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:

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.

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.

"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

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

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.

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!

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.

Source: https://www.dmu.edu/dose/2009/11/anatomy-word-of-the-month-torcular-herophili/

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.

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

References:

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.

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.