Best Post of April 2011: CAP Neuropathology Education CD-ROM is now SAM-eligible!

The next in our "Best of the Month" series is from April 6, 2011:

For those of you who are scrambling to get neuropathology Self-Assessment Module (SAM) continuing medical education credits, the College of American Pathologists (CAP) now has an answer. If you attained your neuropathology board certification after 2006, every two years you must submit to the American Board of Pathology proof that you have obtained 20 SAM-eligible continuing medical education credits. If you subscribe to the CAP Neuropathology Education product, which provides you with two 5-credit SAM modules per year, you've got your requirement covered. This is a particularly attractive option since there are so few neuropathology SAM modules on the market. (For example, the American Association of Neuropathologists currently only offers a single 1-credit SAM module.) I just completed the first 2011 CAP Neuropathology CD-ROM installment. It is outstanding. Each edition features a theme, or  "minisymposium". The current edition's "minisymposium" focuses on tumor predisposition syndromes. (Pictured is a coronal brain section, taken from the current edition of the CD-ROM, of a brain with classic features of a classic tumor predisposition syndrome.) To just get CME credit, you only have to submit to the CAP answers to the questions posed on the CD-ROM itself. But if you want those crucial SAM-designated credits, you must additionally pass a 20-question online post-test.

The CD-ROM product is created by the CAP Neuropathology Committee, whose chair is Dr. Bette DeMasters. She recently informed me that the second 2011 CD-ROM edition will feature the first of a two-part discussion of vascular diseases of the CNS, with University of Florida's Dr. Tony Yachnis as author of the minisymposium introduction. For 2012, Dr. DeMasters tells me that the first edition will feature papillary tumors of the CNS, both primary and metastatic; and the second edition will feature the second part of the vascular disease discussion.

I've always been a big fan of the CAP Neuropathology CD-ROM product, but now it is more than just a quality product. It is now absolutely essential to the young neuropathologist who wants to stay on the good side of the American Board of Pathology.  Thank you, CAP!!!

Update: Since this post's original publication, the second of the 2011 CAP neuropathology education products has arrived in my mailbox.

Benignity in meningioma indicated by smiley face nucleus

Drs. John Donahue and Ed Stopa sent in the photomicrograph below from an article they published in 1999 describing a benign meningioma. They conclude: "In this case, another factor in favor of the tumor being benign is that its nuclei are smiling (arrow)."

University of Missouri pathologists describe novel glioblastoma cell types

From pathology resident Paul McGowan, MD, the "Sphincter Cell of McGowan":

And from the textbook of University of Missouri's Douglas C. Miller, MD, PhD, a glioblastoma cell which he describes as "an ugly little homunculus giving all us neuropathologists, neurosurgeons, and neurooncologists the finger":

Corythosaurus cell in a glioblastoma

Not to be outdone, the illustrious Dr. Mark Cohen just sent me this corythosaurus cell found in a glioblastoma. An actual corythosaurus is depicted below for comparison:

Starburst mitotic figure in a glioblastoma

Came across this today:

Synoptic reporting for CNS tumors

Mark W. Becher, MD

Neuropathologist Mark W. Becher, MD published an article this past June in Archives of Pathology and Laboratory Medicine (Vol 135:789-792) entitiled Practical Neuropathology Synoptic Reporting for Central Nervous System Tumors. Dr. Becher writes that "the CAP [College of American Pathologists] CNS protocol, published in 2008, is an immense comprehensive document that is not conducive to simple inclusion in a narrative report". Dr. Becher notes that few neuropathologists actually apply the CAP protocol in their daily practice. However, he concludes that because of "the multidisciplinary nature of CNS tumor diagnoses, neuropathologists typically collect clinical, demographic, and imaging data on all CNS tumor cases. These data can readily be entered into a primary synoptic report that could replace our standard narrative report." Dr. Becher describes a synoptic checklist designed to accompany, and possibly replace, the standard narrative surgical neuropathology report, stating that it is more streamlined and easier to use than the exhaustive CAP checklist; as such, it is more useful to both clinicians and data collectors. Here is a link to the CAP surgical neuropathology checklist. The CAP should consider Dr. Becher's proposed checklist and adapt its own accordingly.

Best Post of March 2011 - Dawson Fingers: A Cocktail-Party Term Worth Knowing

The next in our "Best of the Month" series is from March 10, 2011:

Dawson Fingers (in box)

One of the nice things about teaching is that you frequently learn a lot from your students and residents. I had never heard of a radiological finding in multiple sclerosis known as "Dawson Fingers" until I was informed of it by Southern Illinois University second-year medical student Joshua Billington and neurology resident Laxmi Prasad Dhakal. "Dawson Fingers" are a purely radiological finding, which may be why the term is not found in neuropathology textbooks (at least not in the indices of eight different neuropathology textbooks that I consulted). Here's what Adams and Victor's Principles of Neurology (9th edition, page 889) has to say on the subject: "Especially diagnostic are oval or linear regions of demyelination, oriented perpendicularly to the ventricular surface; they correspond to the radially oriented fiber bundles of the white matter and periventricular veins. When viewed in sagittal images, they extend outward from the corpus callosum in a fimbriated pattern and have been termed 'Dawson Fingers'. These areas may extend into the centrum semiovale and may reach the convolutional white matter. Even one highly characteristic lesion is sometimes enough to confirm the diagnosis in the proper clinical circumstances; multiple lesions are more convincing. The presence of such lesions in the corpus callosum is diagnostically useful, as this structure is spared in many other disorders."  See the image above (from Adams and Victor, page 876) depicting Dawson Fingers on sagittal T2-weighted FLAIR MRI. The irony here is that this finding was named after a neuropathologist, James Walker Dawson (1870-1927), despite the fact that many neuropathologists are unfamiliar with the term (well, OK, maybe just me). Thanks to Dr. Dhakal and Pre-Dr. Billington for informing me of this eponymous finding -- one that neuropathologists should probably be able to throw around at any neuroscience cocktail party.