A list of neuropathologists who are departmental chairs

There is a disproportionate number of neuropathologists who are chairs of their departments. Some readers thought it would be interesting if a list of these chairs could be compiled. With the help of Mark Cohen, Bette Kleinschmidt-DeMasters, and Robert Mrak, a pretty comprehensive list has been assembled:

Douglas Anthony at Brown

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

Also of note:

William Hickey at Dartmouth (acting chair of pharmacology and toxicology, former pathology chair)

Best Post of December 2015 -- "I'm a neuropathologist with a glioblastoma": A guest post from Susan M. Staugaitis, MD, PhD

The next in our "Best of the Month" series comes from  December 11, 2015:

I’m a neuropathologist with a glioblastoma.  How ironic is that?  For 17 years, my skill in making this diagnosis has been a major part of my job.  I know more about the biology of my disease than most of the physicians involved in my care.  And suddenly, within two weeks, my life expectancy changed from 30+ years to 2-5.  My reality has changed.

Dr. Staugaitis wearing the Novocure Optune electric field generator as part of her treatment 

If I'm freaking you out, you are not alone.  I'm freaking everybody out.  I haven’t had such a good excuse to be so “frontal lobe” since I was a teenager.  In the past five months, I have become so accustomed to my diagnosis and disabilities that I blurt it out to store clerks when explaining why I’m seeking a particular good or service.  I know the song I want to hear over and over again as I cross to the other side.  Would you expect anything less from someone who looks a lot better than her scan?  

I cope by trying to stay realistic and in the moment.  I try to extract anything and everything that is positive from my experience today and defer to tomorrow all thoughts that won’t matter until then.  It’s not much different from the days when I lived in southern California, not worrying about the “big one” that could hit anytime, but keeping myself prepared nevertheless. 

Family and friends remark on the extraordinary strength and courage I display.  Honestly, hearing this can get to be too much.  I do need the people close to me to help me fortify and reinforce the strength I am finding in myself, but quixotic sentiments don’t provide much comfort.  I’m too honest and practical to expect a miracle, to dream the impossible dream.  I’ll be satisfied with the possibility of beating the odds.

But, any gambler will tell you that the odds depend on the game.  I think sports gambling is most relevant to me and my diagnosis.  In sports gambling, it is all in the point spread.  You can win when your team loses and lose when your team wins.

Neuropathologists have inside information in this respect.  We look at the location of the lesion, at the histology in the microscope, at the molecular profile, and the combination gives us a pretty good idea of how to place our bet.  No emotions or wishful thinking here; we’ve got data.  As scientists, we are obligated to describe the data accurately and analyze it objectively.  In fact, if we are to gain and maintain the respect of our peers, we cannot ignore any data, no matter how much we dislike it, no matter how much it conflicts with our view of how the world should be.  And as writers, we find the words that communicate our interpretations as definitively and positively as possible without being incorrect.

Then it is time to sit back and watch the game, wait for the final score.  Did my bet beat the spread? 

And regardless of the game’s outcome, there will always be another game: new questions, new data to acquire.  So we pick ourselves up, dust ourselves off, and start all over again.

© 2015 Susan M. Staugaitis, M.D., Ph.D. 

Retired Consultant Staff, Departments of Pathology and Neurosciences, Cleveland Clinic

Adjunct Assistant Professor of Molecular Medicine

Cleveland Clinic Lerner College of Medicine of Case Western Reserve University

Cornea of an elderly female soft contact lens wearer afflicted by acanthamoeba keratitis

Evacuated cyst walls embedded in corneal stroma

Acathamoeba keratitis classically afflicts soft contact lens wearers who use contaminated homemade saline solutions or wear their contact lenses while swimming or in hot tubs. Corneal infection is usually very painful. In some medically intransigent cases, as exemplified in this case, corneal transplantation may be necessary. The chitinous wall of the organism is oval, while the cytoplasm typically retracts from the cyst wall in tissue sections. The cyst contains a round nucleus with a distinct nucleolus.

Acanthamoeba nucleus with distinct nucleolus

Neuropathologist Thomas J. Montine named new chair of Stanford Pathology

Thomas J. Montine, MD, PhD

Thomas J. Montine, chair of pathology at University of Washington, has been named new chair of the Department of Pathology at Stanford University.

The dean at Stanford stated the following in announcing the appointment: "Tom embodies the academic mission of Stanford Medicine as well as the creativity and collaboration that is our hallmark. He is a consummate clinician scientist committed to our vision to lead the biomedical revolution in Precision Health. The national centers for research on Alzheimer’s disease and Parkinson’s disease that he directs at UW emphasize functional genomics, early detection, and the discovery of tailored therapies. Tom’s research has greatly enhanced our understanding of the structural and molecular bases of cognitive impairment. Ranked among the top recipients of NIH funding among pathology faculty in the United States, he is the author of nearly 500 publications. Through service to the NIH he has helped develop national research priorities for Alzheimer’s disease and Parkinson’s disease."

Montine, who joins a growing list of pathology department chairs who are neuropathologists, starts his new job at Stanford on May 1. Other departmental chairs who are neuropathologists include David Louis at Mass General Hospital, Jeffrey Golden at Brigham and Women's Hospital, Eyas Hattab at University of Louisville, Amyn Rojiani at Augusta University, Doug Anthony at Brown University, Robert Mrak at University of Toledo, and Kevin Roth at Columbia.

Featured Neuropathologist: Michael D. Norenberg, MD

On March 18, the University of Colorado Department of Pathology will be honored to host Dr. Michael Norenberg at grand rounds. Dr. Norenberg's talk will be entitled "Chronic Traumatic Encephalopathy: Mechanisms and Potential Treatments". I take this occasion to feature Dr. Norenberg on this blog. A professor at the University of Miami, Dr. Norenberg was honored last year by the journal Neurochemical Research, which dedicated its February issue to contributions Dr. Norenberg has made to the fields of neuroscience and neuropathology.

Michael D. Norenberg, MD

 “Mike has made seminal contributions to our understanding of the brain and brain pathology,” said Richard J. Cote, M.D., chair of pathology at UMiami. “He was one of the first to show that astrocytes play crucial roles in brain function, and are not merely scaffold cells, as had been previously thought... His work on hepatic encephalopathy — a serious neurological condition that results from liver failure — has basically defined our understanding of this debilitating and prevalent condition. Mike is also particularly proud of uncovering the cause of central pontine myelinolysis (CPM), a devastating demyelinating disorder, usually occurring in chronically ill individuals, and often with prolonged periods of hospitalizations. He and his colleagues found that CPM is caused by an overly rapid correction of hyponatremia. As such, CPM is currently an extremely rare condition. Mike has received numerous awards for his work, but having an entire journal dedicated to him is a rare and very appropriate honor.”

According to a UMiami press release, Norenberg described himself as “totally surprised, shocked and humbled” by the honor. He said, “Research can be a difficult, grueling and a sometimes thankless task, often colored by disappointments and frustrations, but it is also associated with great joy when useful knowledge is generated, and your achievements are recognized and appreciated by your peers and colleagues.”

Dr. Norenberg graduated with a B.A from Trinity College in 1960, then graduated medical school from the University of Rochester in 19645. He did his post-graduate training at Strong Memorial Hospital in Rochester, New York.

Lisch nodules in a patient with NF-1

A. Multiple tan or pale brown dome-shaped nodules on surface of iris of patient with NF-1. Lisch nodules occur in nearly all affected adults with neurofibrosis, type 1. B. Focus of partially pigmented cells rests on anterior iridic surface. Lisch nodules are melanocytic hamartomas.

From: Eagle, Ralph C. Jr.. Eye Pathology: An Atlas and Text. Second Edition (2011). Page 20.

Best Post of November 2015: A 60-year-old woman with a left occipitotemporal brain lesion

The next in our "Best of the Month" series comes from November 18, 2015:

We were sent this case in consultation to rule out infiltrating neoplasm. The diagnosis is amyloid beta related angiitis (ABRA). In this case, no infarction was present in the specimen, but white matter rarefaction (the presumed pathologic correlate to the leukoaraiosis reported on imaging) is present.

Granulomatous vasculitis associated with pink hyaline material in vessel walls

The pink hyaline material is shown to be beta-amyloid by immunohistochemistry

White matter rarefaction (upper half of picture) correlating with leukoaraiosis seen on imaging

Request for updates on job listings

Among the most popular aspects of this blog is the job listings on the right side of the homepage. I try to keep it updated, with the valuable help of Sherry Miller (Dr. Doug Miller's wife). I would ask that if you are looking for a job and discover that one of the listings is no longer valid, please let me know so that I can delete it. Likewise, if there is opening you know about that is not listed, let me know about that as well so that I can add it. Thanks for your assistance in keeping the job listings on this site the most complete and updated list of available US neuropathology positions on the World Wide Web!

Featured Future Neuropathologist: Areli K. Cuevas-Ocampo, MD

Every so often, neuropathology blog posts a profile of a neuropathologist. This time, we feature a future neuropathologist, Dr. Areli K. Cuevas-Ocampo. We wish Areli the best of luck as she embarks upon a neuropathology fellowship at UCSF this summer...

SHORT BIO

I was born and went to Medical School in Cuernavaca Morelos, Mexico. After graduation I moved to Mexico City to train in Anatomic Pathology at the National Medical Center 21st Century, a program of the National Autonomous University of Mexico (UNAM). Because fellowships options in my country were limited, I thought about pursuing specialized training in the United States. I moved to Massachusetts in the summer of 2012 to start my AP/CP training at Baystate Medical Center/Tufts affiliated program. Toward the end of my PGY-2 year, I realized that neuropathology was the perfect fit for me and became more actively involved in the neuropathology activities at my program in addition to my service obligations like signing out neuropathology cases, participating in the organization of the monthly neuropathology interdepartmental conferences and brain cutting sessions for residents. During my 2^nd and 3^rd year of residency I attended and presented scientific posters at the AANP meetings in Portland OR and Denver CO, respectively. During my third year of residency, I became particularly interested in the molecular aspects of brain tumors and started (and currently am) working on a project involving ATRX tumor marker by IHC and its possible function as a surrogate marker for 1p/19q co-deletion. Currently I am the Junior Member of the CAP Neuropathology Committee. Upon completion of my AP/CP residency this summer, I will be starting my fellowship in neuropathology at the University of California in San Francisco.

WHY DID YOU DECIDE TO BECOME A NEUROPATHOLOGIST?

In spite of enjoying pretty much every subspecialty in pathology; the brain is the brain! I have always been interested in such a complex and intimidating organ as a whole: macroscopic, microscopic, and now molecular and genomic levels (and beyond). Obviously there are other subspecialties within neuropathology that I find intriguing as well. Since it is clear that molecular technologies are, and will be changing the way pathologists approach diseases and make diagnoses; l want to be a participant in this shift, helping with the incorporation of those changes into neuropathology and hopefully making contributions in the understanding of cancer biology of brain tumors and neurodegenerative conditions.

​NAME A COUPLE OF IMPORTANT PROFESSIONAL MENTORS. WHY WERE THEY IMPORTANT TO YOU?

I am very fortunate to have met many role models throughout my career, so it is difficult to mention only two. I am sure I will also meet inspiring mentors along the way, but at this moment I want to acknowledge Dr. Christopher Otis for whom I have a deep respect and admiration not only as a pathologist but as a person.  He has many attributes that makes him notable but I especially like his professionalism, competency, leadership and integrity. He inspires me to be better and to go the extra mile. The other crucial person in my career is Dr. Luis A. Moral, the staff neuropathologist at my program. He is not only a knowledgeable and competent neuropathologist but to me he has been a friend and a confidante, playing a crucial role in my fellowship election and being an advisor in my projects. Last but not least I would like to thank my former pathology colleagues and professors from Mexico who always believed in me and encouraged me to pursue my career goals, especially: Dr. Ignacio Felix, Dr. Enrique Blanco-Lemus, Dr. Guillermo Castellanos, Dra. Luz Ma. Gomez, Dr. Miguel Reyes-Mugica (who is the Chair of Pediatric Pathology at UPMC), Dr. Rodolfo Gatica-Marquina and Dr. Victor M. Sanchez-Fernandez.

​WHAT ADVICE WOULD YOU GIVE TO A PATHOLOGY RESIDENT INTERESTED IN DOING NEUROPATHOLOGY FELLOWSHIP?

As everything in life, you should pursue a career in neuropathology because that is what you like and what makes you happy. There are different paths you can follow in order to become a neuropathologist. In my case I took the longest one: the AP/CP -> NP track (6 years) since I found out that my true calling was neuropathology at the end of my 2^nd year of AP/CP residency. The other track is the researcher route, where you find most of the NP residents who also have a MD/PhD degree. They do 2 years of AP first and then 2 years of NP. The career opportunities for neuropathologists (coming from either track) are definitely there, but you need to be flexible in terms of relocation, not ruling out doing another fellowship or a post-doc and staying open to the possibility of covering other pathology services (like general surgical pathology) besides neuropathology once you get a job.

​WHAT CITY WOULD YOU LIKE A FUTURE AMERICAN ASSOCIATION OF NEUROPATHOLOGISTS MEETING TO BE HELD?  

In no particular order; I would include some of the states that I haven't visited yet: Alaska (Anchorage), Minnesota (Minneapolis), Utah (Salt Lake City), and Washington (Seattle).

Immunohistochemical surrogate for BRAF V600E mutation

Quoted highlights  from: Tanboon J, Williams EA, and Louis DN. The Diagnostic Use of Immunohistochemical Surrogates for Signature Molecular Genetic Alterations in Gliomas. J Neuropathol Exp Neurol Vol. 75, No. 1, January 2016, pp. 4–18:

- The most common BRAF alteration is an activating mutation caused by a substitution of valine for glutamic acid at codon 600 (BRAF V600E) in exon 15.

- BRAF V600E status can be screened for using the mutation-specific BRAF V600E immunohistochemistry clone VE1... Only strong homogeneous unambiguous cytoplasmic staining should be interpreted as positive.

- While BRAFV600E can be found in a wide variety of brain tumors, BRAF fusions... are mostly limited to pilocytic astrocytomas (PAs).

- For tumor classification, aBRAF V600E mutation in a ganglion cell-rich lesion biopsied from infratentorial region favors ganglioglioma over PA.

- BRAF V600E mutations are present in pleomorphic xanthoastrocytoma (PXAs) with and without anaplasia (65%–70%), ganglioglioma (33%–60%), and [occasionally] PA, especially extracerebellar PA (6%–8%).

- In addition, BRAFV600E mutations are common in epithelioid glioblastomas (eGBM) (54%), which also tend to occur in children and relatively young adults.

- BRAF V600E mutations have also been reported in a small number of desmoplastic infantile astrocytomas, desmoplastic infantile gangliogliomas, and dysembryoplastic neuroepithelial tumors.

- A few diffuse astrocytomas in children and adults harbor BRAF V600E mutation; the tumors in adults show unusual histologic features such as partly circumscribed portions and spindle cells, and may associated with more favorable prognosis.

- Strong cytoplasmic staining patterns are often observed in PXA and eGBM; on the other hand, staining can be variable in glioneuronal tumors because BRAF can be diffusely positive in the tumor cell population or it can be limited to either a glial or neuronal component. For example, in ganglioglioma, mutant BRAF is predominantly expressed in neuronal tumor cells

- In glioneuronal tumors, BRAF V600E mutation is associated with activation of the mammalian target of rapamycin (mTOR) pathway, worse postoperative seizure outcome, and shorter recurrence-free survival.

Immunohistochemical surrogate for H3 K27M mutations

Quoted highlights on IHC mutational surrogates from: Tanboon J, Williams EA, and Louis DN. The Diagnostic Use of Immunohistochemical Surrogates for Signature Molecular Genetic Alterations in Gliomas. J Neuropathol Exp Neurol Vol. 75, No. 1, January 2016, pp. 4–18:

- K27M mutations in H3F3A [the gene encoding H3.3] and HIST1H3B [the gene encoding H3.1] occur in approximately 40%–80% of pediatric diffuse intrinsic pontine gliomas (DIPG) and 20% of nonbrainstem glioblastomas.

- The central role of these mutations in such tumors will result in these neoplasms being designated as “diffuse midline glioma, H3 K27M-mutant” in the 2016 WHO Classification of Tumours of the Central Nervous System

- The presence of K27M mutations in pediatric glioblastomas (including DIPG) is associated with shorter survival compared to the wild-type tumors... [T]he presence of K27M mutations can be used as a diagnostic marker and poor prognostic marker for pediatric high-grade astrocytoma.

- K27M mutations in both the H3.3 and H3.1 histones can be detected by immunohistochemistry using an anti-H3K27M antibody. Positivity can therefore be useful to establish a diagnosis of infiltrating glioma in lower-cellularity biopsies, and can be used to subtype and genotype these diffuse gliomas. 

- The pattern of positivity is nuclear, with positivity in most of the tumor cells; nontumor cell nuclei are negative.