Mini-review: Eosinophils, a Useful Diagnostic Clue in Surgical Neuropathology

Article information

Kosin Med J. 2012;27(2):79-89
Publication date (electronic) : 2012 January 19
doi : https://doi.org/10.7180/kmj.2012.27.2.79
1Department of Pathology, Wonju College of Medicine, Yonsei University, Wonju, Korea
2Department of Pathology, College of Medicine, Yonsei University, Seoul, Korea
Corresponding author: Se Hoon Kim, Department of Pathology, College of Medicine, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea TEL: +82-2-2228-1769 FAX: +82-2-362-0860 E-mail: paxco@yuhs.ac
Received 2012 August 30; 2012 September 10; Accepted 2012 October 02.

Abstract

Eosinophils are one of the polymorphonuclear granulocytes derived from bone marrow stem cells, and they contain many small cytoplasmic granules that stain bright red with eosin or brick-red with Romanowsky staining. Eosinophilic infiltration is also present in various human central nervous system (CNS) diseases such as parasitic infection, transverse myelitis, vasculitis, Langerhans cell histiocytosis, glioblastoma and etc... Due to the morphologic and functional characteristics, the presence of eosinophils in certain lesions may provide useful diagnostic clues in the right clinical setting. Consideration of this finding may facilitate the diagnosis of CNS pathologic lesions, especially in a small specimen such as a stereotactic biopsy.

Fig. 1.

Organizing hematoma: Low power view shows fresh hemorrhage with organization (A. H-E x 40). High power view shows eosinophilic infiltration into the granulation tissue (B. H-E x 200).

Fig. 2.

Eosinophils in CSF (Papanicolaou stain, x 600). Green granulated cytoplasm with bi-lobed nuclei is characteristic (arrows).

Fig. 3.

A rim-enhancing lesion with edema in the right temporal lobe (A. arrow). Histologic section revealed a fragment of the worm (arrows) and dense fibrosis with a few eosinophilic infiltration (B. H-E x40; inlet. H-E x200).

Fig. 4.

The histologic findings of transverse myelitis. 1) perivascular and parenchymal lymphocytic infiltration with many eosinophils, (A. H-E x 200, B. H-E x 400), 2) degranulation of eosinophils, (B and D. H-E x 400) and 3) reactive gliosis (C. H-E x 400, arrows). In addition, giant cells (D. H-E x 400, arrows), Charcot-Leyden crystal protein (E. H-E x 1000, arrow), and the degeneration of myelin and axons (F. Bielschowsky’s silver x 200) compared to control tissue (G. Bielschowsky’s silver x 200) stain were present in Case 1.

Fig. 5.

The histologic findings of CNS vasculitis, Giant cell arteritis (A. H-E x100 and B. H-E x400) and Churg-Strauss vasculitis (C. H-E x100 and D. H-E x 400). Eosinophilic infiltration is noted (arrows).

Fig. 6.

The histologic findings of Langerhans cell histiocytosis with marked artifacts in CNS. Eosinophilic granules and inflammatory cells are seen in crushed focus (A. H-E x100 and B. H-E x400). Aggregates of cells, which nuclei are eccentrically located and indented (arrow), mixed with eosinophilic granules (arrow head) are noted in rare area (C. H-E x 200 and D. H-E x 400). A cluster of large involuted nuclei show CD1a (E. CD1a x 200) and S-100 (F. S-100 x 100, arrows) immunohistochemical staining positivity.

Fig. 7.

Glioblastoma with eosinophils (A. H-E x40). Adjacent necrotic area, eosinophilic infiltration is noted (B. H-E x400, arrows).

The clinicoradiologic features of 4 cases of transverse myelitis

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Article information Continued

Fig. 1.

Organizing hematoma: Low power view shows fresh hemorrhage with organization (A. H-E x 40). High power view shows eosinophilic infiltration into the granulation tissue (B. H-E x 200).

Fig. 2.

Eosinophils in CSF (Papanicolaou stain, x 600). Green granulated cytoplasm with bi-lobed nuclei is characteristic (arrows).

Fig. 3.

A rim-enhancing lesion with edema in the right temporal lobe (A. arrow). Histologic section revealed a fragment of the worm (arrows) and dense fibrosis with a few eosinophilic infiltration (B. H-E x40; inlet. H-E x200).

Fig. 4.

The histologic findings of transverse myelitis. 1) perivascular and parenchymal lymphocytic infiltration with many eosinophils, (A. H-E x 200, B. H-E x 400), 2) degranulation of eosinophils, (B and D. H-E x 400) and 3) reactive gliosis (C. H-E x 400, arrows). In addition, giant cells (D. H-E x 400, arrows), Charcot-Leyden crystal protein (E. H-E x 1000, arrow), and the degeneration of myelin and axons (F. Bielschowsky’s silver x 200) compared to control tissue (G. Bielschowsky’s silver x 200) stain were present in Case 1.

Fig. 5.

The histologic findings of CNS vasculitis, Giant cell arteritis (A. H-E x100 and B. H-E x400) and Churg-Strauss vasculitis (C. H-E x100 and D. H-E x 400). Eosinophilic infiltration is noted (arrows).

Fig. 6.

The histologic findings of Langerhans cell histiocytosis with marked artifacts in CNS. Eosinophilic granules and inflammatory cells are seen in crushed focus (A. H-E x100 and B. H-E x400). Aggregates of cells, which nuclei are eccentrically located and indented (arrow), mixed with eosinophilic granules (arrow head) are noted in rare area (C. H-E x 200 and D. H-E x 400). A cluster of large involuted nuclei show CD1a (E. CD1a x 200) and S-100 (F. S-100 x 100, arrows) immunohistochemical staining positivity.

Fig. 7.

Glioblastoma with eosinophils (A. H-E x40). Adjacent necrotic area, eosinophilic infiltration is noted (B. H-E x400, arrows).

Table 1.

The clinicoradiologic features of 4 cases of transverse myelitis

Case 1 Case 2 Case 3 Case 4
Age of onset 41 36 46 35
Sex M M M M
Level of lesions T2-4 C1-5 C2-3 T6-9
Past Medical History EGC* - - -
Allergic History - Allergic rhinitis - -
Time course Subacute Subacute Subacute Subacute
/chronic
Clinical course Fluctuant Persistent Persistent Persistent
Initial Symptoms Hyperesthesia Pain on post. Neck Hyperesthesia on Pain on both legs
below right chest & Hyperesthesia Rt chest and back
on Lt hand
Main symptom at biopsy
Paresthesia/Dysesthesia + + + +
Sensory impairment + + + +
Motor weakness + +/- - -
Steroid therapy & Response + + - +
/poor /poor /poor
Duration before biopsy 13 months 3 months 3 months 4 months
Lab findings
% of eosinophil on CBC 5.2 5.2 5.9 3.0
Serum IgE concentration (U/ml) Not checked 2010 Not checked Not checked
MRI
T2WI High High High Not done
T1WI Iso Iso Iso Not done
T1 Gd + + + Not done
CT Not done Not done Not done Mass like lesion

EGC*: Early Gastric Cancer, MRI: Magnetic Resonance Imaging, CT; Computer Tomography