title: Aquaporin-4 antibody-positive myelitis initially biopsied for suspected spinal cord tumors: diagnostic considerations.
abstract: Two patients with longitudinally extensive myelopathy were initially biopsied for suspected spinal cord tumors. Both patients were later diagnosed with neuromyelitis optica spectrum disorders (NMOSD) supported by their AQP4-seropositivity. Pathological review of both biopsies revealed demyelinated lesions with thickened vessel walls and tissue rarefaction. Immunohistochemical staining demonstrated findings compatible with acute NMOSD lesions in one case while the other case exhibited findings consistent with chronic NMOSD lesions. A pre-biopsy differential diagnosis of longitudinally extensive spinal cord tumors should include NMOSD. Specific biopsy features, such as cystic changes with vascular wall thickening and astrocyte injury, should raise suspicion for NMOSD.
authors.affiliation: Department of Neurology, Tohoku University Graduate School of Medicine, Japan.
authors.forename: Douglas Kazutoshi
authors.initials: DK
authors.lastname: Sato
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Misu
authors.forename: Cristiane Franklin
authors.initials: CF
authors.lastname: Rocha
authors.forename: Dagoberto
authors.initials: D
authors.lastname: Callegaro
authors.forename: Ichiro
authors.initials: I
authors.lastname: Nakashima
authors.forename: Masashi
authors.initials: M
authors.lastname: Aoki
authors.forename: Kazuo
authors.initials: K
authors.lastname: Fujihara
authors.forename: Marco Aurelio
authors.initials: MA
authors.lastname: Lana-Peixoto
mesh_terms: D000293:Adolescent; D051401:Aquaporin 4 / Q000276:immunology*; D001323:Autoantibodies / Q000032:analysis*; D015415:Biomarkers / Q000032:analysis; D001706:Biopsy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009471:Neuromyelitis Optica / Q000175:diagnosis / Q000276:immunology* / Q000473:pathology; D011237:Predictive Value of Tests; D013116:Spinal Cord / Q000276:immunology* / Q000473:pathology; D013120:Spinal Cord Neoplasms / Q000473:pathology*
chemical_list: C496030:AQP4 protein, human; D051401:Aquaporin 4; D001323:Autoantibodies; D015415:Biomarkers
keywords: Neuromyelitis optica; aquaporin-4; biopsy; differential diagnosis; pathology; spinal cord tumor
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