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.

Tuesday, March 21, 2017

"Gross only" sign out of intraocular lens prosthesis

When signing out our gross only IOL cases, my ophthalmologists want me to comment as to whether the "haptics" are completely present to confirm that nothing has been inadvertently left behind in the patient. If you are wondering what a "haptic" is, it the curving blue filament that emerges from the prosthetic lens serving to keep the lens in place. The term "haptic" means "related to the sense of touch"; but I am not sure why this term is used in this context. Perhaps a reader knows?

IOL with blue haptics in place

Thursday, March 16, 2017

Retinal biopsy from an elderly woman with suspected ocular lymphoma

The patient had multiple foci of markedly thickened retina on exam. Ophthomologists were able to obtain a relatively large retinal biopsy. We did not find lymphoma in this case, and infections of many sorts were ruled out. But the ophthalmologists wanted an opinion as to whether retinal vasculitis was present. I wonder whether the threshold for calling vasculitis in the retina should be lower than in other tissues. Your input in the comments section would be greatly appreciated.

Low power view


Medium power showing diffuse edema


Arterioles with focus of intramural inflammatory infiltrate on right side of right vessel

Wednesday, March 8, 2017

Emory Neuropathologist Dan Brat delivers Nathan Kaufman Timely Topics Lectures at 2017 USCAP annual meeting


On Monday, March 6, Dan Brat, MD, PhD delivered a presentation entitled "Platforms, Diagnosis and Disease: An Evolution Rooted in Pathology" to attendees of the 2017 annual meeting of the United States and Canadian Academy of Pathology (USCAP) in San Antonio, Texas. Dr. Brat is director of the neuropathology division of the Emory University pathology Department.

Tuesday, March 7, 2017

Johns Hopkins Atlas of Surgical Neuropathology now available on iTunes

Dr. Eberhart
Dr. Rodriquez
Surgical neuropathology is the focus of volume 3 in the Johns Hopkins Atlases of Pathology. This app was released on March 3, 2017 for iPad download for only $4.99 .  Authors Charles Eberhart and Fausto Rodriquez introduce us to the next generation in surgical neuropathology reference with a variety of educational features, updates to the 2016 WHO grading system system for CNS tumors, algorithms for the evaluation of diffuse gliomas, and practice quizzes. Congratulations to Drs. Eberhart and Rodriguez on the creation of a magnificent product!