Friday, September 21, 2018

Multinodular and vacuolating neuronal tumor,WHO grade I

The patient is a middle-aged male with a temporal lobe mass. Histopathology shows a low-grade ganglion cell tumor with clustered ganglion cells with a vacuolated neuropil background. The fragmented nature of the specimen precludes identification of a nodular architecture. The diagnosis is multinodular and vacuolating neuronal tumor, WHO grade I. This entity is a cousin of gangliocytoma.

Thursday, September 20, 2018

A WHO grade IV diagnosis in the face of a low-grade histophenotype: a difficult situation for the surgical neuropathologist


This midbrain mass in a 33-year-old patient has low-grade histology (minimal mitoses, low MIB-1 cell cycling index, and a single Rosenthal fiber), yet it harbors the H3 K27M mutation. Perivascular lymphocytes were present, but ganglioglioma was ruled out. So, the following diagnosis was rendered: diffuse midline glioma, H3 K27M mutant, WHO grade IV.  Other molecular changes included loss of p16 (CDKN2a) and loss of PTEN and 10 centromere, consistent with monosomy for chromosome 10. The discordance between histopathology and molecular findings can make the diagnostician squeamish about rendering a high-grade diagnosis. But, sometimes, this is where we find ourselves.

Tuesday, September 18, 2018

Monday, September 17, 2018

Best Post of August 2018 - Omalu puts a religious spin on his assessment of the football: "It is not of God."

The next in our "Best of the Month" series comes from August 8, 2018:
“We shouldn’t let children play [football] because we are damaging their brains and robbing them of their humanity. That is a fact.” That's what Dr. Bennet Omalu had to say to a reporter associate with Sojourners, a faith-based organization. In the recently released article from Sojourners, Omalu said that football is a sport "not of God". A committed Catholic, Omalu  says that he lets "the Spirit of God percolate into my being... Everything I do, I do through the eyes of faith.”

Bennet Omalu, MD
Omalu is best known for the startling discovery he made after performing an autopsy on former NFL player Mike Webster. As chronicled in the 2015 film Concussion, with Will Smith starring as Omalu, the then-medical examiner in Pittsburgh found Webster had chronic traumatic encephalopathy and related it to Webster's years of playing football.

Wednesday, September 12, 2018

Best Post of July 2018: What is the nodulus?

The next in our "Best of the Month" series come from July 16, 2018:

The nodulus is the lobule of the cerebellar vermis that, together with the flocculus of each hemisphere, forms the flocculonodular lobe.



Tuesday, September 11, 2018

Circadian Rhythm Gene May Serve as Target for Glioblastoma Therapies

Scientists from the Virginia Tech Carilion Research Institute say a gene involved in the body's circadian rhythms is a potential target for therapies for glioblastoma.
Their discovery (“Casein Kinase 1 Epsilon Regulates Glioblastoma Cell Survival”), published in Scientific Reports, points to a subtype of a particular gene that apparently is enabling the survival of cancer cells, although it is more commonly associated with circadian rhythms.
“In our previous work, we identified casein kinase 1 ε (CK1ε, also known as CSNK1E) as a potential survival factor in glioblastoma. However, how CK1ε controls cell survival remains elusive and whether targeting CK1ε is a possible treatment for glioblastoma requires further investigation. Here we report that CK1ε was expressed at the highest level among six CK1 isoforms in glioblastoma and enriched in high-grade glioma, but not glia cells. Depletion of CK1ε remarkably inhibited the growth of glioblastoma cells and suppressed self-renewal of glioblastoma stem cells, while having limited effect on astrocytes,” write the investigators.

Friday, September 7, 2018

A case of posterior cortical atrophy

Posterior cortical atrophy (PCA) is a neurodegenerative syndrome that is characterised by progressive decline in visuospatial, visuoperceptual, literacy, and praxic skills. The progressive neurodegeneration affecting parietal, occipital, and occipitotemporal cortices that underlies PCA is attributable to Alzheimer's disease in most patients. However, alternative underlying causes, including dementia with Lewy bodies, corticobasal degeneration, and prion disease, have also been identified, and not all patients with PCA have atrophy on clinical imaging. (Crutch, S. J., Lehmann, M., Schott, J. M., Rabinovici, G. D., Rossor, M. N., & Fox, N. C. (2012). Posterior cortical atrophyLancet Neurology11(2), 170-178)

This is a case of a 60-year-old female with PCA:

Although there is diffuse neocortical atrophy, note the prominent occipital lobe atrophy

Tau stain of temporal lobe section highlights Alzheimer pathology



Pallor of the substantia nigra was noted, and Lewy bodies noted microscopically (see inset)



Alpha-synuclein staining showed neocortical Lewy bodies (here in the frontal lobe)


The final diagnosis was Alzheimer disease and Diffuse Neocortical Lewy Body Disease in the setting of Posterior Cortical Atrophy.


Thursday, August 23, 2018

A case of Alexander disease

Alexander disease is a progressive and often fatal leukodystrophy wherein innumerable Rosenthal fibers form. Caused by mutation in the gene encoding GFAP, Alexander disease can be inherited in an autosomal dominant manner, but typically arises de novo.


Cerebrum

Cerebrum

Cerebellum

Wednesday, August 22, 2018

New Channel on YouTube: Adventures in Neuropathology

There's a new channel on YouTube called Adventures in Neuropathology. The intended audience appears to be medical students or beginning residents. The channel offers brief reviews of individual topics in bite-size chunks. It looks as though the channel just got underway, with fifteen short videos having been posted with the past two months.

Saturday, August 18, 2018

Friday, August 17, 2018

Tumours of the CNS Dataset is now published to the ICCR website

The International Collaboration on Cancer Reporting has published the Tumours of the CNS Dataset.

According to the published document, the "dataset has been developed for the histological assessment of benign and malignant tumours of the central nervous system (CNS) and its coverings, as well as tumours from those aspects of the peripheral nervous system immediately adjacent to the CNS. This dataset applies to both biopsy and resection specimens. Haematological lesions that may originate in the brain are included. Tumours of the anterior pituitary gland are included as the majority of these tumours are reported by neuropathologists worldwide (a separate dataset specifically for pituitary tumours may be considered when the 5th series of the World Health Organisation (WHO) Classification of Tumours is being developed). It is intended that this dataset should be used in conjunction with the ‘Molecular information for CNS specimens’ and the ‘Final integrated report/diagnosis for CNS specimens’ datasets. A full diagnosis of CNS tumours should ideally conform to the final integrated diagnoses in the 2016 World Health Organisation (WHO) Classification of Tumours of the CNS (2016 CNS WHO), which requires integration of elements from histological and ancillary analyses. Nonetheless, it is realized that some diagnoses may not fit precisely within existing diagnostic categories."

Monday, August 13, 2018

Salzmann nodular degeneration of the cornea


Histopathology of Salzmann nodules (*). Disruption of the Bowman membrane is demarcated in each photomicrograph by the area between the left and right arrows: (A) hematoxylin and eosin stain; (B) periodic acid-Schiff stain; (C) immunohistochemistry with antibody against pan-cytokeratin; and (D) immunohistochemistry with antibody against vimentin. (From Stone DU, et al. Histopathology of Saltzmann Nodular Corneal Degeneration. Cornea. Volume 27(2), February 2008, pp 148-151)

Salzmann nodular degeneration  was once called  Salzmann nodular dystrophy. It is now recognized that this typically unilateral disorder is not heritable and is best classifid as a secondary degenerative process of uncertain cause. Clinically, the corneal epithelium is focally elevated by white mounds of dense collagenous connective tissue. Salzmann nodular degeneration resembles a massive focal pannus histopathologically. Mounds of relatively acellular hyaline connective tissue elevate the corneal epithelium anterior to the plane of Bowman membrane, which may be destroyed.

Source: Reference: Eagle, Ralph C. Eye Pathology: An Atlas and Text [2nd edition] page 86.

Friday, August 10, 2018

Best Post of June 2018: Who was Rosenthal?

Of the ten posts from June 2018, my favorite was "Who was Rosenthal?" from June 22. So, here's the next in our "Best of the Month" series:

A Rosenthal fiber in pilocytic astrocytoma

"In 1898, the German pathologist Werner Rosenthal noted elongated inclusions within the gliotic edge of a syringeal cavity of an ependymoma. Assigned to write the case report by a senior mentor while serving as a “first assistant” at the University of Erlangen, Rosenthal colorfully described these inclusions as a “glossy formation of little bulbs or wavy sausages with one thick and one pointed end.”….  His supposition that they were related to glial fibers would prove surprisingly insightful. Not until some 20 years later did Bielschowsky and Unger use the term 'Rosenthal fibers' when describing structures in the gliotic capsule of a cystic teratoid tumor."

Quoted from:  F.J. Wippold, A. Perry and J. Lennerz. Neuropathology for the Neuroradiologist: Rosenthal Fibers. American Journal of Neuroradiology May 2006, 27 (5) 958-961.

Wednesday, August 8, 2018

Omalu puts a religious spin on his assessment of the football: "It is not of God."

“We shouldn’t let children play [football] because we are damaging their brains and robbing them of their humanity. That is a fact.” That's what Dr. Bennet Omalu had to say to a reporter associate with Sojourners, a faith-based organization. In the recently released article from Sojourners, Omalu said that football is a sport "not of God". A committed Catholic, Omalu  says that he lets "the Spirit of God percolate into my being... Everything I do, I do through the eyes of faith.”

Bennet Omalu, MD
Omalu is best known for the startling discovery he made after performing an autopsy on former NFL player Mike Webster. As chronicled in the 2015 film Concussion, with Will Smith starring as Omalu, the then-medical examiner in Pittsburgh found Webster had chronic traumatic encephalopathy and related it to Webster's years of playing football.

Tuesday, August 7, 2018

CAP Neuropathology Committee meets in Montreal

The College of American Pathologists Neuropathology Committee met this past weekend in Montreal. It marked the end of my six-year term as a member of the committee. It was an honor to have served with such a wonderful collection of neuropathologists over the years. I'll miss working with these great colleagues.

In Montreal, committee members (left to right) Kara Jones, Arie Perry, myself, Eyas Hattab, Andrea Wiens, and junior member Lindsey Lowder

At dinner after a day of committee work (left to iight): CAP staffer Annabel Dizon, Karra Jones, Eyas Hattab, Andrea Weins, myself, Arie Perry, Lindsey Lowder, and Lindsey's husband Jon Lowder

Wednesday, August 1, 2018

Lewy Body Pathology and Chronic Traumatic Encephalopathy Associated With Contact Sports

Dr. Ann McKee's group last week published an article in the Journal of Neuropathology and Experimental Neurology supporting the theory that contact sports increases the risk of developing neocortical Lewy body disease, which may in part explain the extrapyramidal motor symptoms sometimes observed in patients with chronic traumatic encephalopathy. Dr. Thor Stein is the senior author on the paper, entitled Lewy Body Pathology and Chronic Traumatic Encephalopathy Asssociated with Contact Sports. 


Friday, July 20, 2018

A ganglion of neuropathologists spontaneously coalesces at a this week's Association of Pathology Chairs meeting

Neuropathologists serve many roles aside from signing out surgical specimens and performing brain autopsies. That fact was in full display at this week's Association of Pathology Chairs meeting where, at a reception on Monday, a group of neuropathologists found themselves standing together at an afternoon reception. (Perhaps this coalescence was not so much by chance as it occurred directly adjacent to the bar.) It was nice to see old friends.

Left to right: Drs. Douglas Miller, Kymberly Gyure, Jennifer Baccon, Eyas Hattab, and Brian Moore

Monday, July 16, 2018

What is the nodulus?

The lobule of the cerebellar vermis that, together with the flocculus of each hemisphere, forms the flocculonodular lobe.




Friday, July 13, 2018

Hyperbrain: a great resource for learning neuroanatomy

HyperBrain is an online tutorial for human neuroanatomy from the University of Utah.  HyperBrain includes thousand of images and hundreds of linked illustrated glossary terms, as well as movies, quizzes and interactive animations.

Thursday, July 12, 2018

Best Post of May 2018: Moving beyond histologic grading of IDH-wildtype diffuse astrocytic gliomas

The next in our "Best of the Month" series comes from May, 30, 2018:

Despite the fact that the most recent update of the World Health Organization (WHO) classification of central nervous system tumors was published only two years ago, the data is already showing that we are moving beyond that classification system when if comes to IDH-wildtype diffuse astrocytomas. The concept of an "integrated diagnosis" in the setting of IDH-wildtype histologic grade II and III tumors has already been eclipsed in the literature by the primacy of the genetic signature over histologic appearance in predicting outcome. In the near future, diffuse IDH-wildtype astrocytic gliomas with (1) combined whole chromosome gain of 7 and loss of 10, and/or (2) EGFR amplification will be designated as equivalent to WHO grade IV gliomas. Histologic grades for such tumors will be stricken from the top diagnostic line so as to avoid unfounded reassurance that these tumors will behave in any way other than very aggressively.

Friday, July 6, 2018

Malignant astroblastoma in a 23-year-old female


Headaches prompted imaging which showed a large right parieto-occipital tumor. Astroblastic pseudorossettes are prominent, with cells that are fairly monotonous. GFAP was only focally positive, not unusual for this diagnosis. Mitotic rate ranged up to 8 per 10 HPF, with a MIB1 cell cycling index reaching 40%.

Thursday, July 5, 2018

More on Rosenthal

Thanks to Dr. Gregg B. Wells from Texas A&M University for directing me to an article authored by Dr. Hans Goebel of Charite-Universitätsmedizin in Berlin regarding the life and accomplishments of neuropathologist Werner Rosenthal (1870-1942). Dr. Wells was prompted to write to me by my recent post entitled "Who was Rosenthal?". For those who are interested in Dr. Rosethal's travails as a Jew in Nazi Germany forced into exile in India, I encourage you to read Dr. Goebel's open-access article.

Dr. Werner Rosenthal with his wife and daughter in 1917.
(Taken from Dr. Goebel's article in Clinical Neuropathology)

Monday, June 25, 2018

Embryonal tumor with multilayered rosettes, C19MC-altered


Embryonal tumor with multlayered rosettes, C19MC-altered, is a WHO grade IV tumor with alterations -- including amplifications and fusions -- in the C19MC locus at 19q13.42.

Friday, June 22, 2018

Who was Rosenthal?

A Rosenthal fiber in pilocytic astrocytoma

"In 1898, the German pathologist Werner Rosenthal noted elongated inclusions within the gliotic edge of a syringeal cavity of an ependymoma. Assigned to write the case report by a senior mentor while serving as a “first assistant” at the University of Erlangen, Rosenthal colorfully described these inclusions as a “glossy formation of little bulbs or wavy sausages with one thick and one pointed end.”….  His supposition that they were related to glial fibers would prove surprisingly insightful. Not until some 20 years later did Bielschowsky and Unger use the term 'Rosenthal fibers' when describing structures in the gliotic capsule of a cystic teratoid tumor."

Quoted from:  F.J. Wippold, A. Perry and J. Lennerz. Neuropathology for the Neuroradiologist: Rosenthal Fibers. American Journal of Neuroradiology May 2006, 27 (5) 958-961.

Thursday, June 21, 2018

Pennies-on-a-plate cell in a pilocytic astrocytoma

Multinucleated astrocytes with peripherally situated nuclei like this one in a pilocytic astrocytoma
are referred to as having a "pennies-on-a-plate" configuration
This is a common "degenerative" change seen in long-standing pilocytic astrocytomas. I'm not sure from where this "pennies-on-a-plate" designation derives, but please leave a comment if you know.

Tuesday, June 19, 2018

Guest Post - Wanted: Your Opinion on Artificial Intelligence in Pathology

Today features a guest post from Dr. Phedias Diamandis of the University of Toronto:

Phedias Diamandis, MD, PhD
There is a growing body of evidence highlighting the utility of Artificial Intelligence (AI) in pathology. AI is a type of mathematical algorithm that allows computers to carry out human-like tasks considered “intelligent”, such as recognizing diagnostic histologic patterns or counting mitotic figures on digital H&E slides.  This has the potential to radically transform the clinical practice of pathologists. This anonymous survey was developed to understand the familiarity, enthusiasm, and concerns pathologists may have regarding this technology in their practice. Some anonymous demographic information is also requested to understand the relationship of these variables (e.g. specific age groups, practice types and speciality) to the responses of the variables. It is expected that findings of this study will help guide researchers to design AI workflows that meet the specific needs of the study participants.

This survey will take roughly 10-15 minutes to complete. It is anonymous and the investigators of the study have no conflicts of interest.

The survey can be accessed at the following link: https://www.surveymonkey.com/r/AIinpathology

Thank you for your participation! Please circulate to your colleagues. Everyone's opinion counts!

Automated lesion detection and classification in pathology: Upper Panels: A form of artificial intelligence known as deep convolutional neural networks (CNNs) is currently showing impressive results at pattern recognition tasks traditionally carried out by highly skilled humans. In this example, a full digital slide image is analyzed to highlight brain regions infiltrated by this oligodendroglioma. The IDH1-R132H immunostains (right upper panel) highlights where the tumor actually is for comparison. Lower panels: High power view of the same tumor showing it's infiltrative nature. The CNN clearly detects the infiltrative nature of this lesion. The right most panel shows the computer output of another metastatic lesion with a much more circumscribed border. In addition to identifying the lesions, CNNs are beginning to show promise at classifying tumors with different clinical outcomes.  

Monday, June 18, 2018

International Society of Neuropathology set to meet in Tokyo this fall

Keio Plaza Hotel in Tokyo
The 19th International Congress of Neuropathology will take place in Tokyo on September 23-27, 2018. The Congress meets every four years. The upcoming meeting will be hosted by the Japanese Society of Neuropathology with the theme ‘a gateway to modern neuroscience’.  The Congress will be held at the central Keio Plaza Hotel in Tokyo, The meeting will be held in conjunction with the Asian Congress of Neuropathology and the Japanese Societies of Neuropathology and Brain Tumour Pathology. The  programme and other details are now on the Congress website

Friday, June 15, 2018

More on the amazing word "physaliferous"

Since my post this past Wednesday about the etymology of the word "physaliferous" which designates the characteristic cells comprising chordomas, the illustrious Dr. Maria Martinez-Lage (neuropathologist at Massachusetts General Hospital), tweeted about another word which derives from the same Greek root. Here is Dr. Martinez-Lage's tweet:

Physaliferous cells resemble the fruit of the physalis plant, an edible berry that is round and surrounded by a delicate lacy husk. It goes by many names: Golden berry, cape gooseberry, edible Chinese lantern. Delicious!


Thursday, June 14, 2018

A Primer on Giant Cell (Temporal) Arteritis

Neuropathologists are often tasked with handling ophthalmic pathology at their institutions. As such, they are assigned all cases submitted by ophthalmologists -- including temporal artery biopsies for determination of the presence of active giant cell (temporal) arteritis. What follows is a quick reference on the important points to remember about giant cell arteritis. (If there are things I am forgetting, please add your comments.):

Arrow points to a giant cell in a temporal artery wall
(from Robbins Basic Pathology, 10th edition)
Refering to the condition as "temporal arteritis" is not entirely accurate as giant cell arteritis is a granulomatous inflammatory disorder that can affect a variety of large and small arteries in the head. In addition to the temporal artery, ophthalmic arteries can be affected (which is the reason ophthalmologists are often the clinicians performing biopsies in suspected cases). Additionally, vertebral arteries and even the aorta (giant cell aortitis) can be involved. Since ophthalmic arteritis can lead to sudden and irreversible blindness, affected patients must be promptly diagnosed and treated. A negative biopsy result does not entirely exclude the diagnosis as the distribution of inflammation is often patchy.

Because pathologic changes tend to be patchy, examination of several cross-sectional levels is required. Involved segments exhibit nodular intimal thickening (and occasional thromboses). Most lesions exhibit granulomatous inflammation within the inner media which disrupts the internal elastic lamina. A minority of cases do not show either granulomas or giant cells, instead exhibiting only a non-specific acute and chronic inflammatory infiltrate. Healing is characterized by intimal thickening, medial thinning, and adventitial fibrosis.

Reference: Kumar V, Abbas AK, and Aster JC (eds.) Robbins Basic Pathology, Chapter 10 "Blood Vessels", 10th Edition (2018) pp. 384-5.

Wednesday, June 13, 2018

Etymology of the word "physaliferous"

The characteristic cells seen in chordoma, physaliferous cells (which, according to the Oxford English Dictionary, can alternatively be spelled 'physaliphorous') is from the Greek physallis (meaning 'bubble') and phoros (meaning 'bearing').


The "bubble-bearing" physaliferous cells of a chordoma

Tuesday, June 12, 2018

A primary central nervous system lymphoma overwhelmed by necrosis and neutrophil infiltration

This PCNSL (later proved to be EBV-driven) biopsied from the right parietal lobe is hardly discernible among the necrotic debris and neutrophilic infiltration

Tumor cells (outlined) within and surrounding a vessel wall

Wednesday, May 30, 2018

Moving beyond histologic grading of IDH-wildtype diffuse astrocytic gliomas

Despite the fact that the most recent update of the World Health Organization (WHO) classification of central nervous system tumors was published only two years ago, the data is already showing that we are moving beyond that classification system when if comes to IDH-wildtype diffuse astrocytomas. The concept of an "integrated diagnosis" in the setting of IDH-wildtype histologic grade II and III tumors has already been eclipsed in the literature by the primacy of the genetic signature over histologic appearance in predicting outcome. In the near future, diffuse IDH-wildtype astrocytic gliomas with (1) combined whole chromosome gain of 7 and loss of 10, and/or (2) EGFR amplification will be designated as equivalent to WHO grade IV gliomas. Histologic grades for such tumors will be stricken from the top diagnostic line so as to avoid unfounded reassurance that these tumors will behave in any way other than very aggressively.

Friday, May 25, 2018

Dr. Dan Brat interviewed on Northwestern Feinberg School of Medicine Podcast

In the latest episode of the Northwestern Medicine Breakthroughs podcast, Daniel Brat, MD, PhD discusses the emerging integrated molecular-histomorphological classification of diffuse gliomas. In an episode entitled "A New Way to Diagnose Brain Tumors", Dr. Brat -- the new chairman of the Northwestern Pathology -- states that "whenever you go through a reclassification that dramatic, there's going to be gaps in knowledge and gaps in practice and we are recognizing those gaps on a
Dr. Dan Brat
daily basis, on a yearly basis.  And we as a brain tumor community internationally are working to fill those gaps in knowledge. So what we found for example, is that once you classify molecular diseases, the grading criteria that we used in the past to grade things as [World Health Organization] grade one, grade two, grade three, grade four, which really served to predict how patients are going to fair and what type of therapies they are going to need, all of those grading criteria needed to be recalibrated. And that's a significant undertaking as well. And we have certain initiatives within the international community through an organization called cIMPACT-Now [
Consortium to Inform Molecular and Practical Approaches to CNS Tumor Taxonomy – Not Official WHO]. And we as a group, including some colleagues here at Northwestern Feinberg School of Medicine, are writing the guidelines for new grading criteria for the diffuse gliomas within the molecular era." . The podcast aired on May 15 and is available on iTunes and SoundClound.

Thursday, May 24, 2018

Best Post of April 2018: Exuberant endothelial reactive hyperplasia next to a subacute infarct biopsied to rule out neoplasia

The next is on "Best of the Month" series is from Tuesday, April 3, 2018:


Endothelial hyperplasia next to an infarct, not to be confused with microvascular proliferation in a glioma

Tuesday, May 22, 2018

The "specific glioneuronal element" of dysembryoplastic neuroepithelial tumor

A "floating neuron" is circled in this "specific glioneuronal element" of a DNT
A pathognomonic feature of dysembrioplastic neuroepithelial tumors (DNTs) is the "specific glioneuronal element" which consists of oligodendroglial-like cells lined up on either side of a paucicellular and mucinous region in which lone neurons appear to float.

Thursday, May 17, 2018

Astroblastoma


This is a rare, as yet ungraded, cerebral tumor of childhood. It is composed of cells that are GFAP positive and have broad, non-tapering processes radiating toward central blood vessels (astroblastic pseudorosettes). The border with adjacent brain is pushing, not infiltrative. Hyalinized vessels (as seen below) are a hallmark of astroblastoma. No ependymal features have been identified in studies of this unusual entity.

Wednesday, May 16, 2018

Age of First Football Tackles Tied to Neurobehavioral Symptom Onset

Younger age of exposure to tackle football predicts earlier neurobehavioral symptom onset among players with chronic traumatic encephalopathy (CTE), according to a study recently published online in the Annals of Neurology.
Michael L. Alosco, Ph.D., from Boston University, and colleagues examined the brains of 246 tackle football players donated for neuropathological examination. Of the 211 who were diagnosed with CTE, 126 were without comorbid neurodegenerative diseases. Age of first exposure and age of cognitive and behavioral/mood symptom onset were determined through informant interviews.

Monday, May 14, 2018

Understanding Neurophobia Among Medical and Other Health Care Students

Andre Toulouse, PhD, (University College,
Cork, Ireland) lead author on
article about neurophobia
Neurophobia, a trepidation among students in health-related fields when it comes to neuroanatomy, is a real thing and has been studied by several researchers in medical education. A recent paper by an Irish group appearing in Anatomical Sciences Education, entitled "Understanding neurophobia: reasons behind impaired understanding and learning of neuroanatomy in cross-disciplinary healthcare students", examines this phenomenon further. The authors write: "Neuroanatomy is perceived as a more difficult subject compared to other anatomy topics (e.g., reproductive/pelvic anatomy)...[U]nderstanding of neuroanatomy could be enhanced and neurophobia decreased by purposefully designed computer aided learning resources. This data could help curricular designers to refocus attention and guide educators to develop improved neuroanatomy web resources in future." Interestingly, when students were surveyed about what they would find most helpful in online neuroanatomy learning, blog posts were perceived as likely to be least helpful, while photographs of brain prosections and computer animations were perceived to be the most helpful.

Reference: Javaid MA, Chakraborty S, Cryan JF, Schellekens H, Toulouse A. Understanding neurophobia: reasons behind impaired understanding and learning of neuroanatomy in cross-disciplinary healthcare students. Anat Sci Educ 11:81-93 (2018).

Thursday, May 10, 2018

Best Post of March 2018 - Featured Neuropathologist: Michael Punsoni, MD

The next in our "Best of the Month" series is from March 12, 2018

On occasion, we profile a prominent or rising neuropathologist. In the past, we've featured the likes of Craig HorbinskiRoger McLendonJan Leestma, and Karra Jones. Today we feature Michael Punsoni, MD, a 2016 graduate of the Brown University Neuropathology Fellowship Program and now on faculty at the University of Nebraska in Omaha. Dr. Punsoni agreed to engage in a little Q&A:



1. Why did you decide to become a neuropathologist?
I have always had a strong interest in science and medicine, particularly the neurosciences. After college I worked in two research labs, which fueled my interest in basic neuroscience but also drove me to pursue a medical degree. During my clinical years of medical school I had a strong interest in neurology but my eagerness to be involved in all facets of medical care led me to apply for a categorical residency in Internal Medicine. While I am grateful for the skills and knowledge I acquired during my medicine internship I came to the realization (on one of my 36-hour calls if I remember correctly) that clinical medicine was not for me. I went back to the specialty drawing board and ultimately found pathology somewhat by chance. One of my patients on the medical floor needed an aspiration biopsy of a neck mass. I met the cytopathologist and watched closely as she aspirated a small amount of material and looked on in awe at the squamous cell carcinoma cells on her bedside dual-head scope. I fell for pathology hard after that and, while re-applying to the match, I went back to what I knew best, another year of neuroscience research. By the time I was in pathology residency, my interest for neuropathology was cemented and there was no going back.


2. What do you like to do outside of work?
Watching old and new movies and finding great hole-in-the-wall type restaurants. I’m always looking for/open to suggestions for either one.


3.
 Name a couple of important professional mentors. Why were they important to you?
My two PIs at Cornell Medical Center, Joe Pierce and Theresa Milner for the brilliant work they let me participate in, for teaching me to be meticulous in all things particularly bench techniques and for their good humor that stays with me today. To all four neuropathologists at Brown University who shaped the neuropathologist I would become and still hope to be one day. Dr. Suzanne de la Monte to whom I am grateful for her relentless push to make me a good presenter and for sharing her invaluable tips on manuscript writing. Dr. Douglas Anthony whose leadership skills and commitment to the scientific method were inspiring then and now. Dr. Ed Stopa who treats all his fellows like family and never stops guiding them. Dr. John Donahue who taught me that a remarkable memory is only part of what makes a good pathologist and also, that “it’s a tough job but someone’s got to do it!”.


4.
 What advice would you give to a pathology resident interested in doing a neuropathology fellowship?
Do an elective at your home institution and/or elsewhere. Try it out. It’s a fascinating field and will be for years to come. As I once heard one of my mentors say, we have our own language (when describing the structures of the brain) and we like it that way. Join the group, we’d love to have you.


5. What city (other than Omaha, of course) would you like a future American Association of Neuropathologists meeting to be held and why? 
Honolulu. I’ve never been and this would be a great reason to go. Another desirable place would be Boston, which has great restaurants and a good transit system.