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Fine needle aspiration biopsy of progressive multifocal leukoencephalopathy in a patient with AIDS. A case report
T P Poon1, V Tchertkoff, H Win
1Department of Pathology, New York Medical College-Metropolitan Hospital Center, New York 10029, USA.
Background:
Progressive multifocal leukoencephalopathy (PML) is one of the most common opportunistic infections, with a range of 4-7% in acquired immunodeficiency syndrome (AIDS) patients. Clinical diagnosis is often difficult, and the specific pathologic agent requires cytologic and pathologic confirmation.
Case:
A 38-year-old, Haitian male was admitted with a new-onset seizure disorder. On computed tomography (CT), there were right frontoparietal cortex, right external capsule and right basal ganglia lucencies. Fine needle aspiration biopsy (FNAB) of the radiolucent area revealed foci of white matter demyelination and a few eosinophilic inclusions in oligodendrocytes plus abnormal giant astrocytes. Ultrastructurally, JC virions were observed in the nuclei and cytoplasm of the oligodendrocytes.
Conclusion:
Diagnostic cranial CT-guided FNAB, with cytologic and histologic studies, is extremely valuable in evaluating the nature of central nervous system demyelinated and space-occupying lesions in AIDS.
Insights
Diagnosing progressive multifocal leukoencephalopathy (PML) in AIDS patients is challenging. Cranial CT-guided fine needle aspiration biopsy (FNAB) effectively confirms PML by identifying JC virions in demyelinated lesions.
Area of Science:
- Neurology
- Infectious Diseases
- Pathology
Background:
- Progressive multifocal leukoencephalopathy (PML) is a common opportunistic infection in AIDS patients, occurring in 4-7% of cases.
- Clinical diagnosis of PML is often difficult, necessitating definitive pathologic confirmation.
Observation:
- A 38-year-old male with AIDS presented with new-onset seizures.
- Cranial computed tomography (CT) revealed lucencies in the right frontoparietal cortex, external capsule, and basal ganglia.
- Fine needle aspiration biopsy (FNAB) of these lesions showed demyelination, eosinophilic inclusions in oligodendrocytes, and giant astrocytes.
Findings:
- Ultrastructural examination of the biopsy confirmed the presence of JC virions within oligodendrocytes.
- These findings are characteristic of progressive multifocal leukoencephalopathy (PML).
Implications:
- Cranial CT-guided FNAB is a highly valuable diagnostic tool for central nervous system demyelinating lesions in AIDS patients.
- This technique aids in the definitive diagnosis of opportunistic infections like PML, guiding appropriate patient management.
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