Dr. Doug Miller named interim pathology chair at University of Missouri

Dr. Miller (note the "brain in a jar" lapel pin)

Douglas C. Miller, MD, PhD was recently named interim chair of pathology at the University of Missouri in Columbia. Dr. Miller joins several other department chairs who are neuropathologists:

Douglas Anthony at Brown (pathologist-in-chief at Rhode Island Hospital)

Dan Brat at Northwestern

Steven Carroll at Medical University of South Carolina

Robert Corona at SUNY Upstate

Jeffrey Golden at Brigham and Women's Hospital

Eyas Hattab at University of Louisville

Alex Judkins at Children's Hospital Los Angeles (pathologist-in-chief)

David Louis at Massachusetts General Hospital

Jenny Libien at SUNY Downstate

Thomas Montine Stanford

Edwin Monuki at the University of California Irvine

Robert Mrak at the University of Toledo

Dr. Miller should not be confused with
movie director Steven Spielberg

Amyn Rojiani at Augusta University

Kevin Roth at Columbia

John Schweitzer at East Tennessee State University

Crooke cell change in a normal pituitary of a patient with ectopic ACTH producing tumor

CK20 immunohistochemistry highlights Crooke cells

Subcortical band heterotopia

Also known as double cortex syndrome, subcortical band heterotopia is a rare congenital abnormality. Patients can live into adulthood, but seizures, cognitive disability, and behavioral problems can occur. (Picture courtesy of Dr. Nathaniel B. Patterson)

Neuropathologist combines music composition with brain research

Dr. Elaine Bearer

University of New Mexico neuropathologist Elaine Bearer, MD, PhD was featured today on a radio interview with KUNM. You can listen to the interview on the University of New Mexico radio station web site. Dr. Bearer's work includes studying biomarkers of trauma and abuse in children and whether the cause of Alzheimer's disease may come from infections. Dr. Bearer is also a composer and it was music that spurred her interest in studying the brain.

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.

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.

Handy reference photo for orienting an enucleation specimen

(Source: Eagle, RC Jr., Eye Pathology: An Atlas and Text, second edition (2011) p. 291.

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.

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.

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.

(Source: Genetic Engineering and Biotechnology News)

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 atrophy. Lancet Neurology, 11(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.