Schmorl's nodes. Correlation of X-ray and histological findings in postmortem specimens

Histological examinations were conducted on specimens of 368 intervertebral discs (T11/12-L5/S1), using X-ray photography and discography. Specimens were obtained from 61 individuals (36 males and 25 females) whose ages ranged from 25 to 85 years. Fifty-four Schmorl's nodes were found in 28 of the patients (19 males and 9 females), and in 43 discs. In the peripheral regions of Schmorl's nodes, where the vertebral bodies were in contact with the node, growth of cartilaginous cells was seen in many cases. Thickened bone trabeculae were also seen in three nodes accompanied by syncytia. These three nodes were detectable by X-ray photography of all discs containing Schmorl's nodes, and 35 were subjected to discography. Among these discs, 10 showed a limited form of shadow and 25 showed a diffuse form, and Schmorl's nodes were detected in 11 that showed a diffuse form of shadow. It was possible to detect Schmorl's nodes when they were contiguous with a degenerated annulus fibrosus adjoining the nuclear cavity. Pathogenetically, the presence of Schmorl's nodes in patients of middle and advanced age is interpreted to be one of the symptoms of age-related changes in the cartilaginous plate.     

Infarction of spinal cord and medulla oblongata caused by fibrocartilaginous emboli

Summary A fatal case of fibrocartilaginous embolization with massive infarction of the upper spinal cord and lower medulla oblongata is reported. Cartilage from intervertebral discs is believed to cause such emboli, probably first by intrusion into vertebral bodies (Schmorl's nodes) followed by retrograde venous transport from the bone marrow to the spinal veins. This route can be outlined by injecting India ink in the cancellous bone of vertebral bodies. Access of the emboli to arteries can be explained by postulating the existence of arteriovenous shunts in the normal spinal vasculature or by trauma-induced communications between the vascular beds. In our case, the 7th reported in the literature, the majority of occluding cartilaginous emboli were in small arteries and arterioles and the resulting infarcts were of the ischemic rather than the hemorrhagic type.     

PATHOLOGICAL CHANGES IN THE CARTILAGINOUS PLATES IN RELATION TO INTERVERTEBRAL DISC LESIONS

Three hundred sixty-eight intervertebral discs (Tll/12-L5/S1) were obtained at autopsy from 61 individuals (36 male, 25 female) ranging from 25 to 85 years of age, and subsequently examined histopathologically as sagittal-sectioned specimens with special reference to the cartilaginous plates. The numbers of cartilaginous foci found in Assured and ruptured regions of the plates were found to Increase with age, and were considered to represent a restoration mechanism. Measurement of the cartilaginous plate/intervertebral disc antero-posterior length ratio showed a decrease with age in intervertebral discs from the same spinal level. Therefore, cartilage cell proliferation in the vertebral body rim was found following rupture of the outer layer of the annulus flbrosus and was thought to be one of the causes of spur formation in spondylosis deformans. When the changes in a cartilaginous plate with aging were accompanied by destructive processes of the vertebrae such as osteoporosis or metastatic cancer, an increase in the height of the disc, or ballooning, developed. On the other hand, when degeneration of the intervertebral disc increased and the nucleus pulposus collapsed, the height of the disc decreased. Thus, although the cartilaginous plate exhibits a restoration mechanism, degeneration with age progresses, resulting in various disc lesions.     

Pathological changes in the cartilaginous plates in relation to intervertebral disc lesions

Three hundred sixty-eight intervertebral discs (T11/12-L5/S1) were obtained at autopsy from 61 individuals (36 male, 25 female) ranging from 25 to 85 years of age, and subsequently examined histopathologically as sagittal-sectioned specimens with special reference to the cartilaginous plates. The numbers of cartilaginous foci found in fissured and ruptured regions of the plates were found to increase with age, and were considered to represent a restoration mechanism. Measurement of the cartilaginous plate/intervertebral disc antero-posterior length ratio showed a decrease with age in intervertebral discs from the same spinal level. Therefore, cartilage cell proliferation in the vertebral body rim was found following rupture of the outer layer of the annulus fibrosus and was thought to be one of the causes of spur formation in spondylosis deformans. When the changes in a cartilaginous plate with aging were accompanied by destructive processes of the vertebrae such as osteoporosis or metastatic cancer, an increase in the height of the disc, or ballooning, developed. On the other hand, when degeneration of the intervertebral disc increased and the nucleus pulposus collapsed, the height of the disc decreased. Thus, although the cartilaginous plate exhibits a restoration mechanism, degeneration with age progresses, resulting in various disc lesions.     

Diagnostic relevance of pressure-controlled discography

Discogenic pain is a leading cause of chronic low back pain. The authors investigated the efficacy of pressure-controlled discography to determine its role in clinical decision-making for the management of patients with discogenic pain. Pressure-controlled discography was performed in 21 patients (51 discs) with pain-provocation, followed by post-discography computerized tomography scans. Pain response was classified as positive response and negative response, and measured with visual analog scale scores. Discographic findings were graded by the modified Dallas discogram scale. Elastance, pain provocation on intradiscal pressure, pressure and volume of initial pain response, and pain response intensity were statistically analyzed. Elastance showed significant differences between Grade 0 and Grade 4 and 5. Decreased elastance with positive pain response group was a good indicator to imply that disc degeneration presumably is a pain generator. Results of pain response were well correlated with intradiscal pressure but not with the amount of injected volume. Among 31 discs of Grade 4 and 5, 74% showed negative pain response and 26% showed positive response. It was concluded that pressure-controlled discography was useful to diagnose discogenic pain and excellent guide in decision-making for spinal operations.     

Menopause causes vertebral endplate degeneration and decrease in nutrient diffusion to the intervertebral discs

The vasculature in the outer annulus supplies only the periphery of the disc so that nutrition to the bulk of the disc, including all the inner annulus and nucleus pulposus, is derived from the vertebral epiphyseal end arteries where nutrients diffuse across the cartilaginous endplate to reach the disc. In this regard the vertebral endplate plays an important role in disc nutrition. Compromise of diffusion of nutrients to the disc cells may play a large part in the progression or even initiation of disc degeneration. Increasing evidence suggests that estrogen deficiency also influence the severity of disc degeneration in post-menopausal females. Structural disorganization of the vertebral endplate occurs with disc degeneration, with the most common endplate changes observed clinically being Schmorl’s node. Schmorl’s node is more commonly seen in post-menopausal women than younger women. Osteosclerosis, osteonecrosis and fibrosis associated with Schmorl’s nodes can impede nutrient diffusion into the disc as well as removal of metabolites from the disc. We hypothesize that menopause negatively affects vertebral endplate quality and induces endplate degeneration. This endplate degeneration decreases nutrients diffusion from vertebral body into discs, and also impedes removal of metabolites, leads to further disc degeneration. To confirm our hypothesis, a cross-sectional post-contrast MRI study can be performed in pre-menopausal and post-menopausal women. If the hypothesis is confirmed, then low dose hormone replacement treatment may retard disc degeneration in post menopausal women and thereby limit the consequences associated with disc degeneration such as low back pain.     

The Ultrastructural Features of Plasmablastic Lymphoma

Plasmablastic lymphoma was originally described in 1997 by Delecluse et al. and is an aggressive variant of diffuse large B-cell non-Hodgkin lymphoma seen predominantly in a setting of acquired immunodeficiency syndrome and nearly always in extranodal sites. The authors have seen 10 cases in their department between 2001 and 2005. The patients' ages ranged from 24 to 39 years and there were 7 females and 3 males. In 7 cases where human immunodeficiency virus had been tested it was positive. Eight cases were extranodal and 2 cases involved lymph nodes. Five cases were followed up and 4 were confirmed dead within 5 months of diagnosis, verifying the aggressive nature of this condition. Histology showed large, polygonal tumor cells some of which had a slightly plasmacytic appearance. Six cases had a “starry sky” background. Immunohistochemical stains were negative in 1 case, while the other 9 cases were positive for CD138. Electron microscopy showed concentrically arranged rough endoplasmic reticulum in the cytoplasm in 9 cases. In 1 case the cells were too degenerate for evaluation. This study shows that the ultrastructural features are well developed and can help in distinguishing plasmablastic lymphoma from other light microscopically undifferentiated tumors.     

The ultrastructural features of plasmablastic lymphoma

Plasmablastic lymphoma was originally described in 1997 by Delecluse et al. and is an aggressive variant of diffuse large B-cell non-Hodgkin lymphoma seen predominantly in a setting of acquired immunodeficiency syndrome and nearly always in extranodal sites. The authors have seen 10 cases in their department between 2001 and 2005. The patients' ages ranged from 24 to 39 years and there were 7 females and 3 males. In 7 cases where human immunodeficiency virus had been tested it was positive. Eight cases were extranodal and 2 cases involved lymph nodes. Five cases were followed up and 4 were confirmed dead within 5 months of diagnosis, verifying the aggressive nature of this condition. Histology showed large, polygonal tumor cells some of which had a slightly plasmacytic appearance. Six cases had a “starry sky” background. Immunohistochemical stains were negative in 1 case, while the other 9 cases were positive for CD138. Electron microscopy showed concentrically arranged rough endoplasmic reticulum in the cytoplasm in 9 cases. In 1 case the cells were too degenerate for evaluation. This study shows that the ultrastructural features are well developed and can help in distinguishing plasmablastic lymphoma from other light microscopically undifferentiated tumors.     

Waldenström's macroglobulinemia

Summary An autopsy case of Waldenström's macroglobulinemia is reported, in whom an abnormal pulmonary shadow had already existed 2 years before the diagnosis of the disease and was proved to be pulmonary involvement. Immunoelectrophoresis demonstrated a monoclonal increase in immunoglobulin M with kappa light chain. A chest X-ray film showed a reticulo-nodular shadow in the right lower lobe of the lung. A bronchial biopsy specimen revealed a diffuse and dense lymphocytic infiltration. Bone marrow aspirate revealed no remarkable change except for a slight increase in plasma cells (1.7%) and an appearance of atypical lymphocytes (0.5%). At autopsy, more than half of the right lower lobe of the lung was occupied by a pale whitish, viscid and glossy tumour mass. Heptosplenomegaly and lymph node enlargement were not observed. Histological findings of the tumour tissue were similar to those of the biopsy specimen. Lymphocytic infiltration was observed also in the liver, kidneys, spleen, bone marrow and lymph nodes, but was of minor degree. Other reported cases of Waldenström's macroglobulinemia accompanied by pulmonary involvement are reviewed.     

Avian intervertebral disc arises from rostral sclerotome and lacks a nucleus pulposus: implications for evolution of the vertebrate disc

Deterioration of the intervertebral discs is an unfortunate consequence of aging. The intervertebral disc in mammals is composed of three parts: a jelly-like center called the nucleus pulposus, the cartilaginous annulus fibrosus, and anterior and posterior endplates that attach the discs to vertebrae. To understand the origin of the disc, we have investigated the intervertebral region of chickens. Surprisingly, our comparison of mouse and chicken discs revealed that chicken discs lack nuclei pulposi. In addition, the notochord, which in mice forms nuclei pulposi, was found to persist as a rod-like structure and express Shh throughout chicken embryogenesis. Our fate mapping data indicate that cells originating from the rostral half of each somite are responsible for forming the avian disc while cells in the caudal region of each somite form vertebrae. A histological analysis of mammalian and nonmammalian organisms suggests that nuclei pulposi are only present in mammals.     

壮族人蛛网膜下池的CT观测

目的　获取壮族人蛛网膜下池的CT解剖数据及其变化规律。方法　对 2 5 4名健康壮族 (男 12 7,女 12 7)的头部CT片进行了测量 ,测量项目为 6项 ,并进行统计分析。结果　头部 6项指标平均值男大于女 ,性别差异有高度显著性。壮族脑池测量值 ,各年龄组间比较 ,大脑纵裂池和鞍上池各年龄组差异有显著性 (P <0 0 5鞍上池的 5 0～岁除外 ) ;环池除相邻年龄组间差异无显著性 (P >0 0 5 )外 ,各年龄组间均存在差异 (P <0 0 5 ) ;四叠体池 2 0～岁组与各年龄组及 30～组岁与 6 0～组岁间差异有显著性 ;大脑外侧窝池 5 0岁以前 3个年龄组间无显著性差异。结论　壮族人蛛网膜下池各年龄组间变化有自己的特点和一定的规律性 ;蛛网膜下池的解剖数据男大于女 ,存在性别差异     

椎间盘突出临近退变节段是否导致腰痛

背景：椎间盘突出症患者腰痛原因很难判断,一直以来,认为突出的椎间盘是椎间盘突出症患者腰痛及腿痛重要原因,椎间盘突出临近退变节段是否导致腰痛需进一步研究证实。 目的：通过椎间盘造影判断突出临近退变节段是否是椎间盘突出症患者腰痛原因,并报告经椎间盘镜摘除椎间盘后残留腰痛在临近退变疼痛椎间盘经亚甲蓝注射治疗的效果。 方法：20例同时具有腰痛和腿痛椎间盘突出症患者行椎间盘造影检查,这些患者腰椎MRI表现为有1个突出椎间盘外至少合并1个或1个以上的临近退变的椎间盘,全部患者均经椎间盘镜摘除椎间盘切除突出的椎间盘,5例临近退变椎间盘造影阳性患者在椎间盘镜切除后经椎间盘内注射亚甲蓝治疗。腰痛、腿痛采用目测类比评分评定。 结果与结论：20例患者总共64个椎间盘行椎间盘造影,共11个椎间盘造影阳性,其中6个位于椎间盘突出临近退变节段,5个位于引起神经根性痛的椎间盘突出节段。全部病例腿痛行椎间盘镜切除突出椎间盘后明显缓解,腰痛有部分缓解,6例临近椎间盘造影阳性患者经椎间盘镜摘除椎间盘后腰痛明显,影响日常生活,其中5例行临近疼痛椎间盘亚甲蓝注射后腰痛缓解,1例患者拒绝亚甲蓝注射治疗仍有明显腰痛。结果显示椎间盘突出症患者腰痛可能来源于突出临近退变节段。     

Intracytoplasmic eosinophilic hyaline globules in cartilaginous neoplasms: A surgical, pathological, ultrastructural, and electron probe x-ray microanalytic study

Hyaline globules (HGs), spherical intracytoplasmic eosinophilic droplets, have been associated with a variety of conditions, including hepatocellular carcinoma, lung adenocarcinoma, and Kaposi's sarcoma, but they have not been described in cartilaginous tumors. In specimens of 60 cartilaginous neoplasms we found that 22 of 33 chondrosarcomas (67%), eight of 16 enchondromas (50%), and three of seven soft tissue chondromas (43%) exhibited HGs. HGs were seen more commonly in low grade chondrosarcoma (70%) and were relatively rare in high grade chondrosarcoma (25%). No HGs were identified in three osteochondromas, one synovial chondromatosis, or 15 normal cartilaginous tissues taken from various sites. Cartilage associated HGs ranged in size from 2 to 20 μm, were diastase resistant and periodic acid-Schiff (PAS) stain positive, demonstrated autofluorescence, and variably stained with Mallory's phosphotungstic acid-hematoxylin stain (PTAH). A panel of immunostains did not show any specific staining reactions with HGs. Ultrastructurally the HGs were spherical, non-membrane-bound bodies having complex architectural features associated with profiles of rough endoplasmic reticulum. Electron probe x-ray microanalytic (EPXMA) study showed significant peaks of sulphur and calcium. We conclude that HGs represent secretory products of probable glycoprotein nature, may accumulate in a variety of cartilaginous neoplasms, and may be seen more frequently in low grade chondrosarcomas.     

Lectin binding pattern in the embryonal and early fetal human vertebral column

Summary Paraffin sections from vertebral columns of ten human embryos and fetuses ranging from stage 16 to the 12th week were stained with the FITC-coupled lectins PNA, RCA I, Con A and WGA in order to investigate changes in carbohydrate-binding sites during vertebral development. PNA revealed a specific binding site in the vertebral body blastema in the precartilaginous stage of development. Beginning with the 25-mm CRL embryo, PNA-binding sites occurred in the developing fibrous annulus and the inner zone of the intervertebral discs. The first binding sites for RCA I were seen in the extracellular matrix of vertebral bodies during the cartilaginous stage of vertebral development. During early ossification of the vertebrae, staining for RCA I-binding sites in the cytoplasm of the chondrocytes and the area around the future cartilaginous end-plates was observed. Con A bound to the chondrocyte cytoplasm, and also very strongly to notochordal cells in all developmental stages examined. WGA-binding sites appeared simultaneously with cartilage formation. Connective tissue components, e.g. ligaments, were diffusely stained by WGA. Also this lectin showed an affinity for vertebral body chondrocytes. We discuss the biochemical aspects of these lectin-binding sites, and their possible roles in the differentiation process of the human vertebral column. The results of this first lectin histochemical study on human vertebral development are compared with related results in other species.     

Gonadectomy and the development of age-dependent polydipsia and the intake of NaCl solutions in the SWR/J mouse.

Gonadectomies were performed at 25 days of life in SWR/J mice, a strain known to develop age-dependent nephrogenic diabetes insipidus with females drinking far more than males. Effect of gonadectomy was different for each of the 3 nonreproductive behaviors studied. (1) Ovariectomy reduced the age-dependent polydipsia seen in females, but castration was without effect in males. (2) Castration of males resulted in a lower intake of an isotonic NaCl solution, making the castrated males similar to the sham-operated and ovariectomized females which did not differ. (3) For the short-term activity measurement sham-operated males did not differ from sham-operated females and castrated males did not differ from ovariectomized females. In each sex, gonadectomy reduced activity.     

Structure of Mesenteric Lymph Nodes in Healthy Neonatal Rats and Rats Subjected to Prenatal Exposure to Ethanol

The aim of the present work was to study the topography and structure of cranial mesenteric lymph nodes in neonatal rats developing after prenatal exposure to ethanol. Females received 15% ethanol for 1, 2, 3, 4, 5, or 6 months before establishment of pregnancy and on throughout pregnancy. Morphometric and classical histological methods were used. The number of lymph nodes and their areas on sections in neonatal rats varied depending on the duration of pregravid exposure of females to ethanol. The lowest values of these measures were seen in rats born to females exposed to alcohol for three months. Increases in the duration of ethanol exposure led to increases in the number and cross-sectional area of lymph nodes. The largest number of lymph nodes was seen in rats born to females exposed to ethanol for four months, while the maximum area was seen in rats born to females exposed to ethanol for six months.     

Lymphocytotoxic antibodies in the acquired immune deficiency syndrome (AIDS)

The acquired immune deficiency syndrome (AIDS) manifested by opportunistic infections or Kaposi's sarcoma is a newly recognized and often fatal disease. Three patients seen in Syracuse, New York, were noted to have lymphopenia and persistent serum lymphocytotoxic antibodies (LCTAs). In a double blinded study, 25 serum samples were coded and sent to us by the Centers for Disease Control Task Force on Kaposi's Sarcoma and Opportunistic Infections. Samples from 5 patients with Pneumocystis carinii pneumonia, 5 patients with Kaposi's sarcoma, 5 presumably healthy homosexual males, 5 presumably healthy heterosexual males, and 5 presumably healthy heterosexual females were included. Of the ten AIDS patients, nine had "positive" or "suspicious" results on testing for lymphocytotoxic antibodies. The five heterosexual male and five heterosexual female controls had "negative" results. Of the five homosexual male "controls," three had "positive" or "suspicious" LCTA results. Two of these three "controls" were available for follow-up. Both showed deficiencies in studies of their cell-mediated immunity. Lymphocytotoxic antibodies may participate in the ongoing immunodeficiency seen in AIDS.     

Prevalence of Linguatula serrata in lymph nodes of small ruminants: case from Iran

This survey was carried out on prevalence rates of Linguatula serrata in small ruminants in Hamedan, Iran during September till March 2011. The mesenteric lymph nodes (MLNs), livers, and lungs of 75 goats (2 females and 73 males) and 225 sheeps (19 females and 206 males) were examined for L. serrata nymphs. Animals were categorized into three age groups, i.e., under 12 months, 12–24 months, and over 2 years. The results showed that 30.6 % of goats and 10.2 % of sheeps were infected with L. serrata nymphs. The infection in females was significantly higher than that of males (p?<?0.05). Age had no significant effect on the prevalence of the parasite. The results revealed the urgency of a more thorough investigation of MLNs and lung lymph nodes’ inspection in small ruminants of the region.     

Prolymphocytic leukaemia--report of three cases

Prolymphocytic leukaemia is a rare subtype of chronic lymphocytic leukaemia. Three such cases were reported here along with clinical details. All these cases were seen in males above 5th decade. These patients showed moderate to massive splenomegaly, inconspicuous lymphadenoapthy in two cases and one with minimal lymphadenopathy. Peripheral smear showed high leukocyte count with more than 55% of prolymphocytes. Bone marrow aspiration showed diffuse involvement and in one with minimal lymphadenopathy, lymphnode aspiration showed prolymphocytes. All the three patients died within a year after diagnosis.     

Congenital pulmonary lymphangiectasis: Report of an autopsy case masquerading as pulmonary interstitial emphysema

We describe the clinicopathologic features of a case of congenital pulmonary lymphangiectasis (CPL). A male Japanese infant born prematurely at 34 weeks of gestation developed a severe moaning sound, dyspnea, and prominent respiratory acidosis about 10 min after delivery. A chest X-ray film showed bilateral frosted glass-like infiltrates with an air bronchogram and an air leak around the cardiac shadow, suggesting pneumomediastinum. The patient died of hypoxemic respiratory failure 13 h after birth. The death was complicated by bilateral pneumothorax, despite the initiation of artificial ventilation and administration of a surfactant. At autopsy, small cystic lesions were noted in the visceral pleura, interlobular septa, and hilum of both lungs. A histologic examination of the lungs showed diffuse and marked dilation of the lymphatic channels in the subpleural, peribronchial, interlobular, and hilar areas. The channels were lined with flattened endothelium, which was immunohistochemically positive for D2-40. In addition, lymphangiectasis was found around the thymus and intra-abdominal organs, but no cardiovascular anomalies were seen. The findings conformed to a primary form of CPL, Noonan Group 3. Although pulmonary interstitial emphysema (PIE) was considered an important differential diagnosis because of the overlapping clinicopathologic features, a giant cell reaction surrounding the interstitial cystic lesions, a histologic hallmark of PIE, was absent in the present case.