Steve Leber and Pat Robertson's patient with increased ICP.
Impression: Well-organized granulomatous inflammation with giant cells
and hyalinized necrosis with scattered
microcalcifications. See description below.
Movat, iron, Fite, Brown-Hopps, GMS, type IV collagen, S-100 protein, HSV1, MIB-1, CD1A, and CD68 stains on sections of block one show the aforementioned features. The granulomatous inflammation predominates within the brain tissue. It is surrounded by vessels with vasculitis. The leptomeninges show chronic meningitis with collagen deposition and focal vasculitis. There are numerous reactive macrophages and giant cells. Some of the giant cells have nuclei around their rims, and others contain calcific debris. The giant cells and macrophages are negative for S-100 protein and CD1A.
Stains for micro-organisms are negative. Additional stains for hemoglobin, EBER probe for EB virus, factor XIIIa and MPO were done on sections of block 1. These showed few polymorphonuclear leukocytes (PMN) outside of vascular lumens, reflecting a well-organized granuloma and relatively inactive chronic inflammation. Erythrocytes were
present in vascular lumens and in surgical hemorrhage, and this did not support the possibility of hemophagocytic lymphohistiocytosis (HLH). The EBER probe was negative.