Neuropathology

The faculty of the C. S. Kubik Laboratory for Neuropathology participate in all three aspects of academic clinical medicine — patient care, medical education and research. The Neuropathology Service has a long tradition of providing outstanding neurological diagnostic services to physicians and patients at Massachusetts General Hospital, as well as patients, physicians and other pathologists in the United States and abroad through consultation. The Neuropathology service has long maintained an ACGME-approved training program in neuropathology, with graduates of the program flourishing in the field. Additionally, the faculty and fellows participate in the training of neurologists, neurosurgeons and neuroradiologists as well as visiting clinicians and pathologists from around the world.

The major research efforts of the faculty and trainees are focused in neuro-oncology (genetics and classification of glial tumors; primary brain tumors and peripheral nerve sheath lesions associated with inherited tumor syndromes; pituitary tumors), neurodegenerative diseases disorders (Alzheimer and Parkinson disease and others) and vascular disease (cerebral amyloid angiopathy). Much of this research is externally funded by NIH and various foundations, with members of the Neuropathology service as the primary investigators.

Faculty

• Matthew P. Frosch, MD, PhD
  
  • Subspecialty Head, Neuropathology
• David N. Louis, MD
  • Pathologist-in-Chief, Massachusetts General Hospital
• Anat Stemmer-Rachamimov, MD
• Maria Martinez-Lage Alvarez, MD

Associated Faculty

• Bradley T. Hyman, MD, PhD, John B Penney Jr Professor of Neurology, Harvard Medical School;
  Director, Massachusetts Alzheimer Disease Research Center and Neurologist, Mass General (Link to PubMed)

Diagnostic Specimen Volume

During the most recent academic year, the Neuropathology service handled 735 in-house surgical neuropathology cases with just under 2000 total specimens, as well as 549 consultation cases. Associated with in-house cases, the service performed 1005 intra-operative consultations. In addition, there were 113 muscle biopsies and 31 nerve biopsies. Neuropathologic autopsies were performed in 197 cases. All of this diagnostic material was examined by the trainees of the Neuropathology service and signed out by staff members.

In addition to the specimens considered above, Dr. Stemmer-Rachamimov is a member of the ophthalmologic pathology service of the Massachusetts Eye and Ear Infirmary (adjacent to Mass General). She provides instruction in this aspect of neuropathology to trainees on the Neuropathology service, both through didactic teaching sessions and through routine sign out. During the same time period the surgical opththalmic pathology volume was 1,732 cases.

Additional Clinical and Educational Activities

The members of the neuropathology service — faculty and trainees — participate in a number of conferences with related clinical services of the Mass General.  These include the following:

• With the Pathology Service:
             Molecular Pathology and Research conference (weekly)
             Surgical unknown conference ("Outs") (monthly)
             Autopsy case conference (weekly)
• With the Neurology Service:
             Case discussion and brain cutting (weekly)
             Pediatric neuropathology case presentation (monthly)
             Morbidity and Mortality conference (weekly)
             Neuromuscular pathology case conference (weekly)
• With the Neuro-Oncology Service (Neurology / Neurosurgery / Neuroradiology / Radiation Oncology):
               Adult tumor board (weekly)
               Pediatric tumor board (weekly)

In addition to these inter-disciplinary conferences, there is a weekly consensus review session at which all primary brain tumors are discussed, along with cases of complexity or particular interest. This session allows the neuropathology staff to maintain a consistent set of diagnostic criteria and terminology. There is also a weekly session during which a case is provided for review by all trainees, initially without any clinical history. After discussion of histological findings, there is clinical correlation with neurologic history.

Faculty and trainees from the Neuropathology service participate in the teaching of neuroanatomy, neuroscience and neuropathology to students at Harvard Medical School — including students in the MD program as well as PhD students in Neuroscience.

Experience in forensic neuropathology is gained at the Office of the Chief Medical Examiner for the Commonwealth of Massachusetts. Dr. Hedley-Whyte is a consultant in neuropathology to the office, and does brain cutting there approximately once a month.

In addition to research publications, faculty members are involved in many of the major reference texts in pathology and neuropathology:

• Dr. Louis is an editor of the 8th edition of "Greenfield's Neuropathology" and of the 4th edition of the "WHO Classification of Tumors of the Nervous System"
• Dr. Frosch is the author of the chapters on the nervous system in "Robbins and Cotran's Pathologic Basis of Disease" (8th edition) and "Robbins Basic Pathology" (8th edition)
• Drs. Louis and Frosch are co-authors of "Non-Neoplastic Diseases of the Central Nervous System" in the AFIP/ARP series of fascicles.

Research Space

The Molecular Neuro-Oncology Laboratory consists of two principal investigators (Drs. Louis and Stemmer-Rachamimov) in approximately 2500 square feet of laboratory space on the 6th floor of Building 149 on the Mass General-East campus in Charlestown. The Laboratory is part of the Molecular Pathology Unit, which consists of nine principal investigators in approximately 15,000 square feet of laboratory and support space on the 6th and 7th floors of this building. The laboratories provide state-of-the-art facilities for research, including dark rooms, cold rooms, radioactivity rooms, cell culture rooms, reading rooms with current journals, seminar rooms and computer facilities.

The neurodegenerative disease investigators from the Neuropathology Service are located in Building 114 — located a block away from Building 149 in Charlestown and home to the MassGeneral Institute for Neurodegenerative Diseases, a group of 20 investigators and additional laboratory staff — all focused on neurodegenerative diseases. Dr. Frosch's laboratory occupies 750 square feet in this building. Additionally, the Advanced Tissue Resource Center of the Harvard Center for Neurodegeneration and Repair with multiple laser capture microdissection units and real time PCR facilities, which Dr. Frosch oversees, is also located within this building.

The Neuropathology Core of the Massachusetts Alzheimer Disease Research Center, an NIA-funded program since 1984, is also based in Building 114. Currently directed by Dr. Frosch after many years of service in this role from Dr. Hedley-Whyte, the ADRC has a brain cutting room and histology laboratory (320 square feet) as well as office space and extensive room for freezers and tissue storage. This space also serves as the Neuropathology Core for the MGH/MIT Udall Center for Excellence in Parkinson Disease Research, banking brains from patients with Parkinson disease and other Lewy Bodies diseases.