Neuroautopsy from a pt with disseminated coccidiomycosis. Prominent leptomeningeal inflammation with focal breakthrough into underlying parenchyma = meningoencephalitis. Beautiful yet scary spherules filled with endospores are clearly visible on H&E/LFB.
#neuropath
#forensicpath
The
#cerebellum
is easily one of the most beautiful tissues in the human body. What is the approximate age of the person this cerebellum came from? How do you know?
#neuropath
#PathTwitter
🧠🔬
Classic
#neuropathology
that every pathologist should know, lest you end up with egg on your face! 😜 What is the diagnosis? Molecular findings?
#neuropath
🧠 🔬
Touch prep from a particularly nasty
#glioblastoma
with primitive features. Check out those chromosomes! One could do a karyotype from these mitotic figures. 🧠🔬😮
#neuropath
#PathX
For today’s
#FrozenSectionFriday
, all you get is a smear. For this dural-based lesion, it should be all you need! What features are shown here that help with the diagnosis?
#neuropath
#PathTwitter
🧠🔬
Psychedelic calcifications in this large but benign choroid plexus papilloma with <2 mits/10 HPF, no necrosis, and bland appearing cuboidal cells arranged in papillae. 🧠
#neuropath
#pathart
Another
#PathClassic
. Adult with a cerebellar tumor. The inhibin stain is diagnostic but the CD31 stain is just so pretty! 😍 This is must know
#neuropath
for the
#PathBoards
🧠🔬
An interesting example of exuberant (but benign!) perineuronal satellitosis of glial cells around neurons, originally described by Ramón y Cajal. This feature is recapitulated by neoplastic glial cells in infiltrating gliomas, as described by Hans Joachim Scherer.
#neuropath
🧠
This is something you don’t hear about very often: endolymphatic sac tumor. Simple papillary structures often seen invading bone of the inner ear. Benign but often locally destructive. Don’t forget the association with VHL!
#neuropath
#ENTpath
#pathboards
This is an IMPRESSIVE case of intracranial Candida infection. GMS stain demonstrates nicely the mixture of yeast forms and pseudohyphae.
#neuropath
#PathTwitter
🧠🔬
Can you make a
#diagnosis
of this tumor with nothing but a single H&E image? (Coming from me, at least you can reasonably assume it’s
#neuropath
related!). 🧠🔬
Intracranial, dural-based mass. Diagnosis, including grade? (Hint: IHC +PR, +SSTR2A). Residents, gotta know this one for the
#PathBoards
!
#neuropath
#PathTwitter
🧠🔬
Cerebral phaeohyphomycosis: brain infection by darkly pigmented dematiaceous fungi. Notice melanin pigment in the fungal walls. Rare, often fatal, and occurrence is unrelated to immune status.
#neuropath
#pathology
#purplepath
🧠 🔬
Biopsy of thalamic lesion reveals sheets of macrophages (CD68
#ihcpath
) containing PAS-positive, diastase-resistant cytoplasmic material. Cerebral Whipple’s disease! I seem to be posting a lot of these neuro bugs lately. 🧠
#neuropath
#infectiousdisease
Not all mass forming lesions in the brain are tumors! This tuberculoma had the most exuberant mycobacterial forms on AFB stain. I always use this case to help new pathologists train their eyes for these often obscure bugs.
#neuropath
#radpath
#pathbracket
🧠
Young person with seizures has a temporal lobe
#brain
mass. The tumor shows circumscribed growth and BRAF V600E mutation. Diagnosis with just this one H&E image?
#neuropath
🧠🔬
#GlioblastomaAwarenessDay
#Neuropathologists
look at tissue under a microscope to diagnose
#GBM
so that patients can receive appropriate treatment. Features we look for include pseudopalisading necrosis and microvascular proliferation.
Intracranial tumor located in the sellar region. Diagnosis? What is the mystery IHC and what does it suggest about the molecular underpinnings of this tumor?
#neuropath
🧠🔬
#Neuropath
day 14 -
#autopsy
brain with samples taken from the cerebellum, hippocampus, and pons. What is the underlying etiology for the changes present in all three images?
This is relatively common
#neuropath
seen in
#autopsy
brains. What protein forms these neuronal cytoplasmic inclusions? What gene encodes that protein? (Bonus points for the chromosome!) Finally, what conditions can one find these inclusions?
#neuropath
#neurodegeneration
🧠 🔬
Neuropathology Review, 3rd ed. is out! This is a great resource for medical students & residents/fellows (esp
#pathology
,
#neurology
,
#neurosurgery
). Fully updated by Richard Prayson (
@CCFPathRes
) and myself (
@NU_Pathology
). Concise, up-to-date, and MCQs w full color photos.
Dysembryoplastic neuroepithelial tumor (DNET) is a WHO Grade I glioneuronal tumor most often found in the cerebral cortex of children/young adults and causes seizures. Look for oligo-like features 🍳 and floating neurons! Adjacent cortex can be dysplastic.
#neuropath
#pedipath
🧠
I love a good smear when doing
#neuropath
frozens. But sometimes a touch prep can be useful, too! Particularly for these sellar region tumors. Diagnosis? 🧠🔬
#PathTwitter
Clivus mass in an adult. Are you brave enough to render a diagnosis based on these few cells from the intraoperative smear prep? What diagnostic immunostain would confirm the diagnosis? 🧐
#neuropath
#PathTwitter
🧠🔬
#Neuropath
day 29 - leap year bonus for my month long
#neuropathology
blitz! This is from one of the most impressive
#autopsy
brains I have ever seen. What is this critter causing so much havoc in the
#brain
? Hint: see the pinned tweet on my profile.
A stunning example of a florid fungal brain abscess in an immunocompromised patient. Septate & branching hyphae. Molecular speciation reveals Scedosporium apiospermum as the culprit- CNS infection also associated with near drowning & trauma.
#neuropath
#radpath
#infectiousdisease
Another fungal brain abscess- this time in a pt with poorly controlled diabetes. Fungal forms with broad aseptate hyphae: Mucormycosis. Haphazard branching approaching 90 degree angles. Similar findings from this pt’s nasal sinus contents.
#neuropath
#radpath
#infectiousdisease
#Neuropath
day 26 - one high power image is all you need for this tumor, or is it
#TooCloseToDiagnose
? What anatomic structure is present to help localize?
Paraganglioma, WHO grade I, from the spinal cord. Rubbery, circumscribed, polyploid mass. Tumor cells organized in a zellballen architecture, separated by fibrovascular stroma. Synaptophysin (shown) and chromogranin positive.
#neuropath
I have my copy of
@AceMyPath
Surgical Pathology Reimagined! Do you have yours? A must-have for trainees and practitioners alike, with high-yield facts, annotated digital slides
@pathpresenter
, and fully updated Kurt’s notes! Videos and MCQs in progress.
#PathTwitter
#MedTwitter
#Neuropath
day 19 - person died after experiencing severe muscle spasms, confusion, excess salivation, progressing to coma. Recent history of unspecified animal bite. Histology shown (compare this to the Lewy body in yesterday’s post, per request
@bawlmouth
🤓). Diagnosis?
Young adult with seizures and headaches.
#Brain
imaging shows a frontal lobe mass. Here is the
#pathology
after resection. Can you render a diagnosis for this rare lesion?
#PathTwitter
#neuropath
🧠🔬
Sometimes looks can be deceiving… The H&E gives strong oligo vibes for this
#brain
tumor, but do the stains agree? What are the likely molecular alterations? Diagnosis?
#neuropath
🧠🔬
What structure is exuberantly shown in the images, taken from the
#brain
at
#autopsy
? What is the most likely diagnosis and what test would confirm?
#neuropath
🧠 🔬
#Neuropath
day 16 -
#brain
autopsy from an elderly person. What pathological process(es) is(are) demonstrated by these two images? What is the mystery IHC?
(See my prior post). This time, perineuronal satellitosis by malignant glial cells. The malignant cells use pre-existing structures, such as neuronal processes, blood vessels (also seen here!), and white matter tracts as a substrate for infiltration.
#neuropath
#pathtwitter
🧠
A classic case of Cryptococcus meningitis. The pale staining organisms are subtle on H&E, though visible with a keen eye! The capsule can be highlighted by mucicarmine and alcian blue stains. GMS in this case shows nicely the narrow-neck budding of the yeast.
#neuropath
#Neuropath
case 6 - immunocompromised adult with progressively altered mental status. MRI shows multifocal asymmetric white matter
#brain
lesions. H&E from biopsy is shown. Diagnosis? What IHC would confirm your suspicion?
#Neuropath
day 27 - patient with blurry vision and eye discomfort, s/p DSAEK.
#Pathology
is shown. Diagnosis? This is an amazing example of how very simple appearing histopathology can lead to a specific diagnosis.
#PathTwitter
#PathX
: what is your diagnosis for this
#brain
tumor, located near the splenium? Which immunostain(s) would confirm your morphologic impression?
#neuropath
🧠🔬
#Neuropath
case 3. Young person with circumscribed fourth ventricle
#brain
mass. H&E+helpful IHC shown. Diagnosis? Answer and additional info later today!
Extremely proud of my friend and colleague
@PJamshidi_MD
for completing the
#neuropath
fellowship at
@NU_Pathology
! He is an incredible fellow and will make a fantastic addition to the NP division
@NUFeinbergMed
. Congrats, Pouya!! 🎉🧠🔬🎉
#Neuropath
case 1 - Glioblastoma, IDH-wildtype, WHO grade 4. The mc primary CNS malignancy in adults and one of the most malignant cancers in humans. Densely cellular, infiltrative glial neoplasm with brisk mitoses, vascular proliferation, and necrosis.
#Neuropath
day 20 - this histology was from an autopsy
#brain
with prominent (“knife edge”) atrophy of the frontal and temporal lobes. H&E and tau IHC shown. What part of the brain is shown and what neuropathology does this represent?
#Neuropath
case 7 - This time a different kind of critter. What is your diagnosis for this patient with numerous ring enhancing
#brain
lesions? Gram and GMS stains shown.
Another
#neuropath
must-know! This came from an adult with new onset seizures. Diagnosis? You can’t worm your way out of this one! 😜
#PathBoards
#purplepath
🧠🔬🪱
Large motor neurons from the hypoglossal nucleus (CN XII). In which part of the brain do these cells reside? What do we call the purple substance in the cytoplasm of these neurons?
#neuropath
#neuroscience
#anatomy
🧠🔬
#Neuropath
day 12 - this tumor was removed from the cerebrum of an infant. H&E and helpful IHC shown. Diagnosis? There is no doubt that this tumor is Awfully Terrible/Really Terrifying.
🚨
#PathX
#PathTwitter
#MedEd
🚨 Starting tomorrow, I will post one
#neuropath
topic each day throughout the month of February, including a mixture of common and unusual educational cases. Stay tuned! 🧠🔬🤓
#Neuropath
day 21 - Luxol fast blue (LFB) is a great stain to highlight myelin, and pairs nicely with H&E, as shown here. This image shows a sharply demarcated area of demyelination w/o inflammation, typical
#neuropathology
of a burnt out multiple sclerosis plaque.
There are markedly pleomorphic cells in this IDH wildtype
#glioblastoma
, with occasional multinucleated tumor cells. What do you expect to be the TP53 status of this tumor? And how will the p53 immunostain look?
#neuropath
#PathTwitter
#purplepath
🧠🔬
This dural based tumor has prominent nodules with nice chordoid features- cords/trabeculae of epithelioid cells in a myxoid background. Atypical meningioma (brain invasion, not shown) with chordoid features, WHO Grade II.
#neuropath
#neurorad
#radpath
Non-enhancing mass in the cerebral hemisphere of a young adult. These can be tricky, especially on biopsy at infiltrative edge. Thankfully, one (or two) IHC can cinch the diagnosis. Which one(s)?
#neuropath
#PathTwitter
#pathboards
#purplepath