We describe the clinical course of a 20-year-old man who suffered generalized convulsive seizures with postictal aphasia and hemiparesis of the right side. Computed tomography (CT) displayed a left postcentral lesion with prominent perifocal edema and only a little contrast medium enhancement. The completely removed tumor proved to be a primary cerebral non-Hodgkin lymphoma consisting of T-cells. Only ten days after the operation the patient once more presented a clinical deterioration. A nuclear magnetic resonance imaging (MRI) displayed an annular structure in the area previously operated upon, suspected to be an abscess. The second operation disclosed a large recurrence of the primary T-cell lymphoma extending diffusely into the white matter. On account of the rapid recurrence, a whole brain irradiation was started twelve days after the second operation. Four cycles of chemotherapy followed. Immunohistochemical studies of the anaplastic large lymphoma cells showed staining with the pan T-cell markers (UCHL1, CD3) and with the CD30 (Ki-1) antibody. The B-cell markers (L26, LN1) were negative. The EMA (epithelial membrane antigen) was only partially expressed. Further investigation excluded the presence of systemic lymphoma manifestation. 24 months after the last operation the patient remained free of symptoms. The last MRI displayed no evidence for the recurrence of a lymphoma. In reference to this unusual clinical course the few previously reported cases of the extremely rare primary cerebral T-cell lymphoma are reviewed.

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Rabies encephalitis: immunohistochemical investigations.

Three cases of human rabies encephalitis were studied immunohistochemically using a specific antiserum to rabies ribonucleoprotein (RNP) and the peroxidase-antiperoxidase method. In this way, RNP could be specifically demonstrated in all cerebral regions and the spinal cord with a predilection for virus attack on the diencephalon and the brain stem according to the clinical course of the disease, and possibly reflecting the phenomenon of pathoclisis. Virus antigen was mainly present in the nerve cell bodies and processes, and in glial cells, especially in the interfascicular oligodendroglia, which seems to be a route of rabies virus infection in the later course of this fatal disease. Immunohistochemically, virus antigen was not limited to the Negri bodies: it was also traceable in the cytoplasm. Altogether, many more virus infected cells were established by immunostaining than were to be expected by the presence of Negri bodies in hematoxylin-eosin stained sections.

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PubMedDate not supplied

Multiple sclerosis and cerebral tumor.

Two cases of long-standing multiple sclerosis (MS) are presented. During the course of this disease signs of a space-occupying lesion in the brain developed. An astrocytoma was diagnosed by biopsy in both patients. A later postmortem examination in one of them revealed a diffuse glioma with extension of tumor cells into the brain stem and cerebellum. Current opinions on the development of cerebral gliomatous tumors and of malignant lymphomas in patients with MS are discussed. Recent immunopathologic aspects are considered.

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