This is in part a repost
If you want to look at them click here for a previous post
A pathologist sees the snapshots in the tissues and views it as points on a map that take you from one place to another as they use MSers brains to build pictures of what goes on.
Pattern I (~15% Lesions)
-Centered around venule (vein) with sharp, demarcated edges
-oliogodendrocytes in lesion centre
Pattern II (~58% lesions)
-Antibody/complement associated, lesions contain large quantities of immunoglobulin proteins
-Centered around venule, with sharp demarcated edges
-Deposition of immunoglobins and activated complement at site of demyelination
-Resembles an antibody mediated process
-No defects in mitochondrail respiratory chain detected
Pattern III(~26% Lesions)
-Distal oligodendrogliopathy, diffuse lesions with variable inflammation and pronounced microglial activations
-Not centered around venule
-Striking loss of myelin associated glycoprotein
-No complement activation
-Pattern associated with hypoxia
-Dying back of oligodendrocyte
-Looks like white matter stroke
-Defects in mitochondrial respitory chain
Pattern IV(~1% of Lesions)
-sharp macrophage borders
-Degeneration and oligodendrocyte death in white matter
-inactive plaque and no remyelination
Myelin Stain Myelin Stain Myelin Stain Macrophage
(LFB) MOG MAG stain (CD68)
* = loss of MAG compared to LFB and MOG.
Is this astericks not remyelination, which it looks like it to me?
So it tells us that the disease process(es) in MS is/are complex.
Methods: Archival tissue samples derived from patients with pathologically confirmed CNS inflammatory demyelinating disease who had undergone either diagnostic serial biopsy or biopsy followed by autopsy, were analyzed immunohistochemically. Inclusion criteria was the presence of early active demyelinating lesions – required for immunopattern classification – obtained from
Results: Among 1321 surgical biopsies consistent with MS, 22 cases met study inclusion criteria. Twenty-one patients (95%) showed a persistence of immunopathological patterns in tissue sampled from different time points. This
In this study they looked at biopsies and after subsequent death looked at the brain of the MSer and found similar lesions over time in a sample of 22 MSers who had Type I-III lesion types.
However in some instances death was not that much (days) later and so the same type III lesion may have been resampled in a not too distinct state and also as these were active lesions sampled because they looked like tumours, it is strange that a long time later they would not be inactive as lesions often only enhance for a short time (a month).
What does it say about MRI is it cannot distinguish the different lesions?
Does the type III lesion need a different therapy?