malignancies Chronic Lymphoid LeukemiaAcute Lymphoid Leukemia EpidemiologyOlder adults; men>women; Whites>blacks Children and.
T-cell/histiocyte-rich large B cell lymphoma Monirath Hav, MD, PhD fellow Pathology Department Ghent University Hospital.
Brain Biopsy Frozen Section/Touch Prep. Brain Biopsy for Suspected Neoplasm Is it Abnormal? Is it Neoplastic? What Type of Neoplasm is it? What is the.
A 43-year-old man with decreased consciousness Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology.
Combine conference NS 張維傑 / Chief CC Shen.
NOT ALL SWELLING WITH REDNESS AND BAD SMELLY DISACHRGE IS NECESSARLY AN ABSCESS Al-Sharabati, Mohamed Barakat, MD, Pathologist Rasheed, Osaid, RN, CNS.
DR.MOHAMMED ARIF ASSOCIATE PROFESSOR CONSULTANT VIROLOGIST HEAD OF THE VIROLOGY UNIT Epstein Barr virus (EBV)
HIV/AIDS. Human Immunodeficiency Virus  Virus attacks the immune system  Invades and destroys certain white blood cells  Takes time for the HIV to.
Felice Giangaspero BIOPATOLOGIA DEI LINFOMI PRIMITIVI CEREBRALI Mediterranean School of Oncology Burning questions on lymphoproliferative diseases Rieti.
Diagnostic Slide Session Mark Samols 1, Kari-Elise Codispoti 1, Marc Rosenblum 2, Barbara Crain 1 1 Johns Hopkins Hospital, Baltimore MD 2 Memorial.
7.1a. Contrast axial T1 Wtd MRI7.1b. Contrast coronal T1 Wtd MRI Figure 7.1:An enhancing ring lesion within the left posterior frontal lobe 7.1c. Contrast.
2011 AANP Diagnostic Slide Session Case 1 Janna Neltner, MD Dianne Wilson, MD Peter T. Nelson, MD PhD Craig Horbinski, MD PhD University of Kentucky.
Case Study 25 Craig Horbinski, M.D., Ph.D.. The patient is a 56 year-old male presenting with altered mental status. It seems the patient was well until.
Gerrit Blignaut Diagnostic Radiology UFS17/08/2012.
Lymph is the clear interstitial fluid found between the cells of the body. It enters the lymph vessels by filtration travels to one of the lymph nodes.
2011 Diagnostic Slide Session Case 7 Aditya Raghunathan Suzanne Z. Powell.
29-1 A Human Perspective HIV Disease and Complications of Immunodeficiency Eugene Nester Denise Anderson Evans Roberts, Jr. Nancy Pearsall Martha Nester.
White blood cells and their disorders Dr K Hampton Haematologist Royal Hallamshire Hospital.
Case Study 1 Harry Kellermier, M.D.. Question 1 This is a 70 year-old male who presented with paresthesias and clumsiness in his right upper extremity.
Clayton Wiley MD/PhD. 38-year-old male with progressive weakness of upper and lower extremities, in addition to confusion. Describe the MRI findings (location,
Date of download: 6/6/2016 Copyright © 2016 American Medical Association. All rights reserved. From: Lessons Learned From Fatal Progressive Multifocal.
3/17/08 Lymphatic System Chapter 20 – Day 3. 3/17/08 Immune Response  Definition of Immunity  Lines of defense – non-specific vs. specific  Characteristics.
Case 9 A 55 year old male presented with an enlarged axillary lymph node. Staging identified multiple enlarged lymph nodes, and B symptoms, including night.
Paramesh, KA Mazumder, AA Holmes, P Siddiqui, A
Viruses That Infect Humans: The DNA Viruses
Special Treatment Issues in Non-small Cell Lung Cancer
Prognosis of younger patients in non-small cell lung cancer
Frozen Section/Touch Prep
Lymphoma. Malignant lymphomas may occur in the brain, either as primary lesions or as secondary (metastatic) lesion in patients with systemic lymphoma.
Neuro-oncology Board Review
Harika Yalamanchili PGY-3
Neurology Resident and Fellow Section
Chapter 16 Neurologic Dysfunction and Kidney Disease
Cells with CD4 receptor on surface
Figure 3. Brain imaging and neuropathologic studies in patient PT-5 diagnosed with progressive multifocal leukoencephalopathy Brain imaging and neuropathologic.
Radiological evolution of acute respiratory distress syndrome over the first week in a 57-year-old male with non-Hodgkin’s lymphoma and H1N1 infection.
Coronal (A) and axial (B) contrast-enhanced T1-weighted MR images and an axial DWI (C) and ADC map (D) in a patient with primary dural B-cell lymphoma.
How I treat primary CNS lymphoma
Presentation transcript:

CPC #2: 38 year old woman with HIV/AIDS and altered mental status October 9, 2007

Lungs  Combined weight 2,200 gm (normal 685-1,050)  Most of weight increase due to pulmonary edema  Multiple discrete nodules with necrotic centers  Bronchopneumonia  CMV infection

Pulmonary edema

Necrotizing nodules – no AFB or fungi ID’d CD20 – B-cells CD3 – T-cells

Bronchopneumonia

Bronchopneumonia – and CMV infection

CMV in alveoli and around necrotizing masses

Disseminated CMV Kidney Adrenal Pancreas

Disseminated CMV Spleen Ovary

Brain: multiple poorly defined masses Right frontal lobe Left striatum * Right striatum * Left insula Left cerebellum 

Primary CNS lymphoma

Tumor cells in vessel walls Diffuse parenchymal invasion

Primary CNS lymphoma - EBV CD20 – B-cells CD3 – T-cells EBV

Cause of death Part I a)B-cell lymphoma, brain b)Acquired immunodeficiency syndrome Part II a) Disseminated CMV infection

HIV neuroinvasion: “Trojan Horse hypothesis”  Viral entrance into CNS Infected monocytes enter, differentiate into perivascular macrophages Infected CD4+ T cells Direct entrance of virus Transcytosis of virus across endothelial cells  Productive infection of macrophages and microglia Restricted infection of astrocytes Infection of oligodendrocytes and especially neurons is questionable Ghafouri et al. Retrovirology 2006; 3:28

CNS infections in AIDS  Fungi Cryptococcus Aspergillus Coccidioides VFCE%20OLD/jpg/ jpg

CNS infections in AIDS  Fungi Cryptococcus Aspergillus Coccidioides  Parasites Toxoplasma

CNS infections in AIDS  Fungi Cryptococcus Aspergillus Coccidioides  Parasites Toxoplasma  Viruses (encephalitis) Cytomegalovirus (CMV) HIV Ellison & Love: Neuropathology 2e © 2004 Elsevier Ltd.

CNS infections in AIDS  Fungi Cryptococcus Aspergillus Coccidioides  Parasites Toxoplasma  Viruses (encephalitis) Cytomegalovirus (CMV) HIV  Viruses (other pathology) JC virus (PML, demyelination) Epstein-Barr virus (EBV) - lymphoma

Primary CNS lymphoma (PCNSL)  More frequent in both immunocompromised and immunocompetent patients (especially elderly) over last 20 years 6-20% of AIDS patients  EBV implicated in most immunocompromised and some immunocompetent individuals (nearly all AIDS patients)  Usually diffuse large B-cell tumors  Occur anywhere in brain Incidence proportional to volume (i.e., most common in frontal lobe) Often multifocal in AIDS patients Symptoms reflect location

Primary CNS lymphoma (PCNSL)  Imaging (without AIDS): homogeneous enhancement  Imaging (with AIDS): “ring-enhancing”, often multifocal  Histology: Solid sheets of tumor cells (often necrotic) blending into less cellular zones Angiocentric and angioinvasive Positive for B-cell markers, EBV (immunocompromised)  Treatment: radiation and / or chemotherapy  Prognosis: Immunocompetent: median survival 18 months Immunocompromised: median survival 4 months

References  Burger et al. Surgical Pathology of the Nervous System and Its Coverings. Fourth Edition Churchill Livingston.  Ellison et al. Neuropathology. A reference text of CNS pathology. Second Edition 