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Ganglioglioma, BRAF V600E-Mutated

BRAF V600E
Young adult female with a ganglioglioma (GG) in the right temporal lobe. Figure 1 is an MRI Brain image in the T1 sequence post-contrast in the coronal plane, which demonstrates a ~4 cm multicystic mass in the medial right temporal lobe with a solid mural nodular component with heterogeneous enhancement of the solid portions and cystic rim. Calcifications are noted along with the septal and wall components (not well demonstrated in the image shown).  Figure 2 is a hematoxylin and eosin (H&E)-stained section of formalin-fixed paraffin-embedded (FFPE) tissue demonstrating a low-grade glioneuronal tumor containing a dysplastic ganglion cell with a...

Twitter Poll (July 21, 2021)

Cortex and Medulla, Banff criteria, renal transplant Banff classifications
  Which of the following is not a part of the Banff adequacy criteria for the evaluation of acute rejection in a kidney biopsy? A) At least 10 glomeruli B) Minimum 7 glomeruli C) At least 2 Arteries D) Cortex and medulla   Answer: D) Cortex and medulla Per the 2018 Banff reference guide for the evaluation of transplant biopsies, an adequate specimen is one that contains at least 10 glomeruli and at least 2 arteries. Additionally, the guidelines stipulate that there should be at least two cores or two separate areas of cortex in the same core in order...

Episode 24: Knowing Who Is In The Audience Part 5

Stick to Your Knowledge, Never Be Afraid To Ask Questions, Making Time, How to Build A Reputation, Doing the Best You Can, Know Who Is In the Audience, Expanding the Differential Diagnosis, Knowing What Is Normal, Answer the Question, Knowing What You Know, Looking At Every Component, gestalt diagnosis, going deep, examining all the material, Lumping or Splitting, Focus, Using Therapy to Guide a Diagnosis, knowing the therapy, Severity of Change, principles of pathology, representativeness, arkana labs, renal path
Have you ever had a conversation with someone and suddenly realized they might know more about the subject than you think they do? In this episode, Dr. Silva describes how he explained IgA nephropathy to the father of IgA nephropathy, Jean Berger. It's always important to know who is in the audience.  

Ganglioglioma, WHO grade I

Ganglioglioma tumor MRI scan
  Young adult female with headache and a cystic brain tumor in the right temporal lobe.  Figure 1 is an MRI Brain image in the T1 sequence post-contrast in the axial plane, which demonstrates a ~4 cm multicystic mass in the medial right temporal lobe with a solid mural nodular component with heterogeneous enhancement of the solid portions and cystic rim.  Calcifications are noted along with the septal and wall components (not well demonstrated in the image shown).  Figure 3 is a hematoxylin and eosin (H&E)-stained section of formalin-fixed paraffin-embedded (FFPE) tissue demonstrating a low-grade glioneuronal tumor containing dysplastic ganglion...

Art of Medicine: Covid-19 Associated Nephropathy (COVAN)

SARS-CoV-2, COVAN, Covid-19, collapsing Myoglobin cast, renal pathology
Development of acute kidney injury (AKI) in the setting of COVID-19 substantially worsens outcomes, with increased morbidity and mortality, and has been a recent area of investigation.  The painting shown above includes two common disease manifestations in the setting of Coronavirus Disease-2019 (COVID19), which include collapsing glomerulopathy and myoglobin cast nephropathy.   Histologic images of each of these entities are shown below. Collapsing glomerulopathy, also known as COVID-19-associated nephropathy (COVAN), is one of the most common causes of acute kidney injury (as well as nephrotic syndrome) in patients with COVID-19.   COVAN results from SARS-CoV-2 acting as a 'second hit' to individuals...

ENFD Testing

ENFD testing at Arkana Laboratories Neuropathology services
Arkana Laboratories is very pleased to offer epidermal nerve fiber density (ENFD) testing as an addition to our growing Neuropathology service offerings.   What is small fiber neuropathy (SFN)? SFN is a sensory neuropathy that preferentially involves thinly myelinated A-delta and unmyelinated C sensory fibers involved in the perception of pain and temperature. They are typically length-dependent and symmetrical.  Less commonly, patients may have non-length-dependent, focal, or multifocal symptoms. As SFN does not involve large motor and sensory fibers, patients typically present with burning pain and paresthesias beginning in the feet and progressing upwards, with normal EMG and NCS, and...

Lobulated Muscle Fibers with Wedge-shaped Accumulations of Mitochondria

Wedge-shaped Accumulations of Mitochondria
Figure 1 and 2: Lobulated Muscle Fibers with Wedge-shaped Accumulations of Mitochondria. Frozen sections of skeletal muscle stained with NADH-TR preparation (A) show a few scatted type 1 lobulated muscle fibers (black arrows) with coarse internal architecture staining with intensely dark staining wedge-shaped or triangular-shaped accumulations along the periphery of the muscle fiber. A few targetoid muscle fibers are also seen.  Ultrastructural examination confirms that these small accumulations are composed of mitochondria with one such aggregate demonstrated (black arrow).  Original magnifications: A. Frozen Section NADH-TR, 100x; B. Electron microscopy, 1500x.   Considering the clinical vignette from the prior week: An...