Best Post of October 2017: Neuropathologist Hannes Vogel featured in New York Times for examining brain of Las Vegas mass murderer

The next in our "Best of the Month" series is from Friday, October 27, 2017:

Prominent neuropathologist Hannes Vogel of Stanford University was featured in the New York Times yesterday as he is examining the brain of Stephen Paddock, who killed 58 concertgoers in Las Vegas this month in a rampage without any clear motive. Here's the link to the NYT article.

Hannes Vogel, MD

A message from American Association of Neuropathologists President Elizabeth Cochran

Louisville, KY AANP members are already prepping for the 94th Annual Meeting, to be held in Louisville, KY, June 7-10, 2018.  Annual Meeting registration and the abstract submission site have launched, and the call for DSS cases has been sent. We are looking forward to seeing you in Kentucky!

Best Post of September 2017 -- 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

The next in our "Best Post of the Month" series is from Monday, September 11, 2017:

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."

Best Post of August 2017: Choroid plexus carcinoma in an infant

The next in our "Best of the Month" Series is from August 1, 2017:

Some papillary architecture is maintained

Best Post of June 2017: Remarkable en bloc dissection of human central and peripheral nervous system accomplished at University of Colorado

The next in our "Best of the Month" Series is from June 7, 2017:

Shannon Curran, MS with her dissection

Shannon Curran, a graduate student in the Modern Human Anatomy Program at the University of Colorado Anschutz Medical Campus, recently completed an en bloc dissection of the central nervous system along with an extensive portion of the peripheral nervous system from a human cadaver donor.  "It's pretty amazing," said Assistant Professor Maureen Stabio "There are only a handful of these prosections in the world ... We are so lucky to have such talented and ambitious students on our campus."

Curran, who is known among students and faculty as a preternaturally efficient prosector, completed the dissection in under 100 hours. Further detailed work is planned on the specimen, including dissection of the extraocular muscles away from the eyeballs while maintaining their connection to the brain. Discussion is underway about loaning the specimen to the Denver Museum of Nature and Science for community health education.

CNS en bloc dissection with extensive portion of PNS

Connection to the eyeballs is maintained, with plans to dissect away extraocular muscles

Detail showing maintained connection with digital nerves of the left hand

Choroidal hemangioma in a patient with Stuge-Weber Syndrome

Sclera is at bottom of picture; retinal pigment epithelium is at top right. Between them is choroid with cavernous hemangioma

Guest Post from Sandro Santagata, MD, PhD: Papillary Craniopharyngioma Trial

I am pleased to present a guest post from Dr. Sandro Santagata of Brigham and Women’s Hospital/Dana Farber Cancer Center, who writes:

Our group of collaborators has recently opened a Phase II Trial of BRAF/MEK Inhibitors in Papillary Craniopharyngiomas that is sponsored by the Alliance for Clinical Trials in Oncology.

The eligibility criteria are listed here: https://clinicaltrials.gov/ct2/show/NCT03224767

The trial is based on work published in these two papers:

https://www.ncbi.nlm.nih.gov/pubmed/24413733

https://www.ncbi.nlm.nih.gov/pubmed/26498373

I am happy to answer any questions that our colleagues may have about this trial.  ssantagata@bics.bwh.harvard.edu

Neuropathology Blog is Ten Years Old Today

Ten years ago today, I put up the first post to neuropathology blog. At the time, I didn't intend for anyone to actually read any of this stuff. I thought the blog would be a convenient way of taking searchable notes on various neuropathology topics I came across.  Ten years (and 703 posts!) later, the blog has thus far had more than 850,000 page views. I'd like to particularly thank two early supporters: Drs. John Donahue and Mark Cohen. Thanks to both of you for your encouragement early on. And thanks to all the readers and contributors who have participated in making this blog a success over the last decade. Here's to ten more years!

Drs. John Donahue (left) and Mark Cohen

Neuropathologist Hannes Vogel featured in New York Times for examining brain of Las Vegas mass murderer

Prominent neuropathologist Hannes Vogel of Stanford University was featured in the New York Times yesterday as he is examining the brain of Stephen Paddock, who killed 58 concertgoers in Las Vegas this month in a rampage without any clear motive. Here's the link to the NYT article.

Hannes Vogel, MD

Audentes Therapeutics Announces Dosing of First Patient in ASPIRO, a Phase 1/2 Clinical Trial of AT132 for the Treatment of X-Linked Myotubular Myopathy

Following up on the last post, Dr. Mike Lawlor sent me this in an email:

"Audentes Therapeutics officially announced the dosing of the first patient for the X-linked myotubular myopathy treatment trial that we’ve been working on over the past few years.  We’ve been very involved in the translation from dogs to humans, and will be doing the human pathology work for the trial.  Here’s a link to that press release."

Lawlor featured in video about his work in myotubular myopathy

Michael Lawlor, MD, PhD

Medical College of Wisconsin is highlighting the work of our colleague Dr. Michael Lawlor in the area of gene therapy for myotubular myopathy. Check out this wonderful 4-minute video!

Murat Gokden releases "Neuropathologic and Neuroradiologic Correlations: A Differential Diagnostic Text and Atlas"

I got this email from Johns Hopkins AP/NP Fellow Stephen Nix:

Murat Gokden, MD

"I'm not sure if this would be something to feature on the neuropathology blog or not, but Murat Gokden just edited and released a book with Cambridge Press entitled "Neuropathologic and Neuroradiologic Correlations" (link below) focusing on combining neuropathology and neuroradiology information/findings into one resource.  I just got my copy today and the images and text look great.  Pathology contributors include Travis Danielsen, Robin Elliott, Bret Evers, Theodore Friedman, Melissa Gener, Humayun Gultekin, Eyas Hattab, Ali Hussain, Mahlon D. Johnson, Nora Laver, Beatriz Lopes, Declan McGuone, Douglas C Miller, Robert Mrak, Veena Rajaram, Fausto Rodriguez, Amyn M Rojiani, Suash Sharma, Anat O. Stemmer-Rachamimov, and Mahtab Tehrani."



Here the link to what looks like a wonderful text:
https://www.cambridge.org/core/books/neuropathologic-and-neuroradiologic-correlations/1E16A2D262637648F8E3C54B443A3706#fndtn-information

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!

Best Post of March 2017: Why is the confluence of the cerebral venous sinuses called the "torcula"?

The next in our "Best of the Month" series is from March 3, 2017:

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.

Additional photograph of remarkable CNS/PNS dissection

I wanted to share this additional photo related to the last post. It was taken by our staff photographer, Lisa Litzenberger.

Remarkable en bloc dissection of human central and peripheral nervous system accomplished at University of Colorado

Shannon Curran, MS with her dissection

Shannon Curran, a graduate student in the Modern Human Anatomy Program at the University of Colorado Anschutz Medical Campus, recently completed an en bloc dissection of the central nervous system along with an extensive portion of the peripheral nervous system from a human cadaver donor.  "It's pretty amazing," said Assistant Professor Maureen Stabio "There are only a handful of these prosections in the world ... We are so lucky to have such talented and ambitious students on our campus."

Curran, who is known among students and faculty as a preternaturally efficient prosector, completed the dissection in under 100 hours. Further detailed work is planned on the specimen, including dissection of the extraocular muscles away from the eyeballs while maintaining their connection to the brain. Discussion is underway about loaning the specimen to the Denver Museum of Nature and Science for community health education.

CNS en bloc dissection with extensive portion of PNS

Connection to the eyeballs is maintained, with plans to dissect away extraocular muscles

Detail showing maintained connection with digital nerves of the left hand

Prominent Neuropathologist Dan Brat named Pathology Chair at Northwestern

Leading neuropathologist Dan Brat, MD, PhD has been named chair of the pathology department at Northwestern University Feinberg School of Medicine

Daniel Brat, MD, PhD

Brat has been serving as professor and vice chair for Translational Programs in the Department of Pathology and Laboratory Medicine at Emory University School of Medicine.

Brat joins a lengthening list of neuropathologists who are departmental chairs. The list includes:

Douglas Anthony at Brown

Jennifer Baccon at Akron

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

David Louis at Massachusetts General Hospital

Jenny Libien at SUNY Downstate

Thomas Montine currently at University of Washington and soon to be at Stanford

Edwin Monuki at the University of California Irvine

Robert Mrak at the University of Toledo

Amyn Rojiani at Augusta University

Kevin Roth at Columbia

John Schweitzer at East Tennessee State University

Best of luck to Dan in his new adventure leading one of the most prominent pathology departments in the country!

Best Post of February 2017: Hunched Over a Microscope, Santiago Ramon y Cajal Sketched the Secrets of How the Brain Works

The next in our "Best of the Month" series comes from February 20, 2017:

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.