Departments of Paediatrics, University of Calgary Cumming School of Medicine and Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada; Pathology (Neuropathology), University of Calgary Cumming School of Medicine and Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada; Clinical Neurosciences, University of Calgary Cumming School of Medicine and Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.
Departments of Paediatrics, University of Calgary Cumming School of Medicine and Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada; Clinical Neurosciences, University of Calgary Cumming School of Medicine and Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.
Pediatr Neurol. 2019 May;94:21-31. doi: 10.1016/j.pediatrneurol.2018.12.006. Epub 2018 Dec 25.
The area postrema in the caudal fourth ventricular floor is highly vascular without blood-brain or blood-cerebrospinal fluid barrier. In addition to its function as vomiting center, several others are part of the circumventricular organs for vasomotor/angiotensin II regulation, role in neuromyelitis optica related to aquaporin-4, and somatic growth and appetite regulation. Functions are immature at birth. The purpose was to demonstrate neuronal, synaptic, glial, or ependymal maturation in the area postrema of normal fetuses. We describe three area postrema tumors.
Sections of caudal fourth ventricle of 12 normal human fetal brains at autopsy aged six to 40 weeks and three infants aged three to 18 months were examined. Immunocytochemical neuronal and glial markers were applied to paraffin sections. Two infants with area postrema tumors and another with neurocutaneous melanocytosis and pernicious vomiting also studied.
Area postrema neurons exhibited cytologic maturity and synaptic circuitry by 14 weeks'. Astrocytes coexpressed vimentin, glial fibrillary acidic protein, and S-100β protein. The ependyma is thin over area postrema, with fetal ependymocytic basal processes. A glial layer separates area postrema from medullary tegmentum. Melanocytes infiltrated area postrema in the toddler with pernicious vomiting; two children had primary area postrema pilocytic astrocytomas.
Although area postrema is cytologically mature by 14 weeks, growth increases and functions mature during postnatal months. We recommend neuroimaging for patients with unexplained vomiting and that area postrema neuropathology includes synaptophysin and microtubule-associated protein-2 in patients with suspected dysfunction.
第四脑室底部的最后区血管丰富，没有血脑或血脑脊液屏障。除了作为呕吐中心的功能外，还有其他几个功能是作为血管紧张素 II 调节的室周器官的一部分，在与水通道蛋白-4 相关的视神经脊髓炎中的作用，以及躯体生长和食欲调节。这些功能在出生时尚未成熟。目的是证明正常胎儿最后区的神经元、突触、神经胶质或室管膜成熟。我们描述了三个最后区肿瘤。
对 12 例正常胎儿尸检大脑第四脑室尾部的 6 至 40 周和 3 例 3 至 18 个月大的婴儿进行了检查。应用免疫细胞化学神经元和神经胶质标志物对石蜡切片进行了检查。还研究了两个最后区肿瘤患儿和另一个神经皮肤黑色素沉着症和恶性呕吐患儿。
最后区神经元在 14 周时表现出细胞学成熟和突触回路。星形胶质细胞共表达波形蛋白、胶质纤维酸性蛋白和 S-100β 蛋白。最后区的室管膜很薄，有胎儿室管膜下基底突起。神经胶质层将最后区与髓质被盖分开。在恶性呕吐的幼儿中，黑色素细胞浸润了最后区；两个孩子都有原发性最后区毛细胞星形细胞瘤。
尽管最后区在 14 周时在细胞学上已经成熟，但在出生后的几个月中，其生长和功能会继续成熟。我们建议对不明原因呕吐的患者进行神经影像学检查，并建议在怀疑功能障碍的患者中，最后区神经病理学包括突触素和微管相关蛋白-2。
