Superficial Siderosis After Traumatic Brain Injury: A Case Report

Superficial siderosis (SS) is a rare condition in which chronic accumulation of the blood in the subarachnoid space over time leads to the buildup of hemosiderin deposits, which in turn cause neurological dysfunction in those affected. While reversibility of the damage done by this condition is nearly impossible, early detection can allow for immediate surgical intervention and thus prevent further progression of ataxia, hearing loss, and other neurological deficits caused by SS. We present a case of a 53-year-old male who was successfully diagnosed with SS secondary to a chronic post-traumatic pseudomeningocele and underwent surgical repair with the resolution of his symptoms. We aim to encourage more extensive workups for common neurological dysfunctions such as tinnitus or vertigo in patients who have a history of traumatic brain injury or any significant motor vehicle accidents.

Lumbar Subarachnoid-Peritoneal Shunting Deteriorates Superficial Siderosis Associated with a Dural Defect

Superficial siderosis is a disease in which hemosiderin is deposited under the leptomeninges and subpial layers of hindbrain structures, e.g., the cerebellum, brainstem, and eighth cranial nerve. The main symptoms of superficial siderosis are cerebellar ataxia, hearing loss, cognitive decline, and myelopathy. The activities of daily living of patients with superficial siderosis are severely impaired due to the progressive symptoms. Here, we report a patient with superficial siderosis whose symptoms deteriorated after lumbar subarachnoid-peritoneal (L-P) shunt surgery. She received L-P shunt surgery based on the diagnosis of idiopathic normal pressure hydrocephalus at another hospital. The patient had a history of cervical surgery, and a dural defect was identified at the C4-5 level by a detailed magnetic resonance imaging study. We hypothesized that the L-P shunt reduced cerebrospinal pressure and increased bleeding from the fragile vessels in the dural defect, which might have increased hemosiderin deposition.

Post-Surgical Depositions of Blood Products Are No Major Confounder for the Diagnostic and Prognostic Performance of CEST MRI in Patients with Glioma

Amide proton transfer (APT) and semi-solid magnetization transfer (ssMT) imaging can predict clinical outcomes in patients with glioma. However, the treatment of brain tumors is accompanied by the deposition of blood products within the tumor area in most cases. For this reason, the objective was to assess whether the diagnostic interpretation of the APT and ssMT is affected by methemoglobin (mHb) and hemosiderin (Hs) depositions at the first follow-up MRI 4 to 6 weeks after the completion of radiotherapy. A total of 34 participants underwent APT and ssMT imaging by applying reconstruction methods described by Zhou et al. (APTwasym), Goerke et al. (MTRRexAPT and MTRRexMT) and Mehrabian et al. (MTconst). Contrast-enhancing tumor (CE), whole tumor (WT), mHb and Hs were segmented on contrast-enhanced T1wCE, T2w-FLAIR, T1w and T2*w images. ROC-analysis, Kaplan-Meier analysis and the log rank test were used to test for the association of mean contrast values with therapy response and overall survival (OS) before (WT and CE) and after correcting tumor volumes for mHb and Hs (CEC and WTC). CEC showed higher associations of the MTRRexMT with therapy response (CE: AUC = 0.677, p = 0.081; CEC: AUC = 0.705, p = 0.044) and of the APTwasym with OS (CE: HR = 2.634, p = 0.040; CEC: HR = 2.240, p = 0.095). In contrast, WTC showed a lower association of the APTwasym with survival (WT: HR = 2.304, p = 0.0849; WTC: HR = 2.990, p = 0.020). Overall, a sophisticated correction for blood products did not substantially influence the clinical performance of APT and ssMT imaging in patients with glioma early after radiotherapy.

Nailfold Videocapillaroscopic Alterations as Markers of Microangiopathy in COVID-19 Patients

Nailfold videocapillaroscopic alterations have been described in COVID-19, but their correlations with biomarkers of inflammation, coagulation and endothelial perturbation are still unclear, and no information is available on nailfold histopathology. Nailfold videocapillaroscopy was performed on fifteen patients with COVID-19 in Milan, Italy and the signs of microangiopathy were correlated with plasma biomarkers of inflammation (C reactive protein [CRP], ferritin), coagulation (D-dimer, fibrinogen), endothelial perturbation (Von Willebrand factor [VWF]) and angiogenesis (vascular endothelial growth factor [VEGF]) along with genetic drivers of COVID-19 susceptibility. Histopathological analysis of autoptic nailfold excisions was performed on fifteen patients who died for COVID-19 in New Orleans, United States. All COVID-19 patients studied with videocapillaroscopy showed alterations rarely seen in healthy individuals consistent with microangiopathy, such as hemosiderin deposits (sign of microthrombosis and microhemorrhages) and enlarged loops (sign of endotheliopathy). The number of hemosiderin deposits correlated both with ferritin and CRP levels (r = 0.67, p = 0.008 for both) and the number of enlarged loops significantly correlated with the levels of VWF (r = 0.67, p = 0.006). Ferritin levels were higher in non-O groups, determined by the rs657152 C > A cluster, (median 619, min-max 551-3266 mg/dL) than in the O group (373, 44-581 mg/dL, p = 0.006). Nailfold histology revealed microvascular damage, i.e., mild perivascular lymphocyte and macrophage infiltration and microvascular ectasia in the dermal vessels of all cases, and microthrombi within vessels in five cases. Alterations in nailfold videocapillaroscopy and elevated biomarkers of endothelial perturbation that match histopathologic findings open new perspectives in the possibility of non-invasively demonstrating microangiopathy in COVID-19.

Amyloid-Related Imaging Abnormalities: An Update

Amyloid-related imaging abnormalities (ARIA) is a term introduced in 2010 to encompass a spectrum of MRI findings observed in patients receiving investigational anti-amyloid beta (Aβ) immunotherapies for Alzheimer disease (AD). The entity can be broadly categorized into ARIA characterized by edema and effusion (ARIA-E) and ARIA characterized by microhemorrhages and superficial siderosis (ARIA-H). ARIA typically occurs early in the treatment course and has a higher incidence in patients who are apolipoprotein E ε4 allele carriers. ARIA-E has an additional dose dependence, with higher incidence in patients receiving higher doses of anti-Aβ immuno-therapies. ARIA is often asymptomatic and self-resolving. The recognition of ARIA has implications for patient selection and monitoring for Aβ immunotherapies, and its development can potentially lead to a pause or discontinuation of therapy. The FDA's first approval of an Aβ-targeting monoclonal antibody for AD treatment in 2021 will lead to such therapy's expanded use beyond the clinical trial setting and to radiologists more commonly encountering ARIA in clinical practice. This review explores the theorized pathophysiologic mechanisms for ARIA, describes the MRI findings and grading schemes for ARIA-E and AREA-H, and summarizes relevant Aβ immunotherapies. Through such knowledge, radiologists can optimally impact the management of patients receiving targeted AD therapies.

Bronchoalveolar lavage hemosiderosis in lightly active or sedentary horses

BACKGROUND

Hemosiderophages in bronchoalveolar lavage fluid (BALF) are commonly ascribed to exercise-induced pulmonary hemorrhage (EIPH). Little information exists regarding the presence of these cells in horses that perform light or no work and that are referred for respiratory problems.

OBJECTIVES

Evaluate the presence of hemosiderophages in BALF of horses suspected of respiratory disease without history of or risk factors for EIPH and determine predictors of hemosiderophages in BALF in this population.

METHODS

Observational retrospective cross-sectional study using STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. Bronchoalveolar lavage fluid cytology reports of 353 horses evaluated for respiratory disease between 2012 and 2022 at the Cummings School for Veterinary Medicine were reviewed retrospectively. Horses with a history or likelihood of having performed past strenuous exercise were removed, and the remaining 91 horses were divided into hemosiderin-positive (HSD-POS) and hemosiderin-negative groups based on Perls' Prussian blue staining. Potential predictors for the presence of hemosiderophages in BALF (history, clinical evaluation, baseline lung function, airway reactivity, BALF cytology, and hemosiderin score) were compared between the 2 groups, using univariate and multivariate analyses.

RESULTS

Horses with a diagnosis of severe equine asthma (sEA; odds ratio, 11.1; 95% confidence interval, 3.2-38.5; P < .001) were significantly more likely to be HSD-POS than horses with mild-to-moderate equine asthma.

CONCLUSIONS AND CLINICAL IMPORTANCE

Hemosiderophages were found in the BALF cytology in a subset of horses that perform light or no work and presented for respiratory signs; these cells were found more frequently in horses with sEA. The link between hemosiderophages and sEA highlights previously unstudied pathology associated with this common disease.

Magnetic resonance imaging evidence for subclinical joint bleeding in a Dutch population of people with severe hemophilia on prophylaxis

BACKGROUND

Previous studies suggest that subclinical bleeding occurs in persons with hemophilia.

OBJECTIVES

The aim of this study was to investigate whether patients with lifelong access to prophylaxis showed signs of previous subclinical bleeding on magnetic resonance imaging (MRI) in joints without a history of joint bleeding.

METHODS

This single-center cross-sectional study included persons with severe hemophilia A on prophylaxis, aged 16 to 33 years, with lifetime bleeding records available. Per participant, 1 index joint without a history of joint bleeding was evaluated with 3-Tesla MRI, including hemosiderin sensitive sequences. MRI scans were reviewed according to the International Prophylaxis Study Group (IPSG) additive MRI scale (range, 0-17/joint). Hemosiderin deposits with/without synovial hypertrophy were considered signs of previous subclinical bleeding. Additionally, physical examination was performed, followed by ultrasound examination according to the Hemophilia Early Arthropathy Detection with Ultrasound protocol.

RESULTS

In 43 patients with a median age of 23.5 years, 43 joints (16 elbows, 13 knees, 14 ankles) without reported bleeds were evaluated with MRI. The median IPSG MRI score was 1 (range, 0-9). Signs of previous subclinical bleeding were observed in 7 of 43 joints (16%; 95% CI, 7-30): 7 of 7 joints showed hemosiderin deposits, with concomitant synovial hypertrophy in 2 of 7 joints. MRI changes were accompanied by swelling and ultrasound-detected synovial hypertrophy in 1 ankle only. None of the other joints showed abnormalities at physical examination and ultrasound.

CONCLUSION

In this study, 16% of the joints without reported bleeds showed signs of previous subclinical bleeding, providing evidence for subclinical bleeding in people with severe hemophilia with lifelong access to prophylaxis.

Magnetic Resonance Imaging Features and Misdiagnosis of Spinal Epidural Cavernous Hemangioma

OBJECTIVE

Spinal epidural cavernous hemangiomas (SECHs) are rare, and merely a few have previously been described in case reports. The present study aims to explore the magnetic resonance imaging (MRI) features of SECHs and analyze the causes of their preoperative misdiagnosis.

METHODS

The present retrospective study included 11 patients (three male and eight female patients, mean age ± standard deviation: 47.55±17.39 years old) with histopathologically confirmed SECH between January 2015 and April 2021. The MRI features of SECH were analyzed by two radiologists.

RESULTS

The cervical, thoracic and thoracolumbar segments were involved in 2, 7 and 2 patients, respectively. All lesions grew along the long axis of the spine. The tumors were shuttle-shaped in six patients, oval in two patients, pseudopodia-shaped in one patient, clamp-shaped in one patient, and growing outward along the intervertebral foramen in one patient. Nine SECHs had relatively uniform isointense or hypointense T1-weighted imaging (T1WI) and hyperintense T2-weighted imaging (T2WI) signals. On the T2WI, filamentary low-signal shadows (i.e., the hairline or grid sign) with significant contrast enhancement and asymptotic strengthening were observed. Two SECHs had mixed high and low signals on T1WI and T2WI, with significant heterogeneous enhancement, hemorrhage, and hemosiderin deposition. The SECH was misdiagnosed as meningioma, neurofibromatosis and schwannoma in 1, 1 and 4 patients, respectively, while this was not diagnosed in one patient. The preoperative diagnosis was correct in merely approximately 36% of patients. Among the four patients with a correct preoperative diagnosis, hemosiderin deposition was found in three patients and small tortuous vascular shadows were found in one patient.

CONCLUSIONS

SECH presents as a long spindle-shaped mass, and the "'pen cap sign" is common at the lesion edges. SECH also exhibits a hairline or grid sign on T2WI. Furthermore, some lesions present with hemorrhage and hemosiderin deposition. Therefore, the hairline, grid sign and hemosiderin deposition are valuable diagnostic features of SECH.

Pulmonary bleeding in racehorses: A gross, histologic, and ultrastructural comparison of exercise-induced pulmonary hemorrhage and exercise-associated fatal pulmonary hemorrhage

Exercise-induced pulmonary hemorrhage (EIPH) is a common condition of Thoroughbred racehorses that is usually responsible for reduced performance, while exercise-associated fatal pulmonary hemorrhage (EAFPH) is characterized by severe pulmonary bleeding of unknown pathogenesis resulting in sudden death during strenuous exercise. The aim of the study was to characterize and compare anamnestic data together with pulmonary gross, histologic, and ultrastructural findings in racehorses with EIPH (n = 10), EAFPH (n = 10), and control horses (n = 5). No differences in anamnesis were identified between the 3 groups. Grossly cranial lobe reddening and edema scores were significantly more prevalent and severe in the EAFPH group compared with the EIPH and control groups. Histologically, hemorrhage scores were higher in the EAFPH group, while hemosiderophages, iron encrustations of collagen and elastin fibers, and vascular remodeling scores were significantly higher in EIPH group compared with the EAFPH and control groups. In all groups, caudal lung locations exhibited a significantly higher score for vascular remodeling, hemosiderophage accumulation, iron encrustation, and type II pneumocyte hyperplasia when compared with cranial, dorsal, and ventral locations. Ultrastructural analysis of perivascular collagen showed fibrils with significantly larger diameters in the EAFPH group compared with the EIPH group but not compared with the control group. This study demonstrates that lungs of horses that experienced EAFPH show significantly less vascular remodeling and other long-term pulmonary abnormalities that characterize horses with EIPH.

Desquamative Inflammatory Vaginitis and Plasma Cell Vulvitis Represent a Spectrum of Hemorrhagic Vestibulovaginitis

OBJECTIVE

The aim of the study was to identify whether desquamative inflammatory vaginitis (DIV) and plasma cell vulvitis (PCV) are distinct clinicopathologic entities.

MATERIALS AND METHODS

The pathology database identified biopsies described as "vaginitis" or "vulvitis" occurring in nonkeratinized epithelium or mucocutaneous junction. Exclusions were age less than 18 years, unavailable slides or records, concurrent neoplasia, or histopathology consistent with other entities. Clinical data included demographics, symptoms, examination, microbiology, treatment, and response. Histopathologic review documented site, epithelial thickness and characteristics, infiltrate, and vascular abnormalities. Cases were analyzed according to histopathologic impression of DIV or PCV based on previous pathologic descriptions.

RESULTS

There were 36 specimens classified as DIV and 18 as PCV from 51 women with mean age of 51 years; 3 (6%) had concurrent biopsies with both. Pain was more common in PCV, but rates of discharge, itch, and bleeding were comparable. Rates of petechiae or erythema were similar and vaginal examination was abnormal in 72% of PCV cases. All DIV and 33% of PCV occurred in squamous mucosa; the remaining PCV cases were from mucocutaneous junction. Mean epithelial thickness, rete ridge appearance, exocytosis, and spongiosis were similar in DIV and PCV. Epithelial erosion, wide-diameter lesions, plasma cells, and stromal hemosiderin occurred in both but were more common in PCV. Lymphocyte-obscured basal layer, narrow-diameter lesions, hemorrhage, and vascular congestion were seen in both, but more common and marked in DIV.

CONCLUSIONS

Desquamative inflammatory vaginitis and PCV have overlapping symptoms, signs, and histopathologic features. They may represent a single condition of hemorrhagic vestibulovaginitis with varying manifestations according to location and severity.

Superficial Siderosis of the Central Nervous System Caused by Glioneuronal Tumor: A Case Report and Literature Review

Superficial siderosis is a rare disease resulting from the deposited hemosiderin owing to repeated subarachnoid hemorrhage. It has been reported that hemosiderin deposits on the brain surface and brain parenchyma causes nerve disorder, resulting in progressive and irreversible hearing loss, cerebellar ataxia and pyramidal disorder. The brain tumor is one of the cause of superficial siderosis. A 16-year-old female present a nearby hospital with complaints of absence seizure. A magnetic resonance imaging (MRI) revealed a heterogeneously enhanced mass at the right temporal lobe. Susceptibility-weighted imaging revealed diffuse and extensive superficial siderosis on the brain surface. The tumor was gross totally removed and diagnosed as glioneuronal tumor. The patient had been well, although susceptibility-weighted imaging performed one year after the surgery showed superficial siderosis remained. Early diagnosis and prevention of bleeding sources are recommended to prevent symptom progression associated with superficial siderosis. Susceptibility-weighted imaging is considered useful for early detection of superficial siderosis.

"Pauci-Hemosiderotic" Fibrolipomatous Tumor: A Mimicker of Various Lipomatous Lesions

Hemosiderotic fibrolipomatous tumor is a rare soft tissue tumor that preferentially affects the dorsum of foot, shows recurrent t(1;10) translocation targeting TGFBR3 and OGA (MGEA5) genes, and has a high recurrence potential. Hemosiderin deposits, mature adipocytes, and interspersed spindle cells are the 3 cardinal morphologic features of this tumor. We describe a "pauci-hemosiderotic" example involving the left wrist of a 45-year-old female, posing a diagnostic pitfall. The tumor comprised mature adipose tissue traversed by variably thick fibrous septa containing short fascicles of spindle cells. Prominent small- to medium-sized blood vessels were present, often with perivascular fibrosis or aggregates of foamy histiocytes, sometimes associated with red cell extravasation. Hemosiderin was not conspicuous, but fine deposits could be found focally on careful search and with the aid of Perls stain. The diagnosis was further confirmed by diffuse expression of CD34 and presence of OGA translocation by fluorescence in situ hybridization. Pathologists should be aware that hemosiderin deposition can be scanty and focal in hemosiderotic fibrolipomatous, but the rich vasculature with a "damaged" appearance is a useful diagnostic clue.

The effect of different pollutants exposure on the pigment content of pigmented macrophage aggregates in the spleen of Vardar chub (Squalius vardarensis Karaman, 1928)

Pigmented macrophage aggregates (MAs) are known to change under influence of various factors, such as aging, season, starvation, and/or pollution. In this study, changes in the pigment content of the MAs in the spleen of Vardar chub (Squalius vardarensis, Karaman) (n = 129) collected in spring and autumn, from three rivers with different pollution impact was examined: Zletovska River (metals), Kriva River (metals and municipal wastewater), and Bregalnica River (municipal wastewater). Collected data revealed increased relative volume and number of MAs containing hemosiderin under the influence of metals, significant in autumn (p < .05). In chub exposed to metals combined with municipal wastewater, significant increase of lipochrome accumulation in MAs in autumn, melanin in MAs in fish captured in the spring season, and number of splenic MAs containing combination of melanin and lipochrome was noted. Volumes and number of MAs containing combination of hemosiderin and lipochrome increased in spleen of fish captured in autumn from both Zletovska River and Kriva River, most likely due to the contribution of hemosiderin and lipochrome, respectively. Values measured for the various pigments in splenic MAs in fish captured from Bregalnica River, were overall closer to the values measured for fish captured from Kriva River. Notably, melanin and lipochrome are more likely to be found in fish from waters influenced by municipal wastewater (organic pollution) and hemosiderin in fish spleen from water influenced by mining activity (heavy metals pollution).

Histopathological changes in myocardial tissue due to coronary venous hypertension

Introduction

In chronic venous insufficiency (CVI), an increase in venous pressure causes the passage of intravascular blood cells and molecules into the surrounding tissues and induces histopathological changes in the lower extremities, leading to increased pigmentation in the legs, ulceration, and tissue loss to various degrees. This study aimed to investigate whether an increase in venous pressure in the coronary veins can lead to the aforementioned histopathological changes.

Material and methods

Twenty-four New Zealand rabbits were divided into the following three groups: experimental model of coronary venous hypertension (CVH) (n = 8), sham group (n = 8), and control group (n = 8). After 21 days postoperatively, tissue samples from each group were compared for perivascular inflammation, erythrocyte extravasation, macrophage infiltration, and hemosiderin deposits by histopathological scoring under a light microscope. Matrix metalloproteinase-2 (MMP-2) activation was evaluated using immunohistochemical staining.

Results

In the CVH group, hemosiderin accumulation was significantly higher than in the sham and control groups (1.0 (1.0-3.0), 0.0 (0.0-1.0), 0.0 (0.0-0.0); p < 0.001). Immunohistochemically, in the CVH group, MMP-2 levels were significantly higher than in the sham and control groups (2.0 (1.0-3.0), 0.0 (0.0-1.0), 0.0 (0.0-0.0); p < 0.001).

Conclusions

This experimental study showed for the first time the histopathological and immunohistochemical changes in myocardial tissue, similar to those observed in CVI, as a result of increased coronary venous pressure due to coronary vein ligation. Further studies are needed to understand the clinical implications of these results.

Advanced magnetic resonance imaging of cartilage components in haemophilic joints reveals that cartilage hemosiderin correlates with joint deterioration

INTRODUCTION

Evidence suggests that toxic iron is involved in haemophilic joint destruction.

AIM

To determine whether joint iron deposition is linked to clinical and imaging outcomes in order to optimize management of haemophilic joint disease.

METHODS

Adults with haemophilia A or haemophilia B (n = 23, ≥ age 21) of all severities were recruited prospectively to undergo assessment with Hemophilia Joint Health Scores (HJHS), pain scores (visual analogue scale [VAS]) and magnetic resonance imaging (MRI) at 3T using conventional MRI protocols and 4-echo 3D-UTE-Cones sequences for one affected arthropathic joint. MRI was scored blinded by two musculoskeletal radiologists using the International Prophylaxis Study Group (IPSG) MRI scale. Additionally, UTE-T2* values of cartilage were quantified. Correlations between parameters were performed using Spearman rank correlation. Two patients subsequently underwent knee arthroplasty, which permitted linking of histological findings (including Perl's reaction) with MRI results.

RESULTS

MRI scores did not correlate with pain scores or HJHS. Sixteen joints had sufficient cartilage for UTE-T2* analysis. T2* values for cartilage correlated inversely with HJHS (r_s  = -0.81, P < 0.001) and MRI scores (r_s  = -0.52, P = 0.037). This was unexpected since UTE-T2* values decrease with better joint status in patients with osteoarthritis, suggesting that iron was present and responsible for the effects. Histological analysis of cartilage confirmed iron deposition within chondrocytes, associated with low UTE-T2* values.

CONCLUSIONS

Iron accumulation can occur in cartilage (not only in synovium) and shows a clear association with joint health. Cartilage iron is a novel biomarker which, if quantifiable with innovative joint-specific MRI T2* sequences, may guide treatment optimization.

Estimation on Formation Time of Thrombus

OBJECTIVES

To observe the changes of the formation time of venous thrombus in rats, and to provide new ideas and methods for the estimation on thrombus formation time of the forensic cases died from thrombosis.

METHODS

Totally 80 rats were randomly divided into 10 groups （0 h, 3 h, 6 h, 12 h, 1 d, 3 d, 1 week, 2 weeks, 3 weeks and 4 weeks after operation）. A vein thrombosis model was established by the "narrow" method. The processes of thrombosis, organization, recanalization and the features of change on hemosiderin and calcium salt were observed by HE stain, Perls stain and Von Kossa stain. The expression changes of CD61, α-SMA and CD34 were observed by immunohistochemical staining technique.

RESULTS

Platelets adhered to the exposed blood vessel intima 3 h after operation, and platelet trabeculae were formed by the repeated accumulation of platelets 1 d after operation. The thrombus organization formed through the fibroblasts from vessel wall that grew into the interior of the thrombus 3 d after operation. Endothelial cells covered the surface of thrombus and then the new blood vessels were reformed, and the vessels were reconstructed. The expression of CD61 upregulated at the stages of the thrombus formation （3 h） and thrombus reformation （4 weeks）, and reached the peak 1 d after thrombus formation. The release of hemosiderin and the initial expression of α-SMA were detected 3 d later. Calcium deposit and expression of CD34 were observed 1 week later.

CONCLUSIONS

The hemosiderin, calcium salt, CD61, α-SMA and CD34 show time-dependent changing characteristics, which is expected to provide a reference for the estimation on thrombus formation time of the forensic cases died from thrombosis.

Label-free imaging of hemoglobin degradation and hemosiderin formation in brain tissues with femtosecond pump-probe microscopy

The degradation of hemoglobin in brain tissues results in the deposition of hemosiderin, which is a major form of iron-storage protein and closely related to neurological disorders such as epilepsy. Optical detection of hemosiderin is vitally important yet challenging for the understanding of disease mechanisms, as well as improving surgical resection of brain lesions. Here, we provide the first label-free microscopy study of sensitive hemosiderin detection in both an animal model and human brain tissues. Methods: We applied spectrally and temporally resolved femtosecond pump-probe microscopy, including transient absorption (TA) and stimulated Raman scattering (SRS) techniques, to differentiate hemoglobin and hemosiderin in brain tissues. The label-free imaging results were compared with Perls' staining to evaluate our method for hemosiderin detection. Results: Significant differences between hemoglobin and hemosiderin transient spectra were discovered. While a strong ground-state bleaching feature of hemoglobin appears in the near-infrared region, hemosiderin demonstrates pure excited-state absorption dynamics, which could be explained by our proposed kinetic model. Furthermore, simultaneous imaging of hemoglobin and hemosiderin can be rapidly achieved in both an intracerebral hemorrhage (ICH) rat model and human brain surgical specimens, with perfect correlation with Perls' staining. Conclusion: Our results suggest that rapid, label-free detection of hemosiderin in brain tissues could be realized by femtosecond pump-probe microscopy. Our method holds great potential in providing a new tool for intraoperative detection of hemosiderin during brain surgeries.

Dermoscopy of granuloma faciale: a description of a new finding

Granuloma faciale is a rare, chronic dermatologic disorder, which mainly affects the face. Recently, dermoscopy has been demonstrated as an important ancillary tool on the clinical diagnosis of facial dermatoses. We report two cases of granuloma faciale with yellow areas on dermoscopy that was not yet described in the literature, corresponding to abundant hemosiderin on histopathological examination.

Antiplatelet Therapy, Cerebral Microbleeds, and Intracerebral Hemorrhage: A Meta-Analysis

BACKGROUND AND PURPOSE

Antiplatelet therapy is associated with the presence of cerebral microbleeds (CMBs) with limited studies. We further investigate the topic focusing on different effects of antiplatelet therapy on strict lobar and deep/infratentorial MBs.

METHODS

We searched PubMed and EMBASE from January 1, 1997 to December 1, 2017, for relevant studies, calculated the pooled odds ratios (OR) for CMB incidence and distribution (strictly lobar, deep/infratentorial) in antiplatelet users versus nonantiplatelet users and calculated the OR for the incidence of intracerebral hemorrhage in antiplatelet users with CMBs versus those without.

RESULTS

We included 20 988 participants from 37 studies. CMBs were more frequent in antiplatelet users than those in nonantiplatelet users (pooled OR, 1.21; 95% confidence interval, 1.07-1.36; P=0.002). There was a significant association of antiplatelet therapy with strictly lobar MBs (OR, 1.45; 95% confidence interval, 1.15-1.84; P=0.002) rather than deep/infratentorial MBs (OR, 1.37; 95% confidence interval, 0.98-1.90; P=0.062). Intracerebral hemorrhage incidence was higher in participants with CMBs than those without CMBs (OR, 3.40; 95% confidence interval, 2.00-5.78; P=0.000) in antiplatelet users.

CONCLUSIONS

Antiplatelet drug use was associated with increased risk of strictly lobar MBs and increased the intracerebral hemorrhage incidence in participants with CMBs.

T2-hypointense rim of breast mass lesions on magnetic resonance images: Radiologic-pathologic correlation

We investigated the radiologic-pathologic correlation of a strong hypointense rim on T2-weighted images (T2-hypo-rim) surrounding breast mass lesions and evaluated its clinical significance. We retrospectively reviewed 3503 consecutive breast magnetic resonance imaging (MRI) examinations. The T2-hypo-rim was defined as a border of strong hypointensity compared with the fat signal on fat-suppressed T2-weighted images. Detected lesions with T2-hypo-rim were classified as a solid or cystic mass with MRI and correlated with histopathologic findings. Sixty-two masses (2%; 34 solid, 28 cystic) with T2-hypo-rim were detected [44 breast cancers, 18 benign lesions, including 15 (24%) papillary tumors]. Patients with cancer were significantly older than those with benign lesions (P = .002). Breast cancers were significantly larger than benign masses (P = .023). In 49 of 62 lesions (24 solid and 16 cystic cancers; three solid and six cystic benign masses), the rims were accurately correlated with the histopathologic findings. All malignant and benign cystic masses exhibited hemosiderin deposits in the cyst walls. However, 22 of 24 solid cancers and no solid benign masses exhibited hemosiderin at the tumor periphery (92% and 0%, respectively, P < .001). In addition, a thick fibrous capsule was present in nine (38%) of 24 solid cancers and none of the solid benign lesions. Strong T2-hypo-rims mostly correlated with hemosiderin deposits and/or sometimes fibrous capsules. Although the rims could not distinguish malignant from benign cystic lesions, they indicated malignancy in solid mass lesions on MRI. Additionally, the rims often indicated papillary tumors.

Differentiation between papillary renal cell carcinoma and fat-poor angiomyolipoma: a preliminary study assessing detection of intratumoral hemorrhage with chemical shift MRI and T2*-weighted gradient echo

Background Recent literature suggests that intratumoral hemorrhage detection may be helpful in differentiating papillary renal cell carcinoma (pRCC) from fat-poor angiomyolipoma (fpAML). Purpose To determine whether intratumoral hemorrhage detected using chemical shift magnetic resonance imaging (MRI) and T2*-weighted (T2*W) gradient echo (GRE) can be used to differentiate pRCC from fpAML. Material and Methods This retrospective study included 42 patients with pRCC (n = 28) and fpAML (n = 14) who underwent MRI followed by surgery. Two blinded radiologists independently assessed the presence of intratumoral hemorrhage using chemical shift MRI (decrease in signal intensity from opposed- to in-phase) and T2*W GRE ("blooming"). Consensus reading was determined for discrepant cases. MRI findings were compared using Chi-square test. Inter-observer agreement was assessed using kappa statistics. Results Inter-observer agreement was substantial for both sequences ( k = 0.622 and 0.793, P < 0.001). For chemical shift MRI, the prevalence of intratumoral hemorrhage was significantly greater in pRCC than in fpAML (71.4% versus 28.6%, P = 0.019 for reader 1; 64.3% versus 14.3%, P = 0.003 for reader 2; and 75% versus 21.4%, P = 0.002 for the consensus). T2*W GRE showed a similar tendency (46.4% versus 14.3%, P = 0.049 for both readers; and 50% versus 14.3%, P = 0.042 for the consensus). Using the consensus reading, sensitivity and specificity of determining pRCC were 75% and 78.6% for chemical shift MRI and 50% and 85.7% for T2*W GRE. Conclusion The prevalence of intratumoral hemorrhage identified from chemical shift MRI or T2*W GRE was significantly different between pRCC and fpAML. These hemorrhage-sensitive MRI sequences may be used as an adjunctive tool for discriminating between the two entities.

Primary hemosiderotic fibrolipomatous tumor in bone: a case report and review of the literature

Background and aim: Hemosiderotic fibrolipomatous tumor (HFLT) is a locally invasive tumor composed of mature adipocytes accompanied by spindle cells containing hemosiderin deposition. In 2013, it was categorized by WHO as a soft tissue tumor with uncertain differentiation. So far, the literature has reported 60 cases but primary HFLT in bone has never before been reported. We set out to investigate the clinicopathological features of primary HFLT in bone. Methods: We retrospectively reviewed the clinical, imaging, histological, and immunophenotypic features and treatment of 1 case of primary HFLT in bone, and combined this with literature discussion. Results: HFLT occurred in the lateral femoral condyle of a 50-year-old male patient, which might have been overlooked were it not for the knee-joint pain and dysfunction. CT and MRI showed osteolytic bone destruction with a clear 4.0-cm diameter boundary, diagnosed as cystic damage of the lateral condyle of the left femur. SPECT metabolism was not active. Histologically, the lesion was composed of different proportions of mature fat cells, spindle cells, and hemosiderin. Immunohistochemistry revealed spindle cells expressing vimentin, p63, but not CD34, calponin, and others. The tumor tissue was thoroughly removed by curetting, and a bone graft was carried out after immersion in anhydrous ethanol. At the 11-month postoperative follow-up, the patient was recovering well. Conclusions: Primary HFLT in bone is extremely rare. In imaging, it can easily be misdiagnosed as a bone cyst. Histological morphology of the current case is similar to that of soft tissue HFLT.

Adult moyamoya disease associated with abundant phosphorylated tau accumulation in the brainstem: Report of a case with autopsy findings

We report the case of a 72-year-old Japanese woman with moyamoya disease (MMD). She experienced her first intracerebral hemorrhage (ICH) at the age of 32 years, and had nine ICHs and/or intraventricular hemorrhages during the following 40 years. Cerebral angiograms and vascular pathologies at autopsy confirmed that the patient suffered from MMD. Macroscopically, there were brown-colored changes in the subarachnoid space, mainly at the base of the brain and around the cerebellar hemispheres. Microscopically, hemosiderin deposits were observed mainly in the old hemorrhagic lesions and on the surface of the brainstem and cerebellum. Many AT8-immunoreactive neurons and neurites were observed in the pons and midbrain, mainly in the locus ceruleus and reticular formation in the midbrain. Several AT8-immunoreactive neurons and neurites were positive for Gallyas silver staining. A few tiny and short AT8-immunoreactive processes were observed in the molecular, Purkinje cell and granular layers of the cerebellum. There were a few phosphorylated tau accumulations in the cerebrum without senile plaques. Lewy pathologies and transactive response DNA-binding protein 43 kDa proteinopathy were not detected. We suspect that oxidative stress after repeated bleedings with long-term courses in the ventricles and subarachnoid space may accelerate phosphorylated tau accumulation in the brainstem. To our knowledge, this is the first report of MMD with tauopathy in the brainstem.

Prevalence and Natural History of Superficial Siderosis: A Population-Based Study

BACKGROUND AND PURPOSE

Superficial siderosis (SS) is characterized by hemosiderin deposition in the superficial layers of the central nervous system and can be seen during postmortem examination or with iron-sensitive magnetic resonance imaging techniques. The distribution of SS may predict the probable underlying cause. This study aimed to report the prevalence and natural history of SS in a population-based study.

METHODS

Brain magnetic resonance imaging scans from the MCSA (Mayo Clinic Study of Aging), a population-based study of residents 50 to 89 years of age in Olmsted County, Minnesota, were reviewed. Participants with imaging consistent with SS were identified from 2011 through 2016. An inverse probability weighting approach was used to convert our observed frequencies to population prevalence of SS. Additional data abstracted included amyloid positron emission tomography, Apolipoprotein E genotype, coexisting cerebral microbleeds, and extent of SS.

RESULTS

A total of 1412 participants had eligible magnetic resonance imaging scans. Two participants had infratentorial SS, restricted to the posterior fossa. Thirteen participants had cortical SS involving the cerebral convexities (7 focal and 6 disseminated). Only 3 of the participants with cortical SS (23%) also had cerebral microbleeds. The population prevalence of SS was 0.21% (95% confidence interval, 0-0.45) in those 50 to 69 years old and 1.43% (confidence interval, 0.53-2.34) in those over 69 years old. Apolipoprotein E ε2 allele was more common in those with SS (57.1% versus 15.0%; P<0.001). Compared with participants without SS, those with SS were also more likely to have a positive amyloid positron emission tomographic scan (76.9% versus 29.8%; P<0.001).

CONCLUSIONS

SS may be encountered in the general elderly population. The association with increased amyloid burden and Apolipoprotein E ε2 genotype supports cerebral amyloid angiopathy as the most common mechanism. Longitudinal follow-up is needed to evaluate the risk of subsequent hemorrhage in cases of incidentally discovered SS.

Higher Flow Is Present in Unruptured Arteriovenous Malformations With Silent Intralesional Microhemorrhages

BACKGROUND AND PURPOSE

Silent microhemorrhage (hemosiderin) has been observed in resected brain arteriovenous malformations (bAVM) tissue and may represent a subgroup at increased risk for clinical hemorrhage. Previous studies suggest that ruptured bAVMs have faster flow and shorter mean transit time of contrast in blood vessels than unruptured bAVMs. We hypothesized that flow would be faster in unruptured AVMs with hemosiderin compared with those without hemosiderin.

METHODS

We selected unruptured, supratentorial bAVMs >3.5 cc with pathology specimens. Hemodynamic features were evaluated using color-coding angiography, including contrast mean transit time of AVM nidus, time to peak (TTP) of feeding artery (FA) and draining vein (DV), and the ratio (TTP DV/FA). Characteristics of 9 cases with hemosiderin and 16 without hemosiderin were compared using 2-sample t tests and Fisher exact tests.

RESULTS

No difference in FA TTP and DV TTP was observed between groups. However, cases with hemosiderin had significantly shorter mean transit time compared with those without hemosiderin (1.11±0.28 versus 1.64±0.55 seconds; P=0.013) and a lower ratio of DV TTP/FA TTP (1.48±0.32 versus 1.94±0.61; P=0.045). Presence of venous varix was significantly associated with hemosiderin (P=0.003). No other clinical or angioarchitectural factors were associated with hemosiderin.

CONCLUSIONS

Shorter mean transit time through the AVM nidus, lower DV TTP/FA TTP, and the high prevalence of venous varices suggests that high flow is an important feature of unruptured bAVMs with hemosiderin.

Buffered Romanowsky-Giemsa method for formalin fixed, paraffin embedded sections: taming a traditional stain

Romanowsky-Giemsa (RG) stains were devised during the 19th century for identifying plasmodia parasites in blood smears. Later, RG stains became standard procedures for hematology and cytology. Numerous attempts have been made to apply RG staining to formalin-fixed paraffin-embedded tissue sections, with varied success. Most published work on this topic described RG staining methods in which sections were overstained, then subjected to acid differentiation; unfortunately, the differentiation step often caused inconsistent staining outcomes. If staining is performed under optimal conditions with control of dye concentration, pH, solution temperature and staining time, no differentiation is required. We used RG and 0.002 M buffer, pH 42, for staining and washing sections. All steps were performed at room temperature. After staining and air drying, sections were washed in 96-100% ethanol to remove extraneous stain. Finally, sections were washed in xylene and mounted using DPX. Staining results were similar to routine hemalum and eosin (H & E) staining. Nuclei were blue; intensity depended largely on chromatin density. RNA-rich sites were purple. Collagen fibers, keratin, muscle cells, erythrocytes and white matter of the central nervous system were stained pinkish and reddish hues. Cartilage matrix, mast cell granules and areas of myxomatous degeneration were purple. Sulfate-rich mucins were stained pale blue, while those lacking sulfate groups were unstained. Deposits of hemosiderin, lipofuscin and melanin were greenish, and calcium deposits were blue. Helicobacter pylori bacteria were violet to purple. The advantages of the method are its close similarity to H & E staining and technical simplicity. Hemosiderin, H. pylori, mast cell granules, melanin and specific granules of different hematopoietic cells, which are invisible or barely distinguishable by H & E staining, are visualized. Other advantages over previous RG stains include shorter staining time and avoidance of acetone.

Renal Manifestations in Paroxysmal Nocturnal Hemoglobinuria

Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired chronic disorder characterized by a triad of clinical features - hemolytic anemia, pancytopenia, and thrombosis. Not many reports of renal involvement in PNH are available in literature. We present a case series of PNH with renal involvement. We present the data of PNH patients who attended to Departments of General Medicine and Nephrology at a government-run tertiary care institute in South India. The diagnosis of PNH in these patients during initial phase, between 1998 and 2004 was based on sucrose lysis and Ham's test. After 2004, the diagnosis was based on flow cytometry to detect CD59 (membrane inhibitor of reactive lysis), a glycoprotein, and CD55 (decay accelerating factor) in regulation of complement action. The patient data were collected from 1998 to 2014. There were 14 patients of PNH in this period. The mean age was 37 years and the range was 16–68 years. There were eight females. Acute kidney injury (AKI) was noted in six patients. Dialysis was performed in four of them. The mean serum creatinine and urea at the initiation of dialysis were 5.4 ± 0.6 and 64.1 ± 6.1 mg/dl, respectively. The median number of hemodialysis sessions done was four. Renal biopsy was done in four patients. In three patients, the urinalysis and serum chemistry were suggestive of Fanconi syndrome. In our patients, three renal manifestations of PNH were identified. They were AKI, renal vessel thrombosis, and Fanconi syndrome. Chronic renal failure was not identified.

Glandular Odontogenic Cyst: The Value of Intraepithelial Hemosiderin

Glandular odontogenic cyst (GOC) is a relatively rare but well-described clinicopathologic entity. Its rarity and unpredictable clinical behavior are challenging to managing clinicians. Its variable and overlapping histomorphologic features are also diagnostically challenging for pathologists. Other odontogenic cysts and oral cystic neoplasms can simulate GOC. There are specific histologic criteria that help distinguish GOC from other mimickers. To our knowledge, the phenomenon of hemosiderin pigments deposition within the lining glandular epithelium of GOC has not been covered in detail or specifically reported so far in the literature. We report a case of nontraumatized anterior mandibular GOC in a middle-aged male, which histologically showed hemosiderin pigments within the lining epithelium without stromal siderophages. This finding might reflect a nonspecific spontaneous intraluminal hemorrhage. However, intraepithelial hemosiderin in GOC may be an additional helpful diagnostic clue of GOC in challenging cases since this phenomenon has not been reported in other mimicker cystic lesions.

Accumulation of brown pigment-laden macrophages associated with vascular lesions in the lungs of cynomolgus monkeys(Macaca fascicularis)

Accumulation of macrophages containing brown pigments in the lungs is a well-known spontaneous lesion found in cynomolgus monkey. However, its pathogenesis has not been clearly described. In our survey, brown pigment-laden macrophages were found in the lungs of 4 out of 43 cases. Brown pigments were mostly found in the macrophages of the perivascular interstitium, which proved to be hemosiderin. Some small- to medium-sized vessels that exhibited prominent accumulation of brown pigment-laden macrophages showed degeneration and necrosis of the smooth muscle cells of tunica media. Furthermore, ruptures of the internal and external elastic laminae were seen in some of the vessels. These findings suggested that partial fragmentation of the vascular elastic lamina followed by degeneration and necrosis of the tunica media caused blood leakage leading to the accumulation of hemosiderin-laden macrophages in the perivascular interstitium of the lungs.

Intracranial hemorrhage detection over time using susceptibility-weighted magnetic resonance imaging

BACKGROUND

The reliable detection of intracranial hemorrhages is important, but just 1 year after the hemorrhage onset it might be missed using T2-weighted spin-echo and gradient-echo sequences. Susceptibility-weighted imaging (SWI) is a new magnetic resonance imaging sequence that is extremely sensitive in hemorrhage detection and that might improve the detection of hemorrhages over time.

PURPOSE

To investigate whether the detectability of intracranial blood and its degradation products is independent of the time span after intracranial hemorrhage using SWI.

MATERIAL AND METHODS

Sixty-six consecutive patients (28 men, 38 women) with definitely known time point of intracranial hemorrhage and available SWI sequence (1.5 or 3 T) were analyzed retrospectively. Twenty-one patients had a SWI follow-up. All SWI images were assessed by two radiologists in consensus regarding hemorrhage visibility using a 5-point scale. Statistical analysis was performed using Spearman's correlation test.

RESULTS

Median time interval between hemorrhage and first available SWI measurement was 819 days (range, 0 days to 13.2 years). Nine of 66 patients had an isolated subarachnoid hemorrhage (iSAH) and were therefore analyzed separately. In eight of these nine patients the hemorrhage could clearly be detected, the remaining one had minor iSAH. Spearman analysis showed no significant correlation between time span and visibility (P = 0.660). In the remaining 57 patients (no iSAH) the hemorrhage was always visible achieving at least 3/5 points on the 5-point scale, and Spearman's analysis revealed only a weak correlation between time span and visibility (r = 0.493, P < 0.001).

CONCLUSION

The detectability of blood and its degradation products using SWI is reliably possible over a long period after intracranial hemorrhage.

The importance of hemosiderin deposition in the infant brain: an autopsy study

BACKGROUND/AIM

Iron is an essential element involved in many metabolic processes. Presence and accumulation of iron in various body systems can result in different outcomes. Its accumulation in the central nervous system (CNS) cannot be detected routinely by application of hematoxylin-eosin staining. Detection of the presence of hemosiderin in the brain and cerebellum by application of Perls' dye is of importance in cases of infant deaths.

MATERIAL AND METHODS

In this study, brain and cerebellar specimens obtained from 52 eligible infants  (aged 0-1 years) autopsied in our institute between the years 2010 and 2013, independent of the cause of death, were analyzed in order to detect possible presence of hemosiderin. Perls' dye was used to detect histopathological staining intensity and distribution of hemosiderin in the brain and cerebellum.

RESULTS

Cases did not differ significantly as for the patients' age and gender (p =0.473), type of the culprit trauma (p =0.414), death/crime scene (p =0.587), and diagnosis groups (p =0.550). In this autopsy study blue colored hemosiderin granulations, stained with Perls' dye were detected in the brain (n: 39, 75%), and cerebellum (n: 35, 67.3%). A weakly negative, but significant correlation was detected between the postmortem interval and intensity values of cerebellar hemosiderin (Spearman's correlation coefficient: -0.381, p =0.024). A statistically significant difference was found between the distribution scores of cerebral hemosiderin in cases with and without trauma history (p =0.03). Median cerebral hemosiderin distribution scores were 2.5 and 2, respectively.

CONCLUSIONS

The detection of a correlation between the presence of cerebral and cerebellar hemosiderin, and postmortem interval in the age group of 0-1 years, should be interpreted as an important finding in the analysis of cerebral iron. The presence of hemosiderin in the CNS may be a significant finding in the elucidation of infant deaths and this procedure should be carried out on a routine basis.Hippokratia 2015; 19 (2):164-171.

Vascular alterations in schwannoma

Schwannomas or neurilemmoma are benign peripheral nerve sheath tumors, which most frequently occur at the cerebellopontine angle. This morphologic study examines vascular alterations in these tumors, comparing them to other benign spindle cell neoplasms of the nervous system, while correlating these findings with evidence of vascular permeability. Thirty-four nervous system spindle cell neoplasms, sixteen schwannomas, nine fibroblastic/transitional meningiomas and nine peripheral neurofibromas were stained with H&E, Prussian-blue stain, and immunoreacted for factor VIII-related antigen and interstitial albumin. Schwannomas had focal clusters of vascular proliferation including groups of small thin-walled vessels, as well as larger vessels with extensive hyalinization. Neurofibromas and meningiomas almost uniformly had modest numbers of well-defined, thin walled individual vessels. Free hemosiderin and hemosiderin-laden macrophages were frequently identified in schwannomas. Prussian-blue stain for iron revealed focal or fairly widespread positivity in almost all schwannomas, only one meningioma and none of the neurofibromas. Immunoreaction for albumin demonstrated leakage of vascular proteins into the interstitium confirming tumor vessel permeability in schwannomas. Neither neurofibromas nor meningiomas displayed any detectable interstitial albumin. The above findings confirm a degree of reactive proliferation of vessels in schwannoma along with functional deficits in their vascular integrity with permeability to protein and blood. The presence of hyalinized vessels, hemosiderin, both free and within macrophages, and more readily evident Prussian blue staining, may provide an additional diagnostic clue in discriminating between histologically similar spindle cell lesions. The study however raises the possibility that these changes likely precede or facilitate the degenerative 'ancient change' seen in some schwannoma.

Cytologic features of pigmented atypical meningioma mimicking melanoma on intraoperative crush preparations

Pigmented tumors rarely arise in the meninges, and when they do, these are mainly melanocytomas or melanomas. We describe the cytologic findings of atypical meningioma with intratumoral hemosiderin pigment mistaken for spindle cell melanoma in a 33-year-old male patient during intraoperative consultation. Preoperative radiologic images revealed a cystic meningeal mass with intratumoral hemorrhage. The crush preparation demonstrated cellular smears of syncytial clusters as well as fascicles of large pleomorphic spindle cells with discrete cytoplasmic brown pigment. Detection of cytoplasmic brown pigment and a preponderance of large spindle cells with nuclear pleomorphism led to a diagnosis of spindle cell melanoma on intraoperative cytology. Histopathologic examination displayed high cellularity, nuclear pleomorphism with prominent nucleoli, and foci of spontaneous necrosis. In addition, there were areas showing classic meningotheliomatous meningioma features. Altogether, the histologic findings were consistent with atypical meningioma. The cytoplasmic pigment in the tumor cells was confirmed to be hemosiderin using special stains and immunohistochemistry. To the best of our knowledge, this is the first case report describing cytomorphology of atypical pigmented meningioma. We discuss the differential diagnosis in intraoperative cytology and a possible mechanism related to intratumoral hemosiderin deposition in meningiomas.

Induction of hyperhomocysteinemia models vascular dementia by induction of cerebral microhemorrhages and neuroinflammation

Vascular dementia (VaD) is the second leading cause of dementia behind Alzheimer's disease (AD) and is a frequent comorbidity with AD, estimated to occur in as many as 40% of AD patients. The causes of VaD are varied and include chronic cerebral hypoperfusion, microhemorrhages, hemorrhagic infarcts, or ischemic infarcts. We have developed a model of VaD by inducing hyperhomocysteinemia (HHcy) in wild-type mice. By placing wild-type mice on a diet deficient in folate, B6, and B12 and supplemented with excess methionine, we induced a moderate HHcy (plasma level homocysteine 82.93 ± 3.561 μmol). After 11 weeks on the diet, the hyperhomocysteinemic mice showed a spatial memory deficit as assessed by the 2-day radial-arm water maze. Also, magnetic resonance imaging and subsequent histology revealed significant microhemorrhage occurrence. We found neuroinflammation induced in the hyperhomocysteinemic mice as determined by elevated interleukin (IL)-1β, tumor necrosis factor (TNF)α, and IL-6 in brain tissue. Finally, we found increased expression and increased activity of the matrix metalloproteinase 2 (MMP2) and MMP9 systems that are heavily implicated in the pathogenesis of cerebral hemorrhage. Overall, we have developed a dietary model of VaD that will be valuable for studying the pathophysiology of VaD and also for studying the comorbidity of VaD with other dementias and other neurodegenerative disorders.

Hemosiderotic clear-cell acanthoma: a pigmented mimicker

The authors report on a case of a 65-year-old man with pigmented clear-cell acanthoma located on the right thigh. Dermoscopy disclosed a peculiar picture consisting of diffuse black pigmentation with a superficial greyish veil in the central portion, dotted-to-globular dark red-black structures mainly located at the periphery with a homogenous regular reticular arrangement; peripheral translucid desquamation. Dermoscopic features are correlated with the histology, where hemosiderin deposits present in a sheet-like arrangement in the perivascular papillary dermis and in a band-like disposition in the reticular dermis at the base of the lesion can account for the pigmented picture. The lesion arose on a trauma-prone skin site; thus the authors believe that traumatic irritation may be responsible for the clinical and dermoscopic pictures, giving rise to a reaction similar in a way to the Auspitz's sign provocated by trauma for psoriasis. Red blood cells extravasation from extremely superficialized capillaries may have led to hemosiderin deposition in the papillary and the reticular dermis.

Hemosiderotic fibrohistiocytic lipomatous lesion: case report and review of the literature

CONTEXT

Lesions of the adipose tissue are the most common type of soft-tissue lesion among adults.

CASE REPORT

We describe the case of a 33-year-old female patient with a soft-tissue lesion in her left knee that was diagnosed as a hemosiderotic fibrohistiocytic lipomatous lesion. This type of lesion, which was described for the first time in 2000, preferentially affects the ankle region of middle-aged women with a history of previous local trauma. Lesion recurrence is common, caused by incomplete resection, although there have not yet been any reports of metastases. After a review of the literature, we describe the clinical, radiological, morphological and immunohistochemical characteristics, along with their main differential diagnoses.