PMC7838610_01
(A) Brain magnetic resonance imaging (MRI) revealed an irregular enhancing mass with central necrosis on the left parietal lobe. (B) Brain MRI image after surgery at the follow-up 3-mouth.
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Subsequent sagittal magnetic resonance imaging (MRI) revealed an irregular enhancing mass with central necrosis on the left parietal lobe that measured 15 x 13 x 10 mm in size (Figure 1A). The brain MRI scans of the patient showed no enhancing mass lesion or edema in the cerebral parenchyma (Figure 1B).
Pathologic diagnosis of the intracranial syphilitic gumma and cellular organization of microglia. (A-D) Hematoxylin and eosin staining of the intracranial syphilitic gumma reveals that the central portion of the mass contains a necrotizing inflammatory material infiltrated with epithelioid cells(white arrows), lymphocytes(black arrows), plasma cells(yellow arrows), and neutrophils(blue arrows). The vessels show severe endarteritis with endothelial cell swelling (black asterisks) and hyperplasia. (E,F) Immunostaining showing spirochetes in the intracranial syphilitic gumma. (G,H) Immunostaining for Iba-1 in the intracranial syphilitic gumma. (I,J) Immunostaining for iNOS in the intracranial syphilitic gumma. (K,L) Immunostaining for IL-12 in the intracranial syphilitic gumma. (M,N) Immunostaining for Arg in the intracranial syphilitic gumma. (O,P) Immunostaining for IL-10 in the intracranial syphilitic gumma. F, H, J, L, N, P are partial magnifications of E, G, I, K, M, O, respectively. Original magnifications: A, (x10); E, G, I, M, O, (x20); B, F, H, J, L, N, P, (x40); C, D, (x100).
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Postoperative pathological analysis of the resected tissue showed that the central portion of the mass contained a necrotizing inflammatory material(Figures 2A,B) infiltrated with epithelioid cells(Figure 2C), lymphocytes(Figures 2C,D), plasma cells(Figure 2D), and neutrophils(Figure 2C). The blood vessels showed severe endarteritis with endothelial cell swelling and hyperplasia (Figures 2B,D). Spirochete immunostaining (Figures 2E,F) highlighted many organisms, typical spiral and thread-like, in the excised lesion. T. pallidum also showed many histiocytes surrounded by treponemes and rare lymphocytes surrounded by treponemes (Figures 2E,F). Therefore, we explored the cell composition around the T. pallidum and performed immunostaining on the serial cerebral sections. We observed that many histiocytes were gathered around the T. pallidum, and these cells expressed ionized calcium-binding adapter molecule 1 (Iba-1) (Figures 2G,H), which is specifically expressed in activated microglia. By counting the number of positive cells and the total number of cells in the gumma using Aperio ImageScope, we observed that the percentage of Iba-1+ microglia in total cells was 30% (Figures 2G,H). Iba-1+ microglia is Arg-1+ microglia (M2-phenotype) (Figures 2M,N), and iNOS+ microglia (M1-phenotype) (Figures 2I,J) was negative. In addition, M1 microglia-associated cytokine IL-12 showed negative expression (Figures 2K,L), the level of CSF IL-12p70 was 0.24pg/ml. M2 microglia-associated cytokine IL-10 indicated diffuse high expression (Figures 2O,P), the level of CSF IL-10 was 4.12pg/ml.