GPR: 2021 - Week 12

From MGH Learn Pathology

Clinical history

30 year old female with HIV/AIDS presenting with single seizure


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Cryptococcosis
  • Immunocompromised individuals predominantly affected.
  • Meninges are thickened and opacified; often with a slimy/slippery consistency over the surface.
  • Multiple intraparenchymal cysts with soap bubble appearance.
  • Often prominent in the basal ganglia, but can also be seen in the cerebellum and thalamus.
  • Cortex is generally affected only microscopically.
 

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Aspergillosis

  • Hematogenous spread leads to multiple lesions.
  • Often occurs in an anterior and middle cerebral artery distribution.
  • Tends to involve cortex, white matter, and basal ganglia.
  • Lesions often resemble hemorrhagic infarcts with occasional abscess formation.
  • Foci of necrotic material admixed with hemorrhagic tissue.
 

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Toxoplasmosis

  • Multifocal necrotic lesions with variable size
  • Any region of the brain may be affected.
  • May be associated with hemorrhage.
  • Lesions may look cystic if infection is long-term.
  • Radiologically can resemble CNS Lymphoma or metastatic cancer.
 

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CNS Lymphoma

  • Seen in HIV patients with strong association with Epstein-Barr virus
  • Often multi-focal well-demarcated lesions
  • Affected tissue is usually soft and cream to brown colored.
  • Occasionally associated with hemorrhage.
  • Meninges and intraventricular lining may appear thickened if involved by infiltrating disease.
 
Dr. E. Tessa Hedley-Whyte
Ellison, D. & Love, S. A Reference Text of CNS Pathology: Neuropathology. Third Edition. Edinburgh. Mosby, Elsevier. (2013).

This week's Gross Pathology Roundup was presented by Liana Bonanno, MD, PhD on Mon, Mar 22, 2021.