Smith T W, Anwer U, DeGirolami U, Drachman D A
Department of Pathology, Neuropathology, University of Massachusetts Medical Center, Worcester 01655.
Arch Neurol. 1987 Dec;44(12):1225-8. doi: 10.1001/archneur.1987.00520240007003.
A retrospective neuropathologic study of brains from 66 patients with Alzheimer's disease (AD) demonstrated the presence of a vacuolar change (VC) in 50 cases that was virtually indistinguishable histologically from the spongiform change characteristic of Creutzfeldt-Jakob disease (CJD). Indeed, in several instances, there was initial diagnostic confusion with CJD. Unlike the spongiform change in CJD, however, VC was almost entirely restricted to the medial temporal cortex and amygdala. Furthermore, the severity of VC was usually less intense than the spongiform change observed in cases of CJD with severe neurologic impairment. The VC could be readily distinguished from the fine microvacuolation of the upper layers of the isocortex reported in a number of different conditions, including AD. It also differed from the status spongiosus of the cerebral cortex that occurs in advanced AD and CJD as well as in other degenerative diseases. The artifactual rarefaction that occurs in improperly processed paraffin-embedded brain tissue was excluded as a contributory factor to the VC. Since VC does not invariably occur in AD, it conceivably could represent a subtype of this disorder or may represent a variant of the pathologic changes that can occur. Its relationship to CJD or other slow virus disorders is to date unknown but unlikely.
一项对66例阿尔茨海默病（AD）患者大脑进行的回顾性神经病理学研究显示，50例存在空泡改变（VC），其在组织学上与克雅氏病（CJD）特征性的海绵状改变几乎无法区分。实际上，在一些病例中，最初存在与CJD的诊断混淆。然而，与CJD中的海绵状改变不同，VC几乎完全局限于内侧颞叶皮质和杏仁核。此外，VC的严重程度通常不如在伴有严重神经功能损害的CJD病例中观察到的海绵状改变强烈。VC可以很容易地与在包括AD在内的多种不同情况下报道的异皮质上层的细微微空泡化区分开来。它也不同于晚期AD、CJD以及其他退行性疾病中出现的大脑皮质海绵状态。在处理不当的石蜡包埋脑组织中出现的人为稀疏被排除为导致VC的一个因素。由于VC并非在AD中总是出现，它可以想象地代表这种疾病的一种亚型，或者可能代表可能发生的病理变化的一种变体。它与CJD或其他慢病毒疾病的关系迄今为止尚不清楚，但可能性不大。
