title: Extensive cortico-subcortical lesions in Wilson's disease: clinico-pathological study of two cases.
abstract: Wilson's disease (WD) with extensive cortico-subcortical lesions represents a rare neuropathological subgroup, the pathogenesis of which is not clearly determined. We report two new cases with identical lesions. In the families of each of the patient, there were mutations in the ATPase7B gene, especially in the family of proband 1, and in the first cousin of proband 2. These cases included massive destruction of the white matter in superior gyri, mostly frontal, extending to the deep cortex with neuronal loss and capillary proliferation. Astrocytes were of Alzheimer type 1 and 2; and type 1 were labeled by anti-metallothionein. Opalski cells were abundant and their macrophagic lineage was confirmed by immunostaining. Among the possible mechanisms proposed, the role of vascular factors and penicillamine treatment could be excluded. Cerebral copper content in white matter and putamen of case 1 was at the same level as in common WD but accumulation of unbound copper in the white matter was a distinctive feature, which suggested a pathological neurotoxic effect.
authors.affiliation: Department of Pathology, Denis Diderot University, Paris, France. jacqueline.mikol@lrb.ap-hop-paris.fr
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Mikol
authors.forename: Claude
authors.initials: C
authors.lastname: Vital
authors.forename: Michel
authors.initials: M
authors.lastname: Wassef
authors.forename: Philippe
authors.initials: P
authors.lastname: Chappuis
authors.forename: Joël
authors.initials: J
authors.lastname: Poupon
authors.forename: Monique
authors.initials: M
authors.lastname: Lecharpentier
authors.forename: France
authors.initials: F
authors.lastname: Woimant
mesh_terms: D000251:Adenosine Triphosphatases / Q000032:analysis / Q000235:genetics / Q000502:physiology; D000328:Adult; D001253:Astrocytes / Q000737:chemistry / Q000473:pathology; D027682:Cation Transport Proteins / Q000032:analysis / Q000235:genetics / Q000502:physiology; D002540:Cerebral Cortex / Q000737:chemistry / Q000473:pathology*; D003300:Copper / Q000032:analysis / Q000633:toxicity; D000073840:Copper-Transporting ATPases; D005260:Female; D006527:Hepatolenticular Degeneration / Q000175:diagnosis / Q000235:genetics / Q000378:metabolism / Q000473:pathology*; D006801:Humans; D008099:Liver / Q000737:chemistry; D008264:Macrophages / Q000473:pathology; D008297:Male; D008668:Metallothionein / Q000032:analysis; D010375:Pedigree; D011699:Putamen / Q000737:chemistry / Q000473:pathology
chemical_list: D027682:Cation Transport Proteins; D003300:Copper; D008668:Metallothionein; D000251:Adenosine Triphosphatases; D000073840:Copper-Transporting ATPases