Methotrexate myelopathy with extensive transverse necrosis: Report of an autopsy case

Neuropathology - Tập 34 Số 6 - Trang 547-553 - 2014
Masayuki Shintaku1, Nao Toyooka2, Takashi Koyama3, Shunsuke Teraoka2, Mitsuru Tsudo2
1Department of Pathology, Osaka Red Cross Hospital, Osaka, Japan
2Department of Hematology, Osaka Red Cross Hospital, Osaka, Japan
3Diagnostic Radiology Osaka Red Cross Hospital Osaka Japan

Tóm tắt

The patient was a 70‐year‐old woman with lymphoplasmacytic lymphoma which showed a predominantly diffuse involvement of the bone marrow and kidney. Because atypical lymphocytes appeared in the cerebrospinal fluid, the intrathecal administration of methotrexate (MTX) and cytosine arabinoside (Ara‐C) was repeated several times. The patient developed flaccid paraplegia 8 months after the beginning of intrathecal administration, and died 4 months later. Autopsy demonstrated extensive transverse necrosis involving the lower thoracic cord and marked vacuolar degeneration of the white matter of the cervical, upper thoracic and lumbo‐sacral cord. Focal vacuolar degeneration of the white matter was also noted in the left parietal lobe. Although vacuolar degeneration of the white matter is a common feature in MTX myelopathy, extensive transverse necrosis is rare. In the present case, an overlapping of two mechanisms, that is, injury of vascular endothelial cells and the direct toxic effect of MTX and Ara‐C on the white matter, probably played a crucial role in the pathogenesis of severe myelopathy. Because severe myelopathy occurs infrequently, considering the large number of patients receiving the intrathecal administration of MTX, it is possible that a constitutional predisposition or abnormal sensitivity to MTX was involved in the pathogenesis in the present patient.

Từ khóa


Tài liệu tham khảo

10.1002/1097-0142(197502)35:2<306::AID-CNCR2820350203>3.0.CO;2-J

10.1016/S0046-8177(78)80047-1

10.1007/s00401-005-0023-y

10.1002/1097-0142(197502)35:2<291::AID-CNCR2820350202>3.0.CO;2-V

10.1002/1097-0142(19820701)50:1<42::AID-CNCR2820500109>3.0.CO;2-M

10.1002/mpo.2950190309

Honda D, 2012, Methotrexate myelopathy, Neurol Med (Tokyo), 77, 35

10.1111/j.1440-1789.2008.00945.x

10.1007/s00401-007-0214-9

10.1007/BF00707111

10.1056/NEJM197310112891503

10.1007/BF00690468

10.1007/BF00294671

Okeda R, 1971, Two autopsy cases of radiation myelopathy. Consideration about the pathogenesis, Adv Neurol Sci (Tokyo), 15, 619

10.1016/0022-510X(71)90174-2

10.1136/jnnp.35.6.888

10.1002/1097-0142(197402)33:2<468::AID-CNCR2820330223>3.0.CO;2-F

10.1002/1097-0142(197809)42:3<1211::AID-CNCR2820420326>3.0.CO;2-X

10.1002/1097-0142(197202)29:2<370::AID-CNCR2820290217>3.0.CO;2-Z

Tomonaga M, 1978, Paraplegia following intrathecal methotrexate, Adv Neurol Sci (Tokyo), 22, 1204

10.1007/BF00691894

10.1007/BF00687759

10.1212/01.WNL.0000152840.26156.74

Pant SS, 1968, The myelopathy of pernicious anemia. A neuropathological reappraisal, Acta Neurol Scand, 44, 1

10.1215/15228517-2008-082

10.1007/s11060-009-0028-9

10.1002/1097-0142(197712)40:6<2817::AID-CNCR2820400611>3.0.CO;2-V

Wolf HK, 1990, Arterial border zone necrosis of the spinal cord, Clin Neuropathol, 9, 60

10.1097/00005072-198407000-00006

Thông tin
Thông tin xuất bản

Neuropathology

Tập 34 Số 6

547-553

Thông tin tác giả