Myeloid Sarcoma in the Central Nervous System: Case Report and Review of the Literature

Mijeloidni sarkomi su rijetke pojavnosti uglavnom mijeloblastične leukemije. Njihova pojava u središnjem živčanom sustavu je iznimna, pa je dotična literatura danas ograničena na studije pojedinih slučajeva. Mi opisujemo jo. jedan slučaj, dok je pregled literature poslužio kako bismo ispitali značajke i mogućnosti liječenja mijeloidnog sarkoma središnjega živčanog sustva. U žene stare 61 godinu s akutnom mijeloblastičnom leukemijom (FAB M5) i progresivnom lijevostranom hemiparezom utvrđena je desnostrano parieto-okcipitalno epiduralno oštećenje koje je sličilo meningiomu. Učinjena je djelomična resekcija koja je otkrila mijeloidni sarkom. Pregledom literature utvrdili smo 44 slučaja s dostatnim opisom dijagnoze, liječenja i praćenja do jedne godine. Kod tih bolesnika primijenjeni su različiti načini liječenja. Međutim, bolesnici su imali najbolji postotak jednogodišnjeg preživljenja kad je protokol liječenja uključivao sustavnu kemoterapiju ili zračenje.Myeloid sarcomas are rare manifestations of mainly myeloblastic leukemia. Their occurrence in the central nervous system is exceptional and current literature is limited to case studies. A case is added herewith and a review was performed to investigate clinical characteristics and treatment options of central nervous system myeloid sarcoma. A 61-year-old female with acute myeloblastic leukemia (FAB M5) and progressive left sided hemiparesis showed a right parieto-occipital epidural lesion mimicking meningioma. Partial resection was performed to reveal a myeloid sarcoma. Reviewing the literature we identified 44 cases with sufficient description of the diagnosis, treatment and follow up to one year. In these patients different treatment regimens were applied. However, when systemic chemotherapy or irradiation was included in the treatment regimen, patients showed the best 1-year survival proportion

Multifactorial White Matter Damage in the Acute Phase and Pre-Existing Conditions May Drive Cognitive Dysfunction after SARS-CoV-2 Infection: Neuropathology-Based Evidence

Background: There is an urgent need to better understand the mechanisms underlying acute and long-term neurological symptoms after COVID-19. Neuropathological studies can contribute to a better understanding of some of these mechanisms. Methods: We conducted a detailed postmortem neuropathological analysis of 32 patients who died due to COVID-19 during 2020 and 2021 in Austria. Results: All cases showed diffuse white matter damage with a diffuse microglial activation of a variable severity, including one case of hemorrhagic leukoencephalopathy. Some cases revealed mild inflammatory changes, including olfactory neuritis (25%), nodular brainstem encephalitis (31%), and cranial nerve neuritis (6%), which were similar to those observed in non-COVID-19 severely ill patients. One previously immunosuppressed patient developed acute herpes simplex encephalitis. Acute vascular pathologies (acute infarcts 22%, vascular thrombosis 12%, diffuse hypoxic–ischemic brain damage 40%) and pre-existing small vessel diseases (34%) were frequent findings. Moreover, silent neurodegenerative pathologies in elderly persons were common (AD neuropathologic changes 32%, age-related neuronal and glial tau pathologies 22%, Lewy bodies 9%, argyrophilic grain disease 12.5%, TDP43 pathology 6%). Conclusions: Our results support some previous neuropathological findings of apparently multifactorial and most likely indirect brain damage in the context of SARS-CoV-2 infection rather than virus-specific damage, and they are in line with the recent experimental data on SARS-CoV-2-related diffuse white matter damage, microglial activation, and cytokine release