Friday, May 19, 2017

Guest Post: A Case From the Hawkeye State

From the illustrious Dr. Karra Jones of the University of Iowa:

Karra Jones, MD, PhD
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:

Axial MRI T1 Post-Contrast





CD34


CD34

STAT6

Tuesday, May 16, 2017

Best Post of January 2017: Corneal ulceration secondary to Candidal keratitis

The next in our "Best of the Month" Series is from January 20, 2017. A good photomicrograph is worth a thousand words.


GMS stain highlights fungal forms in the corneal stroma

Wednesday, May 3, 2017

Diagnostic Slide Session cases have been released by AANP

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.


Monday, April 24, 2017

Best Post of December 2016: Fibrous Bodies Nicely Demonstrated in a Smear from a Somatotroph Pituitary Adenoma

The next in our "Best of the Month Series" is from December 2, 2016:

Christian Davidson, MD

Dr. Christian Davidson, director of neuropathology at the Robert Wood Johnson University Hospitalin New Jersey, provides today's blog post:

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.


Thursday, April 6, 2017

Screenshots of the surgical neuropathology volume of the Johns Hopkins Atlases of Pathology

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:








Friday, March 24, 2017

This slow growing "pineal mass" was thought by radiologists to be a pineocytoma



Not definitively attached to the dura, but the neuroradiologist wisely put meningioma on the differential diagnosis. Microscopy showed WHO grade I meningioma.

Wednesday, March 22, 2017

An update on SF-1 driven pituitary adenomas

Adenomas 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 adenomas.