I discuss issues pertaining to the practice of neuropathology -- including nervous system tumors, neuroanatomy, neurodegenerative disease, muscle and nerve disorders, ophthalmologic pathology, neuro trivia, neuropathology gossip, job listings and anything else that might be of interest to a blue-collar neuropathologist.
The new edition of the WHO Classification of Tumours of the Eye is now on sale, just in time for Christmas! The latest edition is edited by Drs. Hans E. Grossniklaus, Charles Eberhart, and Tero Kivela. There are sections on all recognized neoplasms of the eye, lacrimal apparatus, and conjuctiva. Included are substantial changes to the classification of conjunctival neoplasia and melanoma, based on the latest molecular studies. Information on clinical features in addition to prognostic and predictive factors for each tumour type are provided. Also included are updates to the existing ICD-O codes and new codes for use in epidemiology and cancer registration.
A recent New York Times article describes a $50 million project by more than a dozen research centers aiming to create a sort of Google Earth of the brain. In a series of 11 papers, published in Science and related journals, a consortium of researchers has produced the most richly detailed model of the brain’s genetic landscape to date, one that incorporates not only genes but also gene regulators, cellular data and developmental information across the human life span. The PsychENCODE Consortium, initiated in 2015 and financed by the National Institute of Mental Health, involves more than a dozen research centers and scores of specialists in cell biology, genetics and bioinformatics. It is an all-hands, brute-force effort, coordinating top brain banks and brain scientists at major research centers, led by Yale, Mount Sinai, UCLA, and UCSF.
Dr. Matthew State, chair of the department of psychiatry at the University of California, San Francisco, and a co-author on two of the papers, said: “Essentially what these papers do is lay out cellular and molecular landscape at a resolution that’s never existed before. I see it as foundational work, and an investment that will pay off in giving us a far richer context to develop new hypotheses and study these disorders.”
Chunyu (Hunter) Cai, Douglas Anthony, and Peter Pytel have authored a wonderfully useful review article in Modern Pathology entitled A Pattern-Based Approach to the Interpretation of Skeletal Muscle Biopsies. Dr. Cai wrote the following to me: "In this review, we take a pathology-friendly approach
and categorize muscle biopsies into 6 morphologic groups, and discuss
common differential diagnoses for each group. I think this review fills a void
that there is not a good quick guide for NP fellows, residents and even
neuropathologists who don’t sign out muscle cases on a routine base." Thanks, Drs. Cai, Anthony, and Pytel for a review article that will be a fixture on the desks of many neuropathologists in the coming years!
At first glance, this tumor with pleomorphic cells and prominent perivascular lymphocytic cuffing strikes one as a pleomorphic xanthoastrocytoma (PXA).
The relative circumscription, as demonstrated by the stark difference in tumor burden in adjacent gyri depicted above also suggests the possibility of PXA.
The presence of mitotic figures (center of picture above) and a small amount of necrosis and microvascular proliferation (not pictured) suggests the possibility of anaplastic PXA.
However, perivascular lymphocytes and relative circumscription can be seen in giant cell glioblastoma (GC-GBM). Pointing away from anaplastic PXA is the fact that there was no evidence of Rosenthal fibers and eosinophilic granular bodies. Additionally, there was strong p53 immunohistochemical positivity. The final diagnosis was Glioblastoma, IDH-wildtype, WHO grade IV, giant cell variant.