Suzuki K, Takemura T, Okeda R, Hatakeyama S
Acta Neuropathol. 1984;65(2):145-9. doi: 10.1007/BF00690468.
We investigated cerebral lesions of methotrexate (MTX)-related disseminated necrotizing leukoencephalopathy (DNL) in two autopsy cases of leukemia by the reconstruction technique of the serial sections and thick sections (700-800 microns) stained with silver impregnation to detect the topographic relation between the vascular changes and parenchymal lesions. We revealed the vascular changes, such as fibrinoid degeneration, hyalinized thickening of the vascular wall, dilatation of lumen and stenosis due to swelling of the endothelial cells and exsudation in the wall, particularly prominent in venules and capillaries of venous side in the territory of the superficial medullary veins. There were no remarkable changes in the arteries, except for the moderate endothelial swelling of arteriolar capillaries. The parenchymal lesions were topographically associated with these vascular changes, and the small necrotic foci confluented each other and formed large irregular necrotic foci. We considered that the DNL may be ascribed to dyshoric damage of the veins and capillaries of the venous side and that the mechanism of vascular injury was probably due to the prolonged direct action of intrathecal MTX on the vessels.
我们通过连续切片和厚切片（700 - 800微米）的重建技术，对两例白血病尸检病例中与甲氨蝶呤（MTX）相关的播散性坏死性白质脑病（DNL）的脑病变进行了研究，厚切片用银浸染染色，以检测血管变化与实质病变之间的地形关系。我们发现了血管变化，如纤维蛋白样变性、血管壁透明样增厚、管腔扩张以及由于内皮细胞肿胀和壁内渗出导致的狭窄，这些变化在浅表髓静脉区域静脉侧的小静脉和毛细血管中尤为突出。除了小动脉毛细血管有中度内皮肿胀外，动脉没有明显变化。实质病变在地形上与这些血管变化相关，小坏死灶相互融合形成大的不规则坏死灶。我们认为DNL可能归因于静脉侧静脉和毛细血管的发育异常损伤，血管损伤机制可能是鞘内MTX对血管的长期直接作用。
