Pathology Commons^™

A Variant Origin Of The Carotid Sinus Nerve., Kevlian Andrew, Joe Iwanaga, Marios Loukas, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

The carotid sinus nerve is known to convey baroreceptive fibers from the carotid sinus. Despite studies on the baroreflex pathway and the course and communications of the carotid sinus nerve with the surrounding nervous and vascular structures, there have been scant reports on variations in the origin of the carotid sinus nerve (CSN). We identified an unusual origin of the CSN. On the right side of a cadaveric specimen, the CSN was found to arise from two small rami extending from the external laryngeal nerve. Such a case can help better understand various pathways used to monitor the carotid sinus. …

Comprehensive Review Of The Cardinal Ligament., Seif Eid, Joe Iwanaga, Rod J Oskouian, Marios Loukas, R Shane Tubbs

Articles, Abstracts, and Reports

The cardinal ligament is thought to be one of the important structures in providing support and stabilization for the pelvic organs e.g., the uterus. However, many discrepancies exist in the literature regarding terminology, anatomy, and histology. The cardinal ligament attaches the lateral side of the vagina and cervix to the lateral pelvic wall, which provides support to the vagina and cervix. Studies have shown variable findings in the collagen content and distribution in the cardinal ligaments of women with a prolapsed uterus. Uterine vessels and the branches of the inferior hypogastric plexus travel in the cardinal ligament, which is of …

The Deep Fascia Of The Forearm And The Ulnar Nerve: An Anatomical Study., Paul J Choi, Chidinma Nwaogbe, Joe Iwanaga, Georgi P Georgiev, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

Introduction A reoperation for a cubital tunnel syndrome is not uncommon. Patients often complain of sensorimotor symptoms in the ulnar nerve distribution after their primary surgery. The documented etiologies for such a phenomenon include a "new" kinking of the distal ulnar nerve and a "new" compression of the ulnar nerve by the fascial septum in between or tendinous bands over the muscles of the forearm. The deep fascial plane along which the ulnar nerve travels in the forearm has had scant attention. We present an anatomical study to provide a better understanding of such etiologies to aid physicians in performing …

Review Of The Variations Of The Superficial Veins Of The Neck., Dominic Dalip, Joe Iwanaga, Marios Loukas, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

The venous drainage of the neck can be characterized into superficial or deep. Superficial drainage refers to the venous drainage of the subcutaneous tissues, which are drained by the anterior and external jugular veins (EJVs). The brain, face, and neck structures are mainly drained by the internal jugular vein (IJV). The superficial veins are found deep to the platysma muscle while the deep veins are found encased in the carotid sheath. The junction of the retromandibular vein and the posterior auricular vein usually form the EJV, which continues along to drain into the subclavian vein. The anterior jugular vein is …

Ophthalmic Artery Aneurysm In A Cadaver: Case Report., Dominic Dalip, Joe Iwanaga, Marios Loukas, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

The ophthalmic artery arises from the supraclinoid segment of the internal carotid artery (ICA) and enters the orbit through the optic canal. It perfuses the orbit and the orbit apparatus. Ophthalmic artery aneurysms (OAA) account for 0.5% to 11% of all intracerebral aneurysms. Patients are usually asymptomatic but, in some cases, patients can present with ophthalmoplegia and total blindness if these aneurysms rupture. Aneurysms are usually diagnosed using computed tomography (CT) angiography but can also be seen on magnetic resonance imaging (MRI) and four-vessel digital subtraction angiography. Treatment of OAA entails either surgical or endovascular approaches with the mortality rate …

An Unusual Back Muscle Identified Bilaterally: Case Report., Juan J Altafulla, Mayank Patel, R Shane Tubbs, Joe Iwanaga, Zachary Litvack

Articles, Abstracts, and Reports

Most muscular structures in the human body are named based on their function, origin/insertion, or shape. During routine dissection of the back, an unusual muscle was found deep to the rhomboid muscles. The details of this case and a review of the extant literature are provided.

Pelvic Kidney: A Review Of The Literature., Seif Eid, Joe Iwanaga, Marios Loukas, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

Kidney development is a complex process that begins during the sixth to eighth weeks of life. Failure of ascent of the kidney will cause the kidney to remain in the pelvis i.e., pelvic kidney. Here, we review this entity in detail and illustrate such embryological derailment. In most cases, a pelvic kidney is an incidental finding and is usually asymptomatic. Anatomic variations of the renal vasculature have been reported in cases of pelvic kidneys and these are highlighted in this review. Clinicians who treat patients for renal or pelvic disease or interpret images of the pelvis should be well informed …

An Unusual Variation Of The Accessory Nerve., Yusuf Alimi, Joe Iwanaga, Marios Loukas, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

The accessory nerve is an important nerve in the head and neck regions. Some variants of this nerve's anatomy have been reported. Herein, we present an unusual report and review the extant medical literature regarding other more commonly found derailments of this nerve's anatomy.

Atrx Mutation In Pineal Parenchymal Tumor Of Intermediate Differentiation, Michelle Nagurney, Md, Christopher Farrell, Md, Zi-Xuan Wang, Phd, Mark T. Curtis, Md

Department of Pathology, Anatomy, and Cell Biology Posters

Objectives

Based on our identification of an ATRX mutation in a PPTID of a 22 year old female, we analyzed the frequency of ATRX loss in pineal parenchymal tumors using ATRX immunohistochemical staining.

A Comprehensive Review Of The Fabella Bone., Dominic Dalip, Joe Iwanaga, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

The fabella is a sesamoid bone that is embedded in the lateral head of the gastrocnemius muscle and often articulates directly with the lateral femoral condyle. It is present in 10-30% of the general population with a higher incidence in Asians. The fabella can lead to various pathologies such as fabella pain syndrome and common fibular nerve palsy. Conservative treatment involves physical therapy or injecting local anesthetics or steroids around this bone. However, if symptoms persist, then a fabellectomy can be performed. Physicians should be aware of the fabella bone and the multiple pathologies associated with it in order to …

Bilateral Carotid Artery Stenosis Causes Unexpected Early Changes In Brain Extracellular Matrix And Blood-Brain Barrier Integrity In Mice, Jill M. Roberts, Michael E. Maniskas, Gregory J. Bix

Neuroscience Faculty Publications

Bilateral carotid artery stenosis (BCAS) is one experimental model of vascular dementia thought to preferentially impact brain white matter. Indeed, few studies report hippocampal and cortical pathology prior to 30 days post-stenosis; though it is unclear whether those studies examined regions outside the white matter. Since changes in the blood-brain barrier (BBB) permeability precede more overt brain pathology in various diseases, we hypothesized that changes within the BBB and/or BBB-associated extracellular matrix (ECM) could occur earlier after BCAS in the hippocampus, cortex and striatum and be a precursor of longer term pathology. Here, C57Bl/6 mice underwent BCAS or sham surgeries …

The Role Of Reactive Astrocitose In The Chronological Evolution Of Traumatic Brain Injury, Roxana M. Duncea-Borca, Vladimir Belis, Mihnea Costescu, Relu G. Calota, Reka Kutasi, Cosmin A. Moldovan

Journal of Mind and Medical Sciences

Introduction and objectives. This study aims to investigate whether the cerebral modifications of posttraumatic reactive astrocitose can be considered an objective criterion for determining the age of traumatic cranio-cerebral lesions.

Materials and methods. The present study consists of a series of 23 medico-legal cases that underwent autopsy inTeleormanCounty(Romania) Department of Forensic Medicine during 2007–2016, with full immune-histochemical microscopic examination using GFAP staining. The study consists of two groups, a series of 13 cases with cranio-cerebral trauma with different posttraumatic survival periods and 9 cases as a control group.

Results and discussions. We discovered GFAP+ reactive astrocytes even when death occurred …

Phosphaturic Mesenchymal Tumor Of The Nasal Cavity: Clinicopathologic Correlation Is Essential For Diagnosis, Aidan Kerr, Ryan Rimmer, Marc Rosen, James J. Evans, Madalina Tuluc, Stacey K. Mardekian

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Phosphaturic mesenchymal tumor (PMT) is a rare neoplasm in which the tumor cells produce fibroblast growth factor 23 (FGF23), leading to oncogenic osteomalacia and thus a distinct clinical presentation. However, the pathologic findings of PMT are often non-specific and variable, especially in tumors occurring in the head and neck. We present a case of a 66-year-old female who presented with osteomalacia-related symptoms and was found to have a nasal cavity mass. Histopathologic examination was suggestive of PMT but certain characteristic features were lacking, requiring confirmation of the diagnosis by chromogenic in situ hybridization (CISH) assay for FGF23 mRNA. The patient's …

Myxopapillary Ependymoma With Anaplastic Features: A Case Report With Review Of The Literature., Tridu R Huynh, Conrad Lu, Doniel Drazin, Gregory Lekovic

Articles, Abstracts, and Reports

Background: Myxopapillary ependymoma (MPE) with anaplastic features is extremely rare, with only three case reports in the literature.

Case Description: We report the case of a MPE with anaplastic features in a 24-year-old female who presented with a dominant lumbar mass along with intracranial and sacral metastases. Upon gross total resection of the dominant tumor located at L2-L3, it appeared to arise from the filum terminale, and had a solid component in addition to soft or necrotic areas. Histologically, the tumor was composed of the two classic components of MPE: (1) low-grade ependymal cells surrounding blood vessels, producing the papillary …

Chronic Traumatic Encephalopathy-Integration Of Canonical Traumatic Brain Injury Secondary Injury Mechanisms With Tau Pathology, Jacqueline R. Kulbe, Edward D. Hall

Spinal Cord and Brain Injury Research Center Faculty Publications

In recent years, a new neurodegenerative tauopathy labeled Chronic Traumatic Encephalopathy (CTE), has been identified that is believed to be primarily a sequela of repeated mild traumatic brain injury (TBI), often referred to as concussion, that occurs in athletes participating in contact sports (e.g. boxing, football, football, rugby, soccer, ice hockey) or in military combatants, especially after blast-induced injuries. Since the identification of CTE, and its neuropathological finding of deposits of hyperphosphorylated tau protein, mechanistic attention has been on lumping the disorder together with various other non-traumatic neurodegenerative tauopathies. Indeed, brains from suspected CTE cases that have come to autopsy …

Macrophage Type 2 Differentiation In A Patient With Laryngeal Squamous Cell Carcinoma And Metastatic Prostate Adenocarcinoma To The Cervical Lymph Nodes., Michael C. Topf, Madalina Tuluc, Larry A. Harshyne, Adam J. Luginbuhl

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

BACKGROUND: The tumor microenvironment often polarizes infiltrating macrophages towards a type 2, or M2 phenotype, that is characterized by expression of various cysteine-rich, scavenger receptors, including CD163. The primary function of M2 macrophages is to facilitate wound healing. As such, they are capable of providing metabolic support to a growing tumor, neovascularization, as well as protection from cytotoxic T cells. The tumor microenvironment contains a milieu of secreted factors and vesicles, which in certain circumstances can gain access to lymphatic vessels that drain to local lymph nodes.

CASE PRESENTATION: We report a 59-year-old male with recurrent T4 squamous cell carcinoma …

Hiding Within The Cracks: Case Report Of Rare Sutural Bone Found At The Nasion., Bryan Edwards, Joy Mh Wang, Joe Iwanaga, Jennifer Luviano, Marios Loukas, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

Pathology such as skull fractures can be misdiagnosed in the presence of anatomical variations. One variant that has had little description in the literature are the sutural bones associated with the nasal bones. Herein, we describe a case of a rare sutural bone at the nasion, between the bones of the right nasal, frontal, and maxillary frontal process. To our knowledge, this is the first report of such a variant bone in this location, and such it should be considered by clinicians when evaluating patients for pathology in this region.

The First Histological Analysis Of The Tissues Lining The Fossa Navicularis: Insights To Its Etiology., Sarvenaz Sheikh, Joe Iwanaga, Steven Rostad, Tarush Rustagi, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

The fossa navicularis (FN) is an anatomical variant on the ventral surface of the basilar part of the occipital bone that, to date, has only been investigated in bone specimens. We aim to clarify the structure of the fossa navicularis by gross anatomical, radiological, and histological methods. The FN was found in the occipital bone of the Caucasian male cadaver. There was no bony or histological continuity between the FN and posterior cranial fossa. The histological analysis found that the overlying tissue was composed of loose connective tissue with a mixture of collagen and elastic fibers and a vascular matrix …

Internal Hernia Of The Greater Omentum: Cadaveric Findings Of A Previously Unreported Variant., Andrea Andrea, Vy Tran, Cameron K Schmidt, Christian Fisahn, Joe Iwanaga, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

Transomental hernias (TOHs) are a rare finding, constituting a fraction of all intestinal hernias. Here, we report the cadaveric discovery of a spontaneous TOH involving the sigmoid colon in an 82-year-old female and discuss the relevant literature. To our knowledge, a TOH involving the sigmoid colon has not been previously reported.

Johann Gaspar Spurzheim: A Life Dedicated To Phrenology., Mohammad Bilal, Bryan Edwards, Marios Loukas, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

Loved for his empathetic nature but admired for his analytical mind, Gaspar Spurzheim (1776-1832) was a prominent contributor to phrenology, a field of neuroscience focused on studying the shapes of the skulls in relation to the activity levels of certain functional areas of the brain. This curiosity about the connection between physical characteristics and brain function was seeded in the young mind of Spurzheim when he observed that classmates with seemingly superb memories also appeared to have bright eyes. It launched Spurzheim on a journey to study the shape and function of the brain, which eventually led him to his …

Multiple Large Perineural (Tarlov) Cysts In The Sacrum Of A Cadaver: A Case Report And Review., Jocelyn Gonzales, Joe Iwanaga, Nitsa Topale, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

Tarlov or perineural cysts are cerebrospinal fluid (CSF)-filled sacs found between the perineurium and epineurium of the nerve roots. It is still unsure whether the origin of these cysts is intradural or extradural. They can either be asymptomatic or create a variety of negative impacts on comfort and quality of life. In this case report, we describe the presentation of multiple Tarlov cysts including one large cyst discovered during a routine cadaveric spinal dissection and the relevant and related literature. To our knowledge, this is the only cadaveric case report of Tarlov cysts and offers an interesting window into their …

Outcomes After Diagnosis Of Mild Cognitive Impairment In A Large Autopsy Series, Erin L. Abner, Richard J. Kryscio, Frederick A. Schmitt, David W. Fardo, Daniela C. Moga, Eseosa T. Ighodaro, Gregory A. Jicha, Lei Yu, Hiroko H. Dodge, Chengjie Xiong, Randall L. Woltjer, Julie A. Schneider, Nigel J. Cairns, David A. Bennett, Peter T. Nelson

Epidemiology and Environmental Health Faculty Publications

OBJECTIVE: To determine clinical and neuropathological outcomes following a clinical diagnosis of mild cognitive impairment (MCI).

METHODS: Data were drawn from a large autopsy series (N = 1,337) of individuals followed longitudinally from normal or MCI status to death, derived from 4 Alzheimer Disease (AD) Centers in the United States.

RESULTS: Mean follow‐up was 7.9 years. Of the 874 individuals ever diagnosed with MCI, final clinical diagnoses were varied: 39.2% died with an MCI diagnosis, 46.8% with a dementia diagnosis, and 13.9% with a diagnosis of intact cognition. The latter group had pathological features resembling those with a final clinical …

GabaB Receptor Attenuation Of GabaA Currents In Neurons Of The Mammalian Central Nervous System, Wen Shen, Changlong Nan, Peter T. Nelson, Harris Ripps, Malcolm M. Slaughter

Pathology and Laboratory Medicine Faculty Publications

Ionotropic receptors are tightly regulated by second messenger systems and are often present along with their metabotropic counterparts on a neuron's plasma membrane. This leads to the hypothesis that the two receptor subtypes can interact, and indeed this has been observed in excitatory glutamate and inhibitory GABA receptors. In both systems the metabotropic pathway augments the ionotropic receptor response. However, we have found that the metabotropic GABA_B receptor can suppress the ionotropic GABA_A receptor current, in both the in vitro mouse retina and in human amygdala membrane fractions. Expression of amygdala membrane microdomains in Xenopus oocytes by microtransplantation …

Relationship Of The Median And Radial Nerves At The Elbow: Application To Avoiding Injury During Venipuncture Or Other Invasive Procedures Of The Cubital Fossa., Vlad Voin, Joe Iwanaga, Juan P Sardi, Christian Fisahn, Marios Loukas, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

INTRODUCTION: The median and radial nerves are two important neural structures found in the cubital fossa. The trajectory and landmarks used to identify their location are important when procedures are done in this area.

METHODS AND MATERIALS: Ten fresh-frozen cadavers were dissected (20 upper limbs) and measurements were taken from the medial epicondyle to the median and radial nerves as well as to the lateral epicondyle of each limb.

RESULTS: The distance between the medial epicondyle and the median nerve was found to be three centimeters with a range of 2.1 to four centimeters and the distance from the medial …

Osborne's Ligament: A Review Of Its History, Anatomy, And Surgical Importance., Andre Granger, Juan P Sardi, Joe Iwanaga, Thomas J Wilson, Lynda Yang, Marios Loukas, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

When discussing the pathophysiology of ulnar neuropathy, Geoffrey Vaughan Osborne described a fibrous band that can be responsible for the symptoms seen in this disorder. In this paper, we take a glimpse at the life of Osborne and review the anatomy and surgical significance of Osborne's ligament. This band of tissue connects the two heads of the flexor carpi ulnaris and thus forms the roof of the cubital tunnel. To our knowledge, no prior publication has reviewed the history of this ligament, and very few authors have studied its anatomy in any detail. Therefore, the aim of the present paper …

Giant Arachnoid Granulation Associated With Anomalous Draining Vein: A Case Report., Randle Umeh, Rod J Oskouian, Marios Loukas, R Shane Tubbs

Articles, Abstracts, and Reports

Giant arachnoid granulations (AG) can mimic intracranial lesions. Knowledge of these structures can help avoid misdiagnosis when interpreting imaging. Here, we report a child who presented with a mass within the superior sagittal sinus and an anomalous draining vein. Herein, the diagnosis of a giant AG was made. Clinicians who view or interpret imaging of the head should be aware of these anatomical variants and though when very large, apparently, do not necessarily result in pathology. Based on our case report, giant AG might also demonstrate anomalous draining veins.

A Previously Unreported Arterial Variant Of The Suboccipital Region Based On Cadaveric Dissection., Christian Fisahn, Brittni Burgess, Joe Iwanaga, Fernando Alonso, Jens R Chapman, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

No abstract provided.

Secretory Paraspinal Paraganglioma Of Thoracolumar Spine: Case Report And Review Of Literature, Saad Akhtar, Sidra Sattar, Muhammad Ehsan Bari, Naila Kayani, Sarosh Moeen

Section of Neurosurgery

Background: Pheochromocytomas are catecholamine secreting tumors of the adrenal medulla chromaffin cells, however, when present extra-adrenally they are called paragangliomas. Paragangliomas rarely produce catecholamine in excess, which is evident by clinical symptoms, urine, and blood biochemistry. Total resection of these tumors can lead to complete clinical and biochemical resolution. This case report presents the clinical features, radiological findings, and neurological outcome in a middle-aged female with a secretory paraganglioma.
Case description: We present the case of a 34-year-old female who presented with a 2-year history of dizziness, flushing, headache, palpitations, and hypertension. Her blood workup showed raised urinary catecholamine levels. …

Biallelic Mutations In Tbcd, Encoding The Tubulin Folding Cofactor D, Perturb Microtubule Dynamics And Cause Early-Onset Encephalopathy., Elisabetta Flex, Marcello Niceta, Serena Cecchetti, Isabelle Thiffault, Margaret G. Au, Alessandro Capuano, Emanuela Piermarini, Anna A. Ivanova, Joshua W. Francis, Giovanni Chillemi, Balasubramanian Chandramouli, Giovanna Carpentieri, Charlotte A. Haaxma, Andrea Ciolfi, Simone Pizzi, Ganka V. Douglas, Kara Levine, Antonella Sferra, Maria Lisa Dentici, Rolph R. Pfundt, Jean-Baptist Lepichon, Emily G. Farrow, Frank Baas, Fiorella Piemonte, Bruno Dallapiccola, John M. Graham, Carol J. Saunders, Enrico Bertini, Richard A. Kahn, David A. Koolen, Marco Tartaglia

Manuscripts, Articles, Book Chapters and Other Papers

Microtubules are dynamic cytoskeletal elements coordinating and supporting a variety of neuronal processes, including cell division, migration, polarity, intracellular trafficking, and signal transduction. Mutations in genes encoding tubulins and microtubule-associated proteins are known to cause neurodevelopmental and neurodegenerative disorders. Growing evidence suggests that altered microtubule dynamics may also underlie or contribute to neurodevelopmental disorders and neurodegeneration. We report that biallelic mutations in TBCD, encoding one of the five co-chaperones required for assembly and disassembly of the αβ-tubulin heterodimer, the structural unit of microtubules, cause a disease with neurodevelopmental and neurodegenerative features characterized by early-onset cortical atrophy, secondary hypomyelination, microcephaly, thin …

Cerebral Aspergillosis And Pulmonary Tuberculosis In A Child With Chronic Granulomatous Disease, Muhammad Waqas, Sidra Zafar, Tooba Rehman, Muhammed Riyaz, Muhammad Ehsan Bari, Romana Idress

Section of Neurosurgery

Background: Chronic granulomatous disease (CGD) is an immune disorder that affects phagocytes. It is characterized by recurrent or persistent bacterial and fungal infections. Reports of tuberculosis (TB) in patients with CGD are rare. In developing countries, where TB is endemic, possibility of other chronic infections is often overlooked by physicians.
Case description: We report the case of a 4-year-old boy who had recurrent respiratory infections and episodes of headache. He was put on antituberculosis (ATT) drugs without microbiological or pathological evidence 2 months prior to presentation. The child did not improve and was brought to our hospital where a computed …