The Active MS Lesion

Proven MS Treatment By Dr Gary Levin

Multiple Sclerosis No More

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On gross inspection, the active MS plaque appears as a cheesy soft area of irregular pink or gray color. Microscopically, active inflammatory demyelination is characterized by an intimate admixture of lipid-laden macrophages and large reactive astro-cytes, accompanied by variable perivascular inflammation. The involved areas demonstrate marked pallor of myelin staining with "relative" preservation of axons, although where damage is most severe, axons may be lost or fragmented and display irregular tortuous and clubbed profiles (Figure 2A). Many macrophages become engorged with phagocytosed myelin remnants and debris and assume the appearance of classic "gitter cells" with abundant vacuolated cytoplasm. Intimately intermingled are enlarged (reactive) astrocytes with prominent, somewhat polymorphic nuclei and conspicuous eosinophilic cytoplasm. The so-called "granular mitosis" (also referred to as a Creutzfeld-Peters cell) is an unusual finding in some reactive astrocytes (Figure 2B). While resembling large chromosomes arranged like mitotic figures, they in fact represent small fragments of the nucleus (micronuclei). Although these cells are nonspecific and may be seen uncommonly in a variety of reactive processes, their presence should prompt consideration of active demyelina-tion and should argue against the possibility of a glioma.

Luxol Glioblastoma

Figure 2 (See color insert.) Active multiple sclerosis lesion. Active lesions are hypercellular demarcated regions of myelin loss characterized by an admixture of macrophages and reactive astrocytes (A, LFB/PAS). Creutzfeld-Peters cells are astrocytes containing fragmented nuclei that resemble astrocytic mitoses (arrows A and B, H&E). Abbreviation: LFB/PAS, luxol fast blue/periodic acid schif.

Figure 2 (See color insert.) Active multiple sclerosis lesion. Active lesions are hypercellular demarcated regions of myelin loss characterized by an admixture of macrophages and reactive astrocytes (A, LFB/PAS). Creutzfeld-Peters cells are astrocytes containing fragmented nuclei that resemble astrocytic mitoses (arrows A and B, H&E). Abbreviation: LFB/PAS, luxol fast blue/periodic acid schif.

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