I discuss issues pertaining to the practice of neuropathology -- including nervous system tumors, neuroanatomy, neurodegenerative disease, muscle and nerve disorders, ophthalmologic pathology, neuro trivia, neuropathology gossip, job listings and anything else that might be of interest to a blue-collar neuropathologist.
40 year old female with progressive headaches over 6-8
months. MRI showed a large cystic and solid mass, favored to be extra-axial and
arising from the anterior skull base just left of midline with possible dural
attachment. Sections showed a densely cellular mass arranged in a mostly
haphazard, slightly fascicular pattern. Alternating hypercellular and
hypocellular areas were seen. Tumor cells were ovoid to spindle shaped with
scant eosinophilic cytoplasm. No eosinophilic bands of wire-like collagen were
noted, and only focal staghorn-like vasculature was identified. Only up to 3
mitotic figures were enumerated in 10 hpf counts. No necrosis was identified. You can see the diagnosis in the comment section after considering the photographs below:
The American Association of Neuropathologists has released the cases for the 2017 Diagnostic Slide Session, which will be held at the association's annual meeting on Saturday, June 10 from 8 to 11 pm. The session, which will be moderated by Drs. Caterina Giannini Rebecca D. Folkerth, focuses on a discussion of 10 cases submitted by members from far and wide.
A 30-year-old man presented with bitemporal hemianopsia and a 3.0 cm pituitary mass was discovered upon MRI. His IGF-1 was elevated to 900, but he had no signs of acromegaly. A smear of tissue sent for frozen section evaluation (see below) revealed that most cells had round, eosinophilic, perinuclear inclusions suggestive of fibrous bodies (some examples are circled). Dot-like CAM5.2 immunostain (not shown) confirmed my smear-based diagnostic suspicion.
A month ago I put up a post regarding the release of Volume 3 of the Johns Hopkins Atlases of Pathology for the iPad. This app only costs $4.99 . Here are some screenshots of the app provided to me by series editor Toby Cornish, MD, PhD:
driven by the transcription factor SF-1, which are exclusively gonadotroph
adenomas, are a common subtype encountered by the surgical pathologist.
Traditionally, gonadotroph adenomas have been defined by positive
immunostaining for luteinizing hormone (LH) and/or follicle stimulating hormone
(FSH) with or without alpha-subunit (αSU). However, evidence is now emerging
that replacement of these three immunostains by the single SF-1 stain results
in a more cost-effective and sensitive means of detecting gonadotrophin
adenomas. Further, the majority of previously classified "null cell"
adenomas -- negative for all hormonal markers including LH, FSH and αSU -- are
in fact positive for SF-1 and therefore better classified as gonadotroph