A 42-yrs-old immunosuppressed male presents with rapidly progressed neurologic symptoms including mental deterioration, visual loss, abnormal speech, and ataxia, Radiographic studies demonstrate multifiocal lesions in the white matter without mass effect. A stereotactic brain biopsy reveals areas of demyelination. Which histologic feature is most likely to be present in this?
* Progressive multifocal leukoencephalopathy (PML) is a viral infection of oligodendrocytes that results in demyelination of the central nervous system. * Signs and symptoms of PML are varied but include dementia and ataxia along with abnormal vision and speech. The causative agents of PML are two closely related polyomaviruses, JC virus and SV40. * The pathognomonic feature of PML is the oligodendrocytes in areas of demyelination, which have a "ground-glass' appearance of their nuclei due to infection with the viral paicles. * PML occurs as a terminal complication in immuno suppressed individuals, especially individuals with AIDS. In contrast to the viral inclusions of PML, beta-A4 amyloid is found in the walls of medium to small aeries an aerioles in the brain and meninges of individuals with cerebral amyloid angiopathy (CAA) , a significant cause of intracerebral hemorrhage in non hypeensive elderly patients. * Prion protein paicles are causes of the spongiform encephalopathies, while Rosenthal fibers within astrocytes are characteristic of juvenile pilocytic astrocytomas, and ubiquitin protein within neurons is associated with Alzheimer's disease.
Beta-A4 amyloid within blood vessels
Prion protein within extracellular plaques
Rosenthal fibers within astrocytes
Viral paicles within oligodendrocytes