General Information
The Yale Neuropathology Program covers both the surgical and the classical
fields of neuropathology. For surgical neuropathology, a major portion
of our service involves rendering neuropathological diagnosis on tumors
of the brain, the spinal cord, and their coverings; brain biopsies
on non-tumorous conditions and epilepsy-related cerebral lesions; and
muscle and nerve biopsies, among others. We also provide service for
the investigation of dementia and degenerative disorders.
State-of-the-art-technology
is utilized to establish the diagnosis by routine and special histochemical
techniques, including enzyme histochemistry, immunohistochemistry,
and electron microscopy.
Molecular diagnostic services are also
provided in conjunction with the molecular diagnostic section of
our department.
We respond promptly to extramural requests for consultation
on cases by communicating with submitting physicians soon after we
receive
the materials for review.
Areas of Expertise
• Tumors of the brain, spinal cord, and their coverings
•
Skeletal muscle and peripheral nerve pathology
•
Pathological investigation of epilepsy related lesions
•
Dementia related disorders, including Alzheimer’s disease and
Creutzfeldt-Jakob disease
•
Other neurodegenerative diseases
•
Biopsied tissue for non-tumorous conditions
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About Alzheimer’s Disease
 Alzheimer’s disease is the most common cause of dementia. The
disease is age-sensitive, afflicting about 3% of people between 65
to 74 years of age, and rising to an incidence of nearly 50% in those
over age 85. Today, about 4 million people in the U.S. suffer from
this relentlessly progressive disease, a number that is expected to
increase as our population ages. The debilitating features of the disease
make it a major emotional and financial drain on family members and
have a considerable socioeconomic impact on society in general.
Initially, the majority of patients show forgetfulness, confusion
and/or abnormal behavior, which become progressively worse. The brain
of an
Alzheimer’s
victim shrinks and the number of brain cells decreases. Also, “tangles” and
granules are observed in many brain cells, and structures called “senile
plaques” accumulate in the brain. Despite intensive research, our understanding
of the basic mechanism of the disease is far from adequate. A few FDA-approved
drugs may lessen symptoms in an early stage of the disease, but so far there
is no cure for Alzheimer’s disease.
The national average of clinical misdiagnosis is between 10 and 15%,
which means that 10 to 15% of patients clinically thought to have Alzheimer’s
disease prove to have a different condition when the brain is examined
at autopsy.
The final diagnosis of Alzheimer’s disease can only be established
by postmortem examination of the brain. Such a determination may be
very important to the surviving members of the deceased, as certain
dementia-causing illnesses (like vascular dementia) may be preventable
through diet, exercise, and other treatment, and may have familial
predilections.
You may obtain a form for a free postmortem pathological evaluation
for Alzheimer’s disease at Yale from:
The Alzheimer’s Association
South Central Connecticut Chapter,
2911 Dixwell Avenue, Hamden, CT 06518
Phone: (203) 230-1777, Fax: (203) 230-1712
The Alzheimer’s Association is the national health organization
dedicated to enhancing the quality of life for all persons affected
by Alzheimer’s disease and related disorders. They offer comprehensive
educational programs, compassionate services, access to other resources
and support for Alzheimer’s research.
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Frequently Asked Questions
Do pathologists need to have unstained slides in addition to stained
sections on consult cases?
Not always, as H&E and other originally prepared special stains
are usually sufficient for us to complete evaluation. However, we occasionally
need to perform special stains before we finish our evaluation, and
additional unstained sections, if immediately available to us, may
facilitate our interpretation without much delay.
We are going to do a muscle biopsy. Could you tell us how to prepare
the tissue before we send it to you?
Pathological evaluation of muscle biopsy requires complicated histological
procedures. The Yale University Department of Pathology offers state-of-the-art
histological procedures and interpretation of skeletal muscle biopsies
including enzyme histochemistry and electron microscopy.
To prepare tissue for pathological evaluation:
• After the tissue is removed, wrap it with a piece of saline-moistened
(not soaked!) gauze and bring it in a container to our pathology
laboratory as soon as possible.
• Do not place the tissue in formalin,
since we
cannot perform enzyme histochemistry on formalin-fixed tissue.
• Do not place the tissue in saline directly,
as the latter induces some artifact.
• If you have to keep the tissue overnight,
you may freeze
the tissue immediately. The tissue should then be sent to us
in dry
ice.
• Always include a detailed clinical history with the specimen,
including EMG results and CPK level
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People
Jung
H. Kim, M.D., is Professor of Pathology,
Director of the Neuropathology Program, and Attending Pathologist, YNHH.
Dr. Kim’s clinical interests include surgical and classical neuropathology,
such as neoplasms, dementia, and epilepsy.
Thomas
Ciesielski, M.D., is Assistant Professor of Pathology,
and Clinical Professor and Staff Pathologist at the West Haven
VA. Clinical interests:
Alzheimer’s disease; neuromuscular pathology and tumors.
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