TITLE:
Pontocerebellar Progressive Multifocal Leukoencephalopathy. Radiological, Clinical, Histological and Immunohistochemical Findings in a Hematological Patient
AUTHORS:
Javier Ortiz, Juan Carlos Paniagua, Isidro Cavaco, Raquel Rivas, Andrea Jimenez, Luis Chinchilla, Elisa Muñoz, María Dolores Ludeña
KEYWORDS:
Progressive Multifocal Leukoencephalopathy, JC Virus, Immunohistochemistry
JOURNAL NAME:
Open Journal of Pathology,
Vol.13 No.4,
August
23,
2023
ABSTRACT: Objective: To describe the radiological, histological and immunohistochemical findings in a case of Progressive Multifocal Leukoencephalopathy (PML) affecting the cerebellar peduncles in a patient with chronic lymphocytic leukemia. Patient and Methods: Magnetic Resonance Imaging (MRI), histological picture (H.E., Kluver-Barrera) and immunohistochemical picture (GFAP, neurofilaments, CD68, JC virus) were obtained. Results: 1) Magnetic resonance imaging: Asymmetric and progressive lesions on middle cerebellar peduncles, that were hyperintense in T2/FLAIR, extended towards the pons, had no mass effect and were unmodified after intravenous contrast. 2) Histology: Marked reactive gliosis with cytopathic changes suggesting viral infection, plus demyelination areas with axonal preservation. 3) Immunohistochemistry: Marked positivity for viral (polyoma and JC virus) markers in glial cells showing cytopathic changes. Conclusions: The importance of histological and immunohistochemical diagnosis in everyday assistance; of the collaboration between clinicians, radiologists and pathologists; and the validity of postmortem studies as a key element for research and clinical quality assessment must be stressed.