The Pigmented Cells of Metastatic Melanoma Traveling Along Virchow Robin Spaces of Adjacent Brain

Chordoid glioma of the third ventricle in a 67-year-old male

The origin of these rare tumors have recently been linked to other midline TTF1-expressing tumors deriving from the organum vasculosum of the lamina terminalis.

Please show your gratitude to outgoing AANP Business Manager Peggy Harris

The Incomparable Peggy Harris

An important message from Mark Cohen, MD and Kathy Newell, MD:Peggy Harris needs no introduction to members of the American Association of Neuropathologists, as over the past 13 years she has supported and guided most of us (including the Executive Council and Committee Chairs) through the often confusing mechanics and byways of the society's functions, and has been instrumental in facilitating every aspect of our Annual Meetings, from abstract submission to registration to finding other members to making sure that everyone got CME credits. It would be almost impossible to list everything that Peggy has done for the AANP during her tenure with us. Pardon the neuropathological pun, but it would not be hyperbole to say that Peggy has been both our pia mater and glia during her tenure with the Association.

Peggy recently learned that she will no longer be assisting the AANP membership in the new year. Many of us will be sad to see her go, and will miss her at our Annual Meetings. For those who wish to contribute to a monetary gift of appreciation and support honoring Peggy's many contributions to the AANP, we have set up this special farewell fund.

This is not an official AANP-sponsored fundraiser. All proceeds donated to this fund will go directly to Peggy to show our gratitude to her. Please join us in showing how much we appreciate all that she has done for each of us individually and for the AANP as a whole. Thanks.

"I’m a neuropathologist with a glioblastoma": A guest post from Susan M Staugaitis, MD, PhD

I’m a neuropathologist with a glioblastoma.  How ironic is that?  For 17 years, my skill in making this diagnosis has been a major part of my job.  I know more about the biology of my disease than most of the physicians involved in my care.  And suddenly, within two weeks, my life expectancy changed from 30+ years to 2-5.  My reality has changed.

If I'm freaking you out, you are not alone.  I'm freaking everybody out.  I haven’t had such a good excuse to be so “frontal lobe” since I was a teenager.  In the past five months, I have become so accustomed to my diagnosis and disabilities that I blurt it out to store clerks when explaining why I’m seeking a particular good or service.  I know the song I want to hear over and over again as I cross to the other side.  Would you expect anything less from someone who looks a lot better than her scan?  

I cope by trying to stay realistic and in the moment.  I try to extract anything and everything that is positive from my experience today and defer to tomorrow all thoughts that won’t matter until then.  It’s not much different from the days when I lived in southern California, not worrying about the “big one” that could hit anytime, but keeping myself prepared nevertheless. 

Dr. Staugaitis wearing the Novocure Optune electric field generator as part of her treatment 

Family and friends remark on the extraordinary strength and courage I display.  Honestly, hearing this can get to be too much.  I do need the people close to me to help me fortify and reinforce the strength I am finding in myself, but quixotic sentiments don’t provide much comfort.  I’m too honest and practical to expect a miracle, to dream the impossible dream.  I’ll be satisfied with the possibility of beating the odds.

But, any gambler will tell you that the odds depend on the game.  I think sports gambling is most relevant to me and my diagnosis.  In sports gambling, it is all in the point spread.  You can win when your team loses and lose when your team wins.

Neuropathologists have inside information in this respect.  We look at the location of the lesion, at the histology in the microscope, at the molecular profile, and the combination gives us a pretty good idea of how to place our bet.  No emotions or wishful thinking here; we’ve got data.  As scientists, we are obligated to describe the data accurately and analyze it objectively.  In fact, if we are to gain and maintain the respect of our peers, we cannot ignore any data, no matter how much we dislike it, no matter how much it conflicts with our view of how the world should be.  And as writers, we find the words that communicate our interpretations as definitively and positively as possible without being incorrect.

Then it is time to sit back and watch the game, wait for the final score.  Did my bet beat the spread? 

And regardless of the game’s outcome, there will always be another game: new questions, new data to acquire.  So we pick ourselves up, dust ourselves off, and start all over again.

© 2015 Susan M. Staugaitis, M.D., Ph.D. 

Retired Consultant Staff, Departments of Pathology and Neurosciences, Cleveland Clinic

Adjunct Assistant Professor of Molecular Medicine

Cleveland Clinic Lerner College of Medicine of Case Western Reserve University

Renowned neuropathologist Peter Burger set to retire at the end of this month

Peter C. Burger, MD

I just got word that the illustrious Johns Hopkins neuropathologist Peter C. Burger, MD is set to retire at the end of this month. In an email yesterday, the 74-year-old professor informed me that he will continue to work on various neuropathology projects, but will not be signing out cases after December 31. He writes that he is "ready for a new phase of life without the daily responsibility of cases". His sage consultations on difficult cases will be missed, but I am sure his impact will continue to be felt in the field through his valuable publications.

Not allowing kids to play football is "our moral duty": Bennet Omalu, MD

In a recent New York Times opinion piece, pathologist Bennet Omalu strongly endorsed a policy that children should not play football. Here are excerpts from his essay:

"We've known since 1964 that cigarette smoking is harmful to your health. We’ve known for more than 40 years that alcohol damages the developing brain of a child. We’ve known since the mid-70s that asbestos causes cancer and other serious diseases. Knowing what we know now, we do not smoke in enclosed public spaces like airplanes; we have passed laws to keep children from smoking or drinking alcohol; and we do not use asbestos as an industrial product.

"If a child who plays football is subjected to advanced radiological and neurocognitive studies during the season and several months after the season, there can be evidence of brain damage at the cellular level of brain functioning, even if there were no documented concussions or reported symptoms. If that child continues to play over many seasons, these cellular injuries accumulate to cause irreversible brain damage, which we know now by the name Chronic Traumatic Encephalopathy, or C.T.E., a disease that I first diagnosed in 2002."

It should be noted that the CTE brain bank at Boston University found evidence of CTE in the brains of 131 out of 165 athletes who played professional, college, or high school football. In other words, based on this sample size, the risk of getting CTE from playing football for a relatively extended period is higher than the risk of getting lung cancer from smoking.

Since we have a legal age at which individuals are allowed to smoke, drink alcohol, and drive, it stands to reason that engaging in an activity that is likely to cause brain damage should also only be engaged in by individuals old enough to make an informed decision, says Omalu. 

Thanks to Dr. Chad Vanderbilt for alerting me to this article.

Nocardia farcinica brain abscess

Pus on H&E

Fite's stain demonstrating the bacteria