Wednesday, February 28, 2018

Course being offered at March 2018 USCAP annual meeting: Non-neoplastic surgical neuropathology that can be mistaken for neoplasia

SC07 - Surgical Neuropathology - The Other Stuff

Thursday, March 22, 2018 - 8:00 am - 11:30 am
This Short Course session includes up to a half-hour break.
Session Credits:
3 CME and 3 SAMs
Bette K. Kleinschmidt-DeMasters, MD, University of Colorado, Aurora, CO
Richard A. Prayson, MD, Cleveland Clinic, Cleveland, OH
Anthony T. Yachnis, MD, University of Florida, Gainesville, FL
Course Description
The majority of cases encountered in surgical neuropathology represent neoplasms. Subsequently, most pathologist, when confronted with a surgical neuropathology case, are usually “thinking tumor” and conjuring up differential diagnoses related to neoplasms. However, at times, non-neoplastic lesions are targeted for biopsy or resection. Most pathologists are less familiar with these entities, less comfortable with them, and consequently, more likely to misdiagnose them. Most continuing education courses and workshops are typically focused primarily on tumors. The treatment for a non-neoplastic condition simulating tumor versus actual tumor is radically different and hence the critical need for avoiding an incorrect diagnosis that might lead to incorrect administration of radiation or chemotherapy. This short course will focus primarily on “the other stuff”, those non-neoplastic conditions one is likely to encounter in a surgical neuropathology setting and the differential diagnostic considerations when faced with these entities. Topics to be addressed include differentiating gliosis from glioma, infarct from demyelinating lesions, angiocentric inflammation epilepsy-related pathologies, dural-based inflammatory lesions and cysts.
Learning Objectives
Upon completion of this educational activity, the learner will be able to:
  • Provide a list of “flags” that should cause one to consider a non-neoplastic diagnosis
  • Discuss differential diagnostic consideration for commonly encountered non-neoplastic lesions of the brain
  • Provide an approach to efficiently workup the aforementioned differential diagnoses

Tuesday, February 27, 2018

McLean Hospital Launches the National Eating Disorders Brain Bank

The Foundation for Research and Education in Eating Disorders (FREED) and the Harvard Brain Tissue Resource Center (HBTRC) at McLean Hospital today announced the establishment of the first and only national brain bank dedicated to research in eating disorders.
The National Eating Disorders Brain Bank is a resource to the community to help advance studies to find the causes of eating disorders which, in turn, will drive breakthroughs in the search for treatments that are desperately lacking for these neuropsychiatric illnesses. The brain bank will also provide researchers with the opportunity to examine the impact of altered nutrition on the brain.
More than 30 million Americans are impacted by eating disorders, including anorexia nervosa, bulimia nervosa and binge eating disorder. These complex conditions can have a profoundly negative impact on those who are affected as well as their families. They are increasingly being recognized as public health concerns. “Eating disorders are associated with the highest rates of health problems, death and suicide among all mental illnesses, but it remains unclear as to what causes these conditions and who are at risk,” notes Dr. Kevin St. P. McNaught, executive director of FREED. “The brain bank will allow researchers to explore the central nervous system to gain a better understanding of the biology of eating disorders.”
“Currently, only one drug is specifically approved by the Food and Drug Administration to treat individuals with binge eating disorder, and none are FDA-approved for the other eating disorders diagnoses,” said Dr. Stuart Koman, co-founder of FREED and chief executive officer of Walden Behavioral Care, a full system of specialized care for individuals and families impacted by all types of eating disorders. “I expect that the national brain bank will help to evaluate and identify structural brain tissue changes and other underlying mechanisms that can be targeted to develop much needed treatments for the millions of people impacted by eating disorders.”
The HBTRC is internationally renowned as a brain tissue repository for neurological and psychiatric brain disorders, including several focused brain collections. “We have long recognized the need to develop similar resources to support research into eating disorders, and are delighted to establish this partnership with FREED to launch this program,” said Dr. Sabina Berretta, scientific director of the HBTRC. Dr. Wilson Woo, medical director of the HBTRC, added, “The National Eating Disorders Brain Collection will represent an invaluable asset to a growing research community focused on eating disorders.”
The national brain bank is in its early developmental stage and in the months and years ahead will drive innovations as have occurred in other neuropsychiatric and neurological disorders. This incredible resource is a vital priority for the eating disorders community and will require broad support to help alleviate the suffering that millions of children, adolescents and adults with these conditions experience,” said William Mosakowski, chief executive officer of Public Partnerships, LLC and a founding sponsor of FREED and the brain bank program.

(This article was adapted from a press release issued by McLean and FREED)

Monday, February 26, 2018

Aldape Takes on Role as Chief of the Laboratory of Pathology at NCI

Kenneth Aldape, MD
Kenneth Aldape, MD, has joined the National Cancer Institute’s Center for Cancer Research as chief of the Laboratory of Pathology, an integral component of the research and clinical community at the National Institutes of Health.

Prior to his current role, Aldape was a professor and department chair of pathology at the MD Anderson Cancer in Houston, Texas. He was later recruited to Toronto General Hospital and Research Institute to develop a brain tumor program and conduct clinical-translational research in neuro-oncology.

Wednesday, February 21, 2018

Tau accumulations in the brains of woodpeckers

Dr. Peter Cummings makes another appearance on the blog, this time as senior author on a paper entitled: Tau Accumulations in the Brains of Woodpeckers. Eight of ten woodpeckers examined showed cerebral tau accumulations, whereas no control brains (red-winged blackbirds) were positive.This is significant in that there has been some research interest in developing football helmets based on the protective design that has evolved to protect the brains of woodpeckers.But maybe the relatively short life of the woodpecker (average less than 10 years) precludes the need for this protective adaptation. Thanks to Dr. Mark Cohen for alerting me to this study.

Tuesday, February 20, 2018

AANP meeting abstract submission deadline extended

American Association of Neuropathologists annual meeting abstract submission deadline has been EXTENDED to March 6, 2018 at 11:59 EST.

Wednesday, February 14, 2018

Las Vegas gunman had unusually high burden of corpora amylacea, but no other significant findings, at autopsy

The New York Times reports that brain autopsy results on Las Vegas gunman Stephen Paddock show that he "had not had a stroke, brain tumor or a number of other neurological disorders that might have helped explain his actions". 

Paddock, 64-years-old, did have an unusually high burden of corpora amylacea, the significance of which is not known.

In the article, Stanford neuropathologist Hannes Vogel commented on the corpora amylacea as follows: “Most people would have them at that age, but not in that profusion,” Dr. Vogel said. “It’s a striking exaggeration of an age-related finding.”

I put up a post a few months ago about Dr. Vogel receiving the brain for examination.

Friday, February 9, 2018

Registration and Abstract Submission for 19th International Congress of Neuropathology (ICN2018 Tokyo) now open

The organizing committees for the 19th International Congress of Neuropathology (ICN2018 Tokyo) have announced that registration and abstract submission for the meeting have officially opened as of Wednesday, February 7, 2018.  ICN2018 Tokyo will take place September 23-27, 2018.  For more information, click here.

Wednesday, February 7, 2018

Meningioma involved by mantle cell lymphoma

70-year-old female with a right frontal lobe mass. Before the meningioma presented itself, the patient already carried the diagnosis of mantle cell lymphoma on peripheral blood analysis.



Tuesday, February 6, 2018

Best Post of December 2017: A message from American Association of Neuropathologists President Elizabeth Cochran

The next in our "Best of the Month" series is form Monday, December 18, 2017. Good to be reminded of the upcoming meeting:

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!

Monday, February 5, 2018

TBI Linked to Increased Dementia Risk Over Several Years

The following is adapted from a recent post on
Traumatic brain injury (TBI) is associated with persistently increased risk of dementia, according to a study published online Jan. 30 in PLOS Medicine.

Anna Nordström, M.D., Ph.D., and Peter Nordström, M.D., Ph.D., both from Umeå University in Sweden, tracked dementia and TBI diagnoses among all 3,329,360 individuals in Sweden

The correlation was strongest in the first year after TBI (odds ratio, 3.52) and persisted at >30 years (odds ratio, 1.25). A weaker association with dementia was seen for single mild TBI versus more severe TBI or multiple TBIs (odds ratios, 1.63 versus 2.06 and 2.81, respectively). Among sibling pairs with discordant TBI status, TBI correlated with increased risk of dementia diagnosis (odds ratio, 1.89).

"The risk of dementia diagnosis decreased over time after TBI, but it was still evident >30 years after the trauma," the authors write.

Friday, February 2, 2018

Best Post of November 2017: Choroidal hemangioma in a patient with Stuge-Weber Syndrome

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

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

Thursday, February 1, 2018

Uveal Melanoma: The Basics

The uvea of the eye is a vascular tunic comprised of the iris, ciliary body, and choroid. Located between the sclera and the retina, the uvea contains dendritic pigmented melanocytes which have the potential to give rise to malignant melanoma. Patients with choroidal melanoma typically present as adults with painless monocular vision loss, while a cataract or glaucoma may be the presenting feature of an anterior segment melanoma. Approximately half of patients with choroidal and ciliochoroidal melanomas eventually die from their tumors. Prognosis is better in cases localized to the iris, presumably because they are recognized earlier.

Uveal melanom on right, melanin pigment in middle, and atropic retina on left
Most uveal melanomas produce at least some melanin pigment. For amelanotic cases, confirmatory immunohistochemical stains for melanoma, such as SOX10 and HMB45, may be helpful. Many uveal melanomas perforate Bruch membrane, enter the subretinal space, and invade the retina (see image), resulting in cystic atrophy of the overlying retina.

Although a small percentage of melanomas diffusely infiltrate the uvea, the vast majority are well-circumscribed. The presence of distinct margins allows for accurate assessment of tumor size. Measurement of largest tumor diameter (LTD) at the base has prognostic significance. 

Histologic assessment of uveal melanoma requires subtyping based on the predominance of particular morphologic cell types: spindle type A, spindle type B, and epitheloid. This cytomorphologic subtyping schema is known as the modified Callender classification, after a system originated in 1931 by Dr. George Russel Callender and then modified in 1978. Spindle type A cells have elongated nuclei, inapparent nucleoli, scant cytoplasm, and indistinct cell borders. Spindle type B cells have oval nuclei with identifiable nucleoli and moderate cytoplasmic volume. Epithelioid cells are larger, with rounded nuclei, prominent nucleoli, and distinct cell borders. Patients with pure spindle tumors have the best prognosis. Indeed, tumors composed entirely of spindle A cells are better classified as benign spindle cell nevi. On the other end of the spectrum, tumors composed purely of epithelioid cells have the worst prognosis. Those with a mix of spindle and epithelioid cell types, which represent the majority of cases, have an intermediate prognosis.

In addition to basal LTD and cytologic phenotype, other histologic features shown to have some negative prognostic implication include: lymphocytic infiltration, macronucleoli, elevated mitotic count, looping vascular networks, and extrascleral extension.

Although the histomorphology of cutaneous and uveal melanomas can be similar, genetic tumorigenesis differs. Early mutations in BRAF characterize cutaneous melanoma while mutations in GNAQ and GNA11 are typical of uveal melanomas. Chromosomal and genetic features also impact prognosis. Monosomy for chromosome 3 indicates a worse prognosis. Gene expression profiling using RT-PCR has emerged as a method of stratifying patients according to risk for metastatic death, and has been reported to be prognostically superior to clinical and histopathologic features. Uveal melanomas naturally cluster into two groups according to expression of thirteen different genes. Class 1 melanomas tend not to metastasize, while Class 2 melanomas have a high risk of metastasis. Not unexpectedly, Class 2 tumors tend to exhibit epithelioid cytomorphology and monosomy for chromosome 3. Elevated expression of the PRAME (preferentially expressed antigen in melanoma) gene on chromosome 22 is an additional indicator of increased risk for metastasis. Increased PRAME expression has been shown to identify the small percentage of Class 1 uveal melanomas that metastasize as well as indicate a shorter time to metastasis for Class 2 tumors.

Therapeutic options such as brachytherapy and focused radiation may obviate the need for enucleation in smaller tumors. For those who undergo enucleation, long-term surveillance includes monitoring liver enzymes as well as hepatic imaging, as the liver is the metastatic site first discovered in 80% of cases. More than half of patients who have metastatic uveal melanoma die within one year.

Neuropathology Blog is Signing Off

Neuropathology Blog has run its course. It's been a fantastic experience authoring this blog over many years. The blog has been a source...