Friday, April 2, 2021

2021 Update on Meningeal Solitary Fibrous Tumor

Meningeal Solitary Fibrous Tumor (SFT) is an uncommon tumor, accounting for less than 1% of CNS tumors. It is a fibroblastic neoplasm with a genomic inversion at the 12q13 locus, leading to NAB2-STAT6 gene fusion and surrogate nuclear STAT6 immunohistochemical expression. SFT generally affects adults in the fifth to seventh decades. It is dural-based and typically supratentorial, but 10% have a spinal location. SFT has a high propensity for recurrence and metstasis, at times occuring decades after initial diagnosis. Imaging often prompts a pre-operative assumption of meningioma as the diagnosis. Histologically, the tumor has a spindle cell appearance and variably cellular with abundant stromal keloid-type collagen. Some examples are very cellular tumors with densely packed round-to ovoid cells and little intervening stroma. Mitoses and necrosis can be present. Can a true SFT be STAT6 negative on immunohsitochemical examination? Yes, but it is just as likely that the pathologist is looking at something else on the differential diagnosis, including other unusual mesechymal tumors. In such cases, molecular testing for STAT6 fusion is required to render a confident diagnosis. Grading of SFT has changes since the last iteration of the WHO Classification in 2016. The 2016 criteria depended on the histologic hemangiopericytoma phenotype as a factor in raising this tumor from a grade I up to a grade II tumor. Now, in the soon-to-be-released 2021 WHO Classification, this phenotype is not considered important -- with emphasis instead on mitotic count as a means of creating grading cut-offs. Specifically, SFTs with fewer than 5 mitoses per ten high-power fields are considered grade 1, while a mitotic count of 5 or greater justifies a grade 2 designation. If, in addition to this elevated mitotic count, necrosis is present, then a grade 3 designation is assigned. There have been reported some rare pattern in SFT, including lipomatous, pappillary, giant cell, and myxoid; but these do not affect prognosis. If STAT6 is negative, the pathologist shoud think about other entities in the differential diagnosis, including fibrous meningioma, a variety of mesenchymal tumors (such as phosphaturic mesenchymal tumor), malignant peripheral nerve sheath tumor, and primary non-pigmented melanocytic tumors of the CNS. To reiterate, three grade of SFT will be recognized in the 2021 WHO classification of CNS tumors: Grade 1 - SFT with less than five mitotic figures per ten high power fields; Grade 2 - SFT with five or greater mitotic figures per ten high power fields; Grade 3 - SFT with five or greater mitotic figures per ten high power fields and necrosis. This information is taken from an excellent lecture on this SFTs delivered by Dr. Caterina Giannini at this year's annual USCAP meeting (see photo of her below delivering her lecture remotely). Thanks Dr. Gianinni for distilling this topic down to a concoction suitable for us blue-collar neuropathologists to imbibe!

Monday, March 15, 2021

Glioma diagnostics and research in JoVE

I recently received an email from Chun-Chieh (Paul) Lin and George Zanazzi at Dartmouth-Hitchcock Medical Center. They were invited as editors for a new Methods Collection in JoVE focusing on "Glioma diagnostics and research". Dr. Lin and Zanazzi write: "We intend to highlight techniques used in the diagnostic classification of glial neoplasms and also in vivo or in vitro glioma research models. We welcome a variety of submissions covering these challenging but interesting neoplasms." Please feel free to contact Paul ( and George ( for details!
Dr. Paul Lin
Dr. George Zanazzi

Monday, March 1, 2021

Dr. Mauro C. Dal Canto (January 1, 1944 – December 16, 2020)

I recently received word from Dr. Eddie Lee of the passing of Dr. Mauro Dal Canto due to a tragic aircraft accident.

Dr. Maura Dal Canto

Dr. Dal Canto was a neuropathologist at Northwestern for many years and a member of the American Association of Neuropathologists as well. Here is Dr. Canto's obituary

Friday, February 26, 2021

History and Overview of Digital Pathology Webinar Scheduled for Monday, March 8

I recently received notification from Margaret E. Flanagan, M.D., assistant professor of pathology at Northwestern, about an upcoming event featuring several well-known neuropathologists.  You can register for the event here. Thanks very much, Dr. Flanagan!

Dr. Margaret E. Flanagan


History & Overview of Digital Pathology

Webinar - March 8, 2021



The ADRC Digital Pathology Working Group and National Alzheimer's Coordinating Center are excited to host the following webinar on Monday, March 8, 2021 at 11am ET/ 8am PT!


History and Overview of Digital Pathology

Join us on March 8th as we kick off our 2021 Digital Pathology Webinar Series with our first event: History and Overview of Digital Pathology Webinar. This one-hour webinar session will provide an introduction and overview of digital pathology. The speaker and panelists are outlined below.



Charles L. White, III MD


Charles L. White III MD

Sandra Camelo-Piragua, MD

C. Dirk Keene, MD, PhD

Peter T. Nelson, MD, PhD

Jeanelle Azira Torres

Brittany N. Dugger, PhD


Have questions you want to ask our panelists? Submit them in advance to


About the 2021 Digital Pathology Webinar Series

At 11am ET on the second Monday of each month*, keep an eye out for our Digital Pathology Webinars, showcasing 30 minutes of panel discussion and 30 minutes of Q&A.


Topics include an overview of digital pathology, slide scanner purchasing considerations, HALO Software Applications, Aperio Software Applications, QuPath Software Applications, Machine Learning for Digital Pathology and general troubleshooting.


Thursday, February 4, 2021

Dr. William Yong of UC Irvine co-authors timely update of neuro-COVID

 I recently received an email from the illustrious William Yong, MD at UC Irvine Health. He alerted me to an excellent article which he co-authored entitled Neuropathology of COVID-19 (neuro-COVID): Clinicopathological Update.  Dr. Yong writes: "I don’t normally forward my pubicationss but will do so for this COVID Neuropath review (reviewed over 180 cases from the literature) since things move fast with COVID literature and as Free Neuropathology is a new journal and not in Pubmed yet.  The paper will eventually get into Pubmed as its is NIH funded but process is slower. The article is open access and free to download at Free Neuropathology. If you think it will be of some value to your readers, please feel free to share in your wonderful blog." A PDF version is available here

Thanks very much, Dr. Yong, for alerting us to this timely update!

2021 Update on Meningeal Solitary Fibrous Tumor

Meningeal Solitary Fibrous Tumor (SFT) is an uncommon tumor, accounting for less than 1% of CNS tumors. It is a fibroblastic neoplasm with ...