The College of American Pathologists unveils updated patient website today

The College of American Pathologists (CAP) unveiled today new resources and features on MyBiopsy.org to help patients better understand their disease. Neuropathological diagnoses discussed on the site include: anaplastic astrocytoma, glioblastoma, pilocytic astrocytoma, and oligodendroglioma. If one of your patients has questions about one of these pathological diagnoses, you can refer them to this website, which is part of a larger Transforming Pathology initiative by the CAP.

An Abundance of Job Opportunities Exist in Neuropathology

Since starting the job listings feature of this blog (see column on right) , the number of entries to the list has exploded! Right now, I count TWENTY JOB OPENINGS, an impressive number for such a tiny subspecialty. A special thanks to Sherry Miller (wife of U Missouri neuropathologist Doug Miller, MD, PhD) for providing the majority of listings.

A Message from the President of the CAP Foundation regarding the Haiti Relief Effort

Dr. Jennifer Hunt ask me to publish the following open letter to pathologist colleagues regarding the College of American Pathologists Foundation Haiti Relief Effort. I urge readers to participate in this important initiative:

Dear Colleagues,

All of us are reading and watching the devastating news and seeing the wrenching pictures from Haiti in the aftermath of the terrible earthquake earlier this week. As a physician, I read the news and looked at the images with grief, with shock, and with a strong desire to reach out to the struggling people, injured and terrified. But, as a pathologist, I also realize that there is little I would be qualified to do in Haiti today, besides comfort those who are alive and have suffered loss and provide rudimentary first aid.

The CAP Foundation does have a way that you can help Haiti in this hour of need.

Our Humanitarian Grant program has sponsored several pathologists who have done wonderful laboratory outreach work in Haiti in the past. We are working with these pathologist-humanitarians to identify the areas where the CAP Foundation can help Haiti with short-term immediate support and the longer term struggles ahead. I urge you to join me in donating to the CAP Foundation, where pathologists will be part of providing laboratory services, humanitarian efforts, and medical aid during Haiti's moment of crisis and beyond.

I know that each and every one of you would go to Haiti, comfort the survivors, give medical care, and help laboratories cope with the medical situation. And, if you are a pathologist who is planning to join an established relief mission to Haiti, please contact the CAP Foundation and tell us your story. But, we are also acutely aware that there will be incredible needs, short and long term, that will require funding, supplies, and equipment, for health care and laboratory services. By donating to the CAP Foundation Haiti Relief Effort, pathologists can contribute what is needed most, when it is needed most, to provide these desperately needed services.

To help the CAP foundation provide support to the impoverished nation of Haiti, use this link and donate today.

Sincerely,

Jennifer Hunt, MD, MEd, FCAP
Interim President
CAP Foundation

Can that brain you left in storage since 1996 still be assessed immunohistochemically?

The current issue of the Journal of Neuropathology and Experimental Neurology features an article about the effect of prolonged fixation time on the immunoreactivity of brain tissue being assessed for neurodegenerative disease. Dr. Irina Alafuzoff from Uppsula University in Sweden is the senior author on this study which looked at 20 post-mortem brains to determine whether prolonged fixation time has a deleterious effect on typical immunohistochemical stains used for neurodegenerative disease diagnosis.  A panel of commercial antibodies to amyloid-[beta], ubiquitin, p62/sequestosome, tau, and [alpha]-synuclein was assessed using tissue microarray with several antigen retrieval methods. Short-term fixation was defined as a time period of up to 70 days before paraffin embedment. Long-term fixation was defined as 71 days to 14 years in formalin. The bottom line is that brains that are stored in 10% formalin for periods far exceeding a decade do indeed lose some immunoreactivity. But with proper antigen retrieval techniques (which are outlined in detail in the article) immunoreactivity can be maintained in these long-fixed tissues. Keep this article in mind to avoid false-negative results in brain autopsy specimens that have fixed for prolonged periods of time.

POSTSCRIPT: In an email to me regarding this article, Dr. Alafuzoff wanted to add this: "[A]s new antibodies are produced almost monthly and some of them work better than others on archived material (ex. synuclein), maybe we all working in this field should try out new antibodies at regular intervals."

Eight states still do not mandate reporting of CJD cases to public health authorities

Neuropathologists are obligated to keep generally up to date on Creutzfeldt-Jakob disease (CJD) research as they are called upon to perform autopsies on patients whose dementia may have been caused by a prion disease. The most overlooked players in the CJD research arena are patient advocates. Many patient advocates are fiercely motivated, often having been inspired to act by the CJD-related death of a loved one. One such advocate is Theresa Matthews (pictured on a 2006 lobbying visit to Washington with her teenage daughter Mary and Illinois Senator Durbin and then Senator Obama). Patient advocates often raise worthy questions about issues surrounding CJD research. One such question is whether adequate epidemiological data on CJD is being collected in every state. Ms. Matthews informs me that currently there are eight states that do not require physicians to report CJD cases. She testified about this issue at a June 2009 meeting of the FDA's Transmissible Spongiform Encephalopathies Advisory Committee. Here's an excerpt from her testimony:

"Accurate disease reporting is a basic and fundamental step of epidemiology... This cannot possibly be done if you are not even counting the cases. The current state of CJD epidemiology in this country is a joke and it is no laughing matter."

Strong words. But Ms. Matthews makes a good point. Mandated reporting is the first step in reliable epidemiological research. Every state should mandate reporting of CJD cases, whether discovered pre-mortem or only at autopsy. Here are the states that fail to mandate reporting: Washington, Nevada, New Mexico, Iowa, Indiana, Alabama, Kentucky, and West Virginia. If you are a resident of one of these states, contact your governor or state legislator to get this situation corrected!