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!

Friday, March 3, 2017

Why is the confluence of the cerebral venous sinuses called the "torcula"?

Torcula is derived from a Latin word meaning to “twist” and was also used to refer to a wine press. Within the cranium the venous sinuses come together at the back of the skull in a structure called the confluence of the sinuses. This cavity has four large veins radiating from it, supposedly resembling the spigots that pour dark purple juice out of the four sides of the ancient wine press used to squeeze grapes with a handled screw on the top. The same stem is found in common words such as torture and tortuous.


Monday, February 20, 2017

Hunched Over a Microscope, Santiago Ramon y Cajal Sketched the Secrets of How the Brain Works

Last month, the Weisman Art Museum in Minneapolis opened a traveling exhibit that is the first dedicated solely to Ramón y Cajal’s work. According to a New York Times article, it will make stops in Minneapolis; Vancouver, British Columbia; New York City; Cambridge, Mass.; and Chapel Hill, N.C., through April 2019.

Ramon y Cajal in his laboratory, circa 1885
 Thanks to Drs. Mark Cohen and John Evans for alerting me to this exhibit.

Thursday, February 16, 2017

Best Post of November 2016: Calcifying Pseudoneoplasm of the Neuroaxis (CAPNON)

The next in our "Best of the Month" series is from November 11, 2016:

Approximately 59 cases of CAPNON have been reported in the literature, A non-neoplastic entity that can be found in either an intra-axial or extra-axial location, the pathogenesis of CAPNON is unclear but a reactive process has been favored. The outcome is generally considered to be excellent, with gross total resection typically curative. This case is somewhat unique in that it harbors adipose tissue.

Foci of calcification and fat are present in this midline example

Nodules of basophilic calcification

The calcifications have a chondromyxoid appearance

Surgery was complicated as the lesion encased the anterior cerebral arteries

Aiken AH, Akgun H, Tihan T, Barbaro N, Glastonbury C. Calcifying pseudoneoplasms of the neuroaxis: CT, MR Imaging, and Histologic Features. American Journal of Neuroradiology 30 (2009) 1256-1260.

Duque SG, Lopez DM, de Mendivil AO, Fernandez JD. Calcifying pseudoneoplasms of the neuroaxis: Report of four cases and review of the literature. Clinical Neurology and Neurosurgery 143 (2016) 116-120.

Friday, February 3, 2017

Ophthalmologist and Eye Pathologist David Wilson Visits University of Colorado Pathology Department

Dr. David Wilson (left) with residents and attendings at University of Colorado Pathology Dept today
The pathology department was one stop made by Dr. David Wilson, ophthalmologist and eye pathologist from Oregon Health and Science University, when he visited the University of Colorado today.

Wednesday, January 25, 2017

Diagnostic and Prognostic Value of Human Prion Detection in Cerebrospinal Fluid

A report appearing in the current issue of Annals of Neurology (2017;81:79-92) titled "Diagnostic and Prognostic Value of Human Prion Detection in Cerebrospinal Fluid" investigates the second-generation real-time quaking-induced conversion (RT-QuIC) prion test in a broad spectrum of prion diseases. The study concludes as follows: "The diagnostic performance of the improved CSF RT-QuIC is superior to surrogate marker tests for prion diseases such as 14-3-3 and tau proteins, and together with PRNP gene sequencing the test allows the major prion subtypes to be differentiated in vivo. This differentiation facilitates prediction of the clinicopathological phenotype and duration of the disease—two important considerations for envisioned therapeutic interventions." Among the authors are Aaron Foutz (first author), Mark Cohen, and Jiri Safar (senior author).

Monday, January 23, 2017

FDA approves first drug for spinal muscular atrophy

The U.S. Food and Drug Administration recently approved Spinraza (nusinersen), the first drug approved to treat children and adults with spinal muscular atrophy (SMA). The FDA granted this application fast track designation and priority review. The drug also received orphan drug designation, which provides incentives to assist and encourage the development of drugs for rare diseases.

Thanks to Dr. Nick Willard for alerting me to this development.

Wednesday, January 18, 2017

Nice Example of STAT6 nuclear positivity in a WHO grade III Solitary Fibrous Tumor/Hemangiopericytoma

STAT6 immunostaining shows strong nuclear positivity among tumor cells, while the cytoplasm is uniformly negative.  STAT6 nuclear immunoreactivity has been reported as a surrogate marker for the NAB2-STAT6 gene fusion, which is the defining driver mutation of solitary fibrous tumor/hemangiopericytoma. 

Friday, January 13, 2017

Bo Jackson says he won't let his kids play football

Bo Jackson in 2004
The implications of the description of Chronic Traumatic Encephalopathy continue to reverberate as yet another former professional football player states that he will not let his children play football. The Kansas City Star reported yesterday that former Heisman Trophy winner and Oakland Raider star running back Bo Jackson said he would not play football if he were growing up today and will not let his children play the sport.

“If I knew back then what I know now. I would have never played football. Never. I wish I had known about all of those head injuries, but no one knew that. And the people that did know that, they wouldn’t tell anybody,” Jackson said in an interview. He went on to say that he has encouraged his children to play "anything but football". 

The NFL admitted in 2016 — after much hand-wringing and many denials and delays — that there is a link between football and CTE.

As a father of a 9-year-old boy myself, I communicated the same thing to my own son. 

(Thanks to Dr. Doug Shevlin for alerting me to this development.)

Wednesday, January 4, 2017

Neuroscience Online, the Open-Access Neuroscience Electronic Textbook

This online, interactive courseware for the study of neuroscience is worth bookmarking. It's provided by McGovern Medical School at UTHealth in Houston. The project is under the direction of Neurobiology and Anatomy Chair John H. Byrne, PhD.

John H. Byrne, PhD.