2b). The Sommer’s sectors of hippocampi bilaterally exhibited brownish discoloration (Fig. 2b). The superior temporal gyri were relatively spared compared with the middle and inferior temporal gyri (Fig. 2b). The substantia nigra and locus ceruleus were depigmented. Histopathological examination revealed marked neuronal loss and gliosis

in widespread areas, including the frontal and temporal Protein Tyrosine Kinase inhibitor cortices, hippocampi and parahippocampal regions, amygdala, thalamus, hypothalamus, midbrain and cerebellar cortex. Degeneration was advanced to form laminar necrosis-like changes in the middle layers of the frontal and temporal cortices (Fig. 3a). Numerous swollen storage neurons were present throughout the CNS (Fig. 3b). NFTs were frequently found in the CNS regions where neuronal loss and gliosis were prominent, such as the frontal and temporal cortices, hippocampus, amygdala, hypothalamus, basal ganglia, thalamus, brainstem and spinal cord (Fig. 3c,d). These findings strongly suggested the diagnosis of NPC. Histopathological

findings outside the CNS included the occurrence of lipid-laden foamy macrophages in the bone marrow, spleen (Fig. 4a), liver (Fig. 4b) and lung. Filipin staining of the liver sections revealed that Kupffer cells (sinusoidal macrophages) accumulated intracellular free cholesterol (Fig. 4c). Ultrastructural examination revealed accumulation of electron-dense materials in liver macrophages PKC412 in vivo (Fig. 5a) and membrane-bound oligolamellar inclusions typical of NPC in the occipital cortex (Fig. 5b,

arrows). In addition to the above-mentioned findings, which have been well recognized as characteristic of NPC, LBs were observed in many CNS regions. aminophylline In HE-stained sections, LBs presented as eosinophilic hyaline masses against a background of accumulated lipids in swollen storage neurons (Fig. 6a,b). Cortical LBs were also found in some neurons with minimal lipid storage (Fig. 6c). LBs were distributed mainly in deeper layers of the cortices of the frontal and temporal lobes, especially the anterior cingulate cortex, as well as the subiculum, amygdala, basal forebrain, hypothalamus, substantia nigra, oculomotor nucleus, superior colliculus, locus ceruleus, inferior olivary nucleus, and dorsal motor nucleus of the vagus nerve. LBs were immunohistochemically stained for α-synuclein and ubiquitin, as well as for HDAC6 and p62/SQSTM1, both of which are known to localize in LBs of Parkinson’s disease and dementia with LBs (Fig. 6d–g).[10, 11] The distribution of swollen storage neurons, NFTs and LBs is summarized in Table 1. Immunohistochemical staining with anti-ApoE4 antibody revealed no immunoreactivity in the brain, suggesting that this patient did not have the ApoE ε4 allele (data not shown).