Aaron Hernandez Had Severe C.T.E. When He Died at Age 27

The New York Times reported yesterday that an autopsy report on 27-year-old Aaron Hernandez, the former New England Patriots tight end and convicted murderer, showed evidence of severe chronic traumatic encephalopathy (CTE). Hernandez committed suicide earlier this year. 

Excerpts from the article:

"Dr. Ann McKee, chief of neuropathology at the VA Boston Healthcare System and director of the CTE Center at Boston University, examined his brain and said in a statement that Mr. Hernandez had “early brain atrophy” and “large perforations in the septum pellucidum, a central membrane” of the brain. The slides also showed what she called “classic features of C.T.E. in the brain,” including deposits of tau protein in the front lobes of the brain in nerve cells around small blood vessels."

"The trauma to Mr. Hernandez’s brain raises fresh questions about the dangers of playing tackle football. This week, other researchers at Boston University published research that found that adults who began playing tackle football before they were 12 years old developed more cognitive and behavioral problems later in life than those players who started tackle football after they reached that age."

Thanks to Dr. Mark Cohen for alerting me to this article.

"I'm a brain scientist and I let my son play football" -- Peter Cummings, MD

Peter Cummings, MD with his son

Dr. Peter Cummings, an accomplished forensic neuropathologist, just posted an article on Yahoo Sports giving his perspective on the controversial question of whether we should let our children play football given the risk for chronic traumatic encephalopathy. Here is the link. Thanks to Dr. John Donahue of Brown University for alerting me to this article.

Guest Post from Dr. PJ Cimino: Blue discoloration of the gray matter in a patient who received methylene blue for respiratory distress prior to death

Dr. PJ Cimino, whom we profiled when he was a fellow back in November of 2013, is a now faculty member at the University of Washington. I was delighted to receive this email from him today:

"I had an autopsy case with interesting gross pathology findings, which made for some nice clinical images (below). The patient received therapeutic methylene blue in the setting of respiratory distress prior to death. The gross pathology showed striking widespread green-blue gray matter discoloration. I thought these images might be of interest to share with the general neuropatholgy community, and thought your blog might be a good platform to do so, especially since you have posted many good clinical images."

American Board of Pathology Maintenance of Certification Exam Pass Rate Dips to 97.7%!!!

The American Board of Pathology (ABP) recently published their pass rates for the Spring 2017 administration. After maintaining a 100% pass rate for the previous four administrations of the exam over two years, the Spring 2017 exam pass rate has dipped to an appalling 97.7%!

A total of 265 individuals took the exam (at $700 per examinee, the ABP brought in a paultry $185,000 from this administration). Included in this number is probably the few like me who only took the neuropathology exam, with the majority likely taking the AP/CP exam.

Bottom line: No need to worry about either your likelihood of passing the MOC exam or the financial well-being of the ABP.

I took the American Board of Pathology Neuropathology Maintenence of Certification Exam

I took the American Board of Pathology neuropathology maintenance of certification exam this week. Given that the ABP goal is virtually a 100% pass rate, I found the test more difficult than I anticipated. I suppose I shouldn't have been surprised by the level of difficulty of some of the questions, given that the ABP publishes the topics covered. But in some cases knowing the topic does not really help with preparation. For example, one topic listed is: "abnormal corticospinal tracts/pyramids". In any case, I am sure the cut-off score for passing is relatively low. Results, which only entail whether or not one has passed, will be released in October.

Best Post of June 2017: Additional photograph of remarkable CNS/PNS dissection

The next in our "Best of the Month" series is from June 12, 2017:

Taken by our staff photographer, Lisa Litzenberger.

College of American Pathologists Neuropathology Committee met in Monterey, CA this past weekend

The College of American Pathologists Neuropathology (CAP-NP) Committee met in Monterey, CA this past weekend.  We are making plans for our next SAM-eligible educational product that will, among on things, update you on the latest World Health Organization system of pituitary adenoma classification. After a long day at work on the CAP-NP educational product, committee members retired to a nearby restaurant where this picture was snapped:

Some of the CAP Neuropathology Committee members (left to right, in the foreground)" Brett Harris, Andrea Weins, Areli Cuevas-Ocampo, Matt Scheiderjan (standing), Eyas Hattab (seated), and Rania Hattab (wife of Dr. Eyas Hattab)

Choroid plexus carcinoma in an infant

Some papillary architecture is maintained

Best Post of May 2017 - Guest Post: A Case from the Hawkeye State

The next in our "Best of the Month" series is from May 19, 2017:

From the illustrious Dr. Karra Jones of the University of Iowa:

Karra Jones, MD, PhD

40 year old female with progressive headaches over 6-8 months. MRI showed a large cystic and solid mass, favored to be extra-axial and arising from the anterior skull base just left of midline with possible dural attachment. Sections showed a densely cellular mass arranged in a mostly haphazard, slightly fascicular pattern. Alternating hypercellular and hypocellular areas were seen. Tumor cells were ovoid to spindle shaped with scant eosinophilic cytoplasm. No eosinophilic bands of wire-like collagen were noted, and only focal staghorn-like vasculature was identified. Only up to 3 mitotic figures were enumerated in 10 hpf counts. No necrosis was identified. You can see the diagnosis in the comment section after considering the photographs below:

Axial MRI T1 Post-Contrast

CD34

CD34

STAT6

Best Post of April 2017: Screenshots of the surgical neuropathology volume of the Johns Hopkins Atlases of Pathology

The next in our "Best of the Month" series is from April 6, 2017:

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:

Which subtypes of pituitary adenoma must you be aware of as tending to be more clinically agressive?

Certain subtypes of pituitary adenoma have been shown to be more clinically aggressive in that they tend to be more invasive, have earlier recurrence, and are more resistant to treatment. The following adenoma subtypes are recognized as having a more aggressive clinical behavior:

- Acidophil stem cell adenoma

- Crooke cell adenoma

- Lactotroph adenoma when occurring in men

- Pit-1 positive plurihormonal adenoma

- Sparsely granulated somatotroph adenoma

- Silent corticotroph adenoma

Thanks to Dr. Bea Lopes of the University of Virginia for consulting on the compilation of this list!