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Consultation Request Form (.pdf)

Mailing Address/Contact Information

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Basic Consult

Typical turnaround times for surgical neuropathology consults are <1-2 days in uncomplicated cases and 2-5 working days in cases requiring immunohistochemical and/or genetic studies (see below). Dr. Perry routinely calls the referring pathologist with an initial impression at the time the consult is received and with a final diagnosis, when it is completed. However, in less urgent cases where there is general agreement with a final diagnosis that has already been rendered by the referring pathologist, the phone call is often omitted. If Dr. Perry is out of town, the neuropathology fellow will show the case to other attendings in the Neuropathology Division and will often call the referring pathologist with a preliminary impression. For those who wish to call ahead of time to determine whether Dr. Perry will be in town, this information can be obtained from the Neuropathology secretary at 314-362-7426. A final report and consult letter is faxed the same day that the case is finalized, with original copies subsequently mailed. Clinical and radiographic correlations are often critical for optimal interpretation of surgical neuropathology specimens, particularly with small needle biopsies. The following material is required:

• Cover letter with brief clinical history, including patient age, sex, location of tumor/lesion, and imaging characteristics.
• Copy of your pathology report, even if there is no diagnosis yet. This provides basic information for accessioning of specimen (e.g., date of birth, date of surgery, etc.).
• Either a representative paraffin block or 10 unstained sections cut at 4-6 microns onto charged or sialinized slides, in case either immunohistochemical or FISH studies are required. The latter often saves a day in turnaround time, since no sectioning of the block is required.
• Billing information. If insurance information is provided, then the patient can be billed directly for the professional fees. If not, then the individual or department who sent the case is billed. Technical fees must be charged to the referring hospital or medical center for all surgical specimens derived from inpatients. Questions regarding billing issues should be referred to Mrs. Jean Loehr at the pathology billing office at 314-362-5641.
• Copies of pre-operative radiographic studies (films, digitized images on CD, etc.) are not required, though greatly appreciated when available. Otherwise, a copy of the radiologist’s report or a description in the cover letter is sufficient.

Consult with Genetic Analysis

(Important Note: Genetic studies are not performed in this lab in the absence of a consult.)

Fluorescence in situ hybridization (FISH) analysis on paraffin embedded tissue is available in our lab for a variety of tumor types, including gliomas, embryonal tumors (e.g., rhabdoid tumors, medulloblastoma/PNET), meningiomas, and a variety of pediatric and/or soft tissue tumors (e.g., translocations associated with Ewing sarcoma/pPNET, synovial sarcoma, DSRCT). Additional assays are also being developed on an ongoing basis. The most common application is testing for chromosome 1p and 19q deletions in gliomas (see Figure), given that this is associated with a more favorable prognosis and therapeutic responsiveness in patients with oligodendroglial tumors. Another common application is in the differential diagnosis between an anaplastic oligodendroglioma/mixed oligoastrocytoma or glioblastoma with oligodendroglial features (better prognosis, increased chemosensitivity) versus a small cell variant of astrocytoma/glioblastoma (worse prognosis, chemoresistance). Rather than 1p and 19q deletions, the latter frequently manifests EGFR amplification (70%) and 10q deletions (>95%), with all four alterations detectable by FISH. We do not offer FISH analysis in the absence of a pathology consult, because we firmly believe that just like immunohistochemical data, genetic alterations should not be interpreted in a vacuum without correlating them to the appropriate clinical and histopathologic findings. Therefore, our results are incorporated into a full pathology report analogous to the current practice with immunohistochemistry. The report includes both the diagnosis and the interpretation of genetic results within the proper clinicopathologic context. The required material for performing FISH analysis is the same as that listed above for the basic consult. As opposed to LOH studies, no matching blood specimens or normal tissue is required. The majority of paraffin specimens yield diagnostic results (>98%), though rare cases are considered uninterpretable due to insufficient hybridization signals.

Figure Legend: A. Glioblastoma with oligodendroglial features, showing both 1p (B: one green 1p and two red 1q signals in most nuclei) and 19q (C: one red 19q and two green 19p signals in most nuclei) deletions by FISH. D. Small cell glioblastoma with morphologic features that overlap with anaplastic oligodendroglioma. FISH analysis showed 10q deletion [E: one green PTEN (10q23) and one red DMBT1 (10q25-q26) signal in most nuclei] and EGFR gene amplification (innumerable red signals in most nuclei).