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!

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 (Chun-Chieh.Lin@hitchcock.org) and George (George.J.Zanazzi@hitchcock.org) for details!

Dr. Paul Lin

Dr. George Zanazzi

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. 

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.   Speaker: Charles L. White, III MD Panelists: 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 naccmail@uw.edu   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.

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  https://www.uni-muenster.de/Ejournals/index.php/fnp/article/view/2993/3173

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

There is no right career path: A perspective from an immigrant physician-scientist and neuropathologist

Subhojit Roy, MD, PhD recently wrote an interesting post on his journey as a immigrant physician-scientist in the United States. Here's the link. His conclusion:

"Some amount of foresight and planning is obviously important for success in any field. But most successful careers do not follow a prescribed trajectory. It’s debatable whether meticulous career forecasting and vetting is any better than planning for the future in broad strokes, leaving some things to chance, and believing that one always has the power to make a change. Life is an exploration, not a Cuneiform tablet. And there is no such thing as the right career path."

Brain Pathology and the International Society of Neuropathology have established Twitter accounts

For readers wanting updates on the latest developments in neuropathology via social media, I recommend two Twitter accounts:

Brian Pathology

International Society of Neuropathology (ISN)

Among recent tweets were a link to a minisymposium on the molecular pathogenesis of prion diseases (Brain Pathology) and the latest news about the upcoming AANP meeting (ISN).

J. Hume Adams has passed away

J. Hume Adams in 1972

J. Hume Adams, Professor of Neuropathology in Glasgow, has died. With David Graham, Adams edited the fourth and fifth editions of Greenfield's Neuropathology. During his career, Adams made great advances in the study of neurotrauma.

Neuropathologist Matija Snuderl featured in major journal discussing the use of artificial intelligence in cancer diagnostics

Matija Snuderl, MD

Dr. Matija Snuderl, neuropathologist and molecular pathologist at  New York University Langone Health, was featured in a recent article appearing in Nature (March 26, 2020, Vol 579, p S14-S16). The article, which addresses the use of artificial intelligence (AI) in cancer diagnostics, opens with Dr. Snuderl experiencing a moment that many of us neuropathologists have had wherein we hesitate before signing out a case because of a feeling that something might be just a bit different about a particular specimen. That feeling prompts us to do something else (run more ancillary testing, get a consult, sleep on it and take another look the next day, etc.). In Dr. Snuderl's case, he was looking at a case which was thought to be a recurrence of a medulloblastoma in a young girl. Some of the histologic features didn't quite fit with medulloblastoma. "So, to help him make up his mind, Snuderl turned to a computer. He arranged for the girl to have a full-genome methylation analysis," writes Neil Savage, author of the article. Snuderl relays the result of this investigation: "The tumor came back as a glioblastoma...  If I had finalized the case just on pathology, I would have been terribly wrong." The AI system Snuderl used involved a database of thousands of tumor methylation profiles at the German Cancer Research Center. NYU Langone's Perlmutter Cancer Center is applying AI to the classification of tumors of all sorts, not only using pathologic samples, but also MR imaging, mammograms, and other means of diagnosis.

Thanks to Dr Snuderl for representing the important role neuropathologists play in cancer diagnostics in the age of molecular medicine and article intelligence. Thanks also to Dr. Michael Lawlor, of the Medical College of Wisconsin, for alerting me to this article!

Lost Smell and Taste Hint COVID-19 Can Target the Nervous System

Matthew Anderson, MD, PhD

Dr. Matt Anderson, chief of neuropathology at Beth Israel in Boston, forwarded me a recent article from The Scientist. The article describes the experience of Alessandro Laurenzi, a biologist working in Bologna, Italy, regarding the proposition that COVID-19 infected patients can have transient loss of the sense of smell. Olfactory sensory loss may play a role in early diagnosis, but it may also help in understanding pathogensis.

Dr. Anderson is quoted in the article, stating that central nervous system involvement by the virus may play a part in the respiratory symptomatology.

George Perry, former AANP president, granted meritorious award by the American Society for Investigative Pathology

George Perry, PhD

It was recently announced that Dr. George Perry has been given the Rous-Whipple Award by the American Society for Investigative Pathology.  According to the ASIP website, the Rous-Whipple Award "is presented to a senior scientist with a distinguished career in research who has advanced the understanding of disease and has continued productivity at the time of the award."

Congratulations, Dr. Perry. And thanks to Dr. Charles White for sharing this news.