Dastur D K, Dave U P
Am J Pathol. 1977 Oct;89(1):35-50.
The fine structure of small blood vessels in and around ten brain tuberculomas was examined. In the peripheral reactive zone of the tuberculomas, examination of 1-mu-thick survey sections established the chronic inflammatory process and the vasculitis characterized by infiltration of the vasomurium (vessel wall) by large and small mononuclear cells. This reaction was typical of chronic epithelioid cell granuloma. Electron microscopic examination of the reactive zone confirmed the vascular proliferation and vasculitis, the venule being the most frequently involved type of blood vessel. It showed the infiltrating cells to lie amidst osmiophilic, concentrically proliferated basement membrane laminae, which formed the greater part of the thickened vessel wall, generally surrounding the endothelial cells directly, the pericytes having disappeared. This appearance, together with the results of Gomori's reticulin stain on paraffin sections, suggested that the altered basement membrane material was reticulin. The possibility is discussed that the altered basement membrane material could be antigenic and that it might be responsible for perpetuating the necrotic vascular and perivascular reaction in tuberculous meningitis and tuberculomas. The above change in the basement membrane was not encountered in the blood vessels of the surrounding edematous brain. The endothelial cells and tight junctions were relatively well-preserved. Intact arterioles could be recognized even in severely edematous brain tissue. At both sites the fine structure of the blood vessels was typical of that expected in the central nervous system. Fenestrated vessels were not seen. The perivascular astrocytic end-feet were destroyed in the reactive zone and either distended or ruptured in the overtly edematous brain tissue also. In the central caseous part of the tuberculoma, there were few blood vessels, and they were in a state of advanced necrosis, but ghost outlines of proliferated basement membrane could be seen.
对10个脑结核瘤及其周围的小血管精细结构进行了检查。在结核瘤的外周反应区，对1μm厚的概略切片检查发现了慢性炎症过程和血管炎，其特征为大小单核细胞浸润血管壁（血管膜）。这种反应是慢性上皮样细胞肉芽肿的典型表现。对反应区的电子显微镜检查证实了血管增生和血管炎，小静脉是最常受累的血管类型。它显示浸润细胞位于嗜锇性、同心增生的基底膜板层之间，这些基底膜板层构成了增厚血管壁的大部分，通常直接围绕内皮细胞，周细胞已消失。这种表现，连同石蜡切片上Gomori网状纤维染色的结果，提示改变的基底膜物质是网状纤维。文中讨论了改变的基底膜物质可能具有抗原性，并且可能是结核性脑膜炎和结核瘤中坏死性血管及血管周围反应持续存在的原因。在周围水肿脑组织的血管中未见到上述基底膜的变化。内皮细胞和紧密连接相对保存完好。即使在严重水肿的脑组织中也能识别出完整的小动脉。在这两个部位，血管的精细结构都是中枢神经系统中预期的典型结构。未见到有窗孔的血管。血管周围星形胶质细胞的终足在反应区被破坏，在明显水肿的脑组织中也出现扩张或破裂。在结核瘤的中央干酪样部分，血管很少，且处于晚期坏死状态，但可见到增生基底膜的残影。
