Neuropathology, one of the oldest medical subspecialties, emerged as a profession during the 19th century. Many distinguished individuals during the early days of neurology and psychiatry were practicing neuropathologists, including Freud, Alzheimer, Charcot and Kraepelin. Neuropathology is primarily an academic discipline, aimed at understanding the pathologic reactions of all parts of the central and peripheral nervous systems at both the gross and microscopic levels. In addition, neuropathologists serve as valuable consultants to other clinicians who are involved in the treatment of patients with brain tumors, neuromuscular disorders, infections, and degenerative diseases.

The Division of Neuropathology in the Warren Alpert Medical School of Brown University is physically located on the third floor of the Physicians’ Office Building (POB) at Rhode Island Hospital, with lab space on the twelfth floor of the Ambulatory Patient Center (APC) building. The faculty includes four neuropathologists:  Drs. Ivana Delalle, Douglas Anthony, John Donahue, and Michael Punsoni, as well as a full-time histotechnologist devoted to doing the special stains required for studying the nervous system. There are also two full-time neuropathology fellows plus rotators from the neurology, neurosurgery, neuroradiology, psychiatry, and pathology residencies and medical students from the Warren Alpert Medical School of Brown University. The program provides didactic instruction to Alpert Medical School students and graduate students in the multidisciplinary departments associated with the Carney Institute for Brain Science at Brown University (neuroscience, mathematics, computer science, and engineering). 

The neuropathology division covers a patient service area of over 1 million people and includes all of the Brown University-affiliated hospitals, as well as most of the neighboring community hospitals in Rhode Island, southeastern Massachusetts, and eastern Connecticut. We also provide regular consultation services to the Rhode Island Medical Examiner’s Office and have been used as consultants by other state Medical Examiner’s Offices, as well as pathologists at distant hospitals and universities. The neuropathology division enhances our neurology, psychiatry, and neurosurgery residency training programs by providing academically-oriented, didactic instruction to trainees in these other disciplines. All neurology and neurosurgery residents rotate through neuropathology during their training. A neuropathology division is also necessary for the accreditation of these residency programs.

 

Program Details

Goals

To train career neuropathologists in clinical diagnostic skills through the use of gross, microscopic, and ultrastructural analyses of tissue samples obtained within a hospital setting which offers a diverse and steady case mix and excellent support services.

To provide research skills by exposure to techniques and methodology which will enable the trainee to qualify, enter, and contribute in research fields or academic medicine.

To encourage dialogue, independent investigation, and interdisciplinary cooperation with other members of the Pathology Department, the Norman Prince Neurosciences Institute, and various basic science departments with the medical school.

 

Supervision

In accordance with hospital guidelines, an attending pathologist with the appropriate hospital privileges must make all autopsy and surgical final diagnoses.  Fellows are expected to participate in this process by organizing autopsy and surgical case material, rendering a preliminary pathologic diagnosis, and signing out final diagnoses under the supervision of a member of the neuropathology staff.  The attending staff works closely with the fellows and is readily available to make recommendations and answer questions.

Drs. Delalle, Anthony, Donahue, and Punsoni represent the third generation of neuropathologists at Rhode Island Hospital.  Various records within our division date back to the turn of the 20th century.  The neuropathology fellowship originated in the early 1970’s under the mentorship of Dr. Stanley Aronson, the former dean of the Brown University School of Medicine.  At that time, there were approximately six full-time neuropathologists working within the state of Rhode Island.  The fellowship has been ACGME-approved since its origin.  In the past, the fellowship position was filled primarily by anatomic pathology, neurosurgery, or neurology residents who wanted one year of additional neuropathology experience. 

 

Curriculum Expectations

Fellows are expected to participate in all weekly conferences and other service-related activities and play an instrumental role in the autopsy service and are responsible for reviewing the clinical record and removing the brain and other relevant tissue specimens.  In addition, they are responsible for reviewing relevant clinical, pathologic, and molecular studies related to the case.  Fellows are expected to assist in all frozen sections diagnoses, nerve and muscle biopsies, and final surgical diagnoses. A minimum of 12 months must be devoted to clinical service activities.  Fellows are encouraged to devote 3-12 months pursuing an independent research project in basic or translational neuroscience and to publish their findings in a peer reviewed journal.

 

Teaching Opportunities and Responsibilities

Neuropathology is a division within the Department of Pathology.  Its primary concern is the teaching of diagnostic neuropathology to the neuropathology fellows, pathology residents, rotators, and medical students utilizing clinical-pathologic correlation, as well as a variety of molecular, histologic, and immunologic techniques.

 

Fellow Salary and Benefits

Fellows are employees of the Rhode Island Hospital and are appointed with renewable one- year contracts approved by the Graduate Medical Education Committee at Rhode Island Hospital.  Stipends are commensurate with the year of postgraduate training, four weeks of paid vacation plus approximately 10 holidays, malpractice insurance, and reduced rates for health insurance.  Some moneys are available for travel expenses, book purchase, and meeting/course registration.

Fellows will have ready access to the Program Director, as well as to the technical and clerical staff within the Neuropathology Division.

 

Scholarly Activity

Trainees bolded.  Staff underlined.

Recent trainee publications:

Punsoni M, Friedman JH, Resnick M, Donahue JE, Yang DF, Stopa EG. Enteric Pathologic Manifestations of Alpha-Synucleinopathies. Appl Immunohistochem Mol Morphol. 2019 Aug;27(7):543-548. doi: 10.1097/PAI.0000000000000613. PMID: 29189256.

Telfeian AE, Punsoni M, Hofstetter CP. Minimally invasive endoscopic spinal cord untethering: case report. J Spine Surg. 2017 Jun;3(2):278-282. doi: 10.21037/jss.2017.06.10. PMID: 28744513; PMCID: PMC5506310.

Punsoni M, Mangray S, Lombardo KA, Heath N, Stopa EG, Yakirevich E. Succinate Dehydrogenase B (SDHB) Immunohistochemistry for the Evaluation of Muscle Biopsies. Appl Immunohistochem Mol Morphol. 2017 Oct;25(9):645-650. doi: 10.1097/PAI.0000000000000432. PMID: 27556822; PMCID: PMC5323393.

Ripp K, Orellana V, Dugdale C, Punsoni M, Doberstein CE, Beckwith CG. The Masquerading Cyst: Extraparenchymal Neurocysticercosis Presenting as Acute Meningitis. Am J Med. 2016 Mar;129(3):e1-3. doi: 10.1016/j.amjmed.2015.09.012. Epub 2015 Oct 22. PMID: 26477948.

Punsoni MDonahue JE, Elinzano HD, Kinsella T. Updates in Molecular Pathology of Central Nervous System Gliomas in Adults. R I Med J (2013). 2015 Nov 2;98(11):17-9. PMID: 26517249.

Lakis NS, Lombardo KA, Mangray S, Netto GJ, Salles D, Matoso A. INSL3 Expression in Leydig Cell Hyperplasia and Leydig Cell Tumors. Appl Immunohistochem Mol Morphol. 2019 Mar;27(3):203-209. doi: 10.1097/PAI.0000000000000567. PMID: 29084059.

Donahue JE, Yakirevich E, Zhong S, Treaba DO, Lakis NS, Ali SM, de la Monte SM, Mangray S. Primary Spinal Epidural CIC-DUX4 Undifferentiated Sarcoma in a Child. Pediatr Dev Pathol. 2018 Jul-Aug;21(4):411-417. doi: 10.1177/1093526617707856. Epub 2017 May 5. PMID: 28474974; PMCID: PMC5575979.

Ahmed AK, Morrison JF, Lakis NSStopa E, Doberstein C. Atypical meningioma mimicking high-grade glioma. Neurology. 2016 Nov 22;87(21):2281-2282. doi: 10.1212/WNL.0000000000003364. PMID: 27872223.

Syed S, Karambizi DI, Baker A, Groh DM, Toms SA. A Comparative Report on Intracranial Tumor-to-Tumor Metastasis and Collision Tumors. World Neurosurg. 2018 Aug;116:454-463.e2. doi: 10.1016/j.wneu.2018.04.109. Epub 2018 Apr 26. PMID: 29704691.

Doberstein C, Noor A, Choi D, Smith J, Groh D, Mermel L, Doberstein C. Cerebral Epidural Abscess Secondary to Blastomyces Masquerading as an Epidermoid Tumor. Open Forum Infect Dis. 2017 May 29;4(3):ofx112. doi: 10.1093/ofid/ofx112. PMID: 28721351; PMCID: PMC5508773.

Stonebridge R, Taliano RJ, Velilla TD, Anthony DC. Hypertrophy of the Anterior External Arcuate Fasciculus: A Rare Variant With Implications for the Development of the Arcuate Nucleus. Front Neuroanat. 2020 Nov 27;14:595500. doi: 10.3389/fnana.2020.595500. PMID: 33328906; PMCID: PMC7729007.

Kanach C, Blusztajn JK, Fischer A, Delalle I. MicroRNAs as Candidate Biomarkers for Alzheimer's Disease. Noncoding RNA. 2021 Feb 1;7(1):8. doi: 10.3390/ncrna7010008. PMID: 33535543; PMCID: PMC7930943.

Abdulrazeq H, Anderson M, Poggi J, Sampath S, Kanach CDelalle I, Sampath P, “Management of pituitary spindle cell oncocytomas:  A case report and review of the literature,”Interdiscip Neurosurg 2021; 23 (article number 100972); doi: 10.1016/j.inat.2020.100972 (Epub ahead of print; no PMID).

Alexander AL, Lim SY, Massingham LJ, Phillips O, Chambers MK, Donahue JE, “Pathologic Alexander disease with normal GFAP sequencing:  an autopsy case report and literature review,” J Neuropathol Exp Neurol 2022 Sep 22 [Epub ahead of print].

Tubre T, Hacking S, Alexander A, Brickman A, Delalle I, Elinzano H, Donahue JE, “Prostate-specific membrane antigen expression in meningioma:  a promising theranostic target,” J Neuropathol Exp Neurol 2022 Sep 30 [Epub ahead of print].

 

Recent trainee abstracts:

Punsoni M, Friedman J, Resnick M, Donahue J, Yang DF, Stopa E, “Enteric Manifestations of Alpha-Synucleinopathies,” J Neuropathol Exp Neurol 2016; 75: 598-599 (abstract 114). 92nd Annual Meeting of the American-Association-of-Neuropathologist-Inc, JUN 16-19, 2016, Baltimore, MD.

Punsoni M, Julian J, Jolly G, Boxerman JL, Choi DB, Chopra P, Donahue JE, Moldovan K, Stopa EG, Klinge PM, “Filum Pathology of Occult Tethered Cord Syndrome in Ehlers Danlos Patients,” Lab Invest 2016; 96 (Suppl 1): 436A (abstract 1728). 105th Annual Meeting of the United-States-and-Canadian-Academy-of-Pathology MAR 12-18, 2016 Seattle, WA.

Punsoni M, Lombardo KA, Mangray S, Stopa EG, Yakirevich E, “Succinate Dehydrogenase B (SDHB) Immunohistochemistry Is an Effective Alternative to SDH Histochemistry in the Evaluation of Muscle Biopsies,” Lab Invest 2016; 96 (Suppl 1): 436A (abstract 1729). 105th Annual Meeting of the United-States-and-Canadian-Academy-of-Pathology MAR 12-18, 2016 Seattle, WA.

Punsoni M, Sachs G, de la Monte S, “Post-Polio Syndrome Revisited,” J Neuropathol Exp Neurol 2015; 74: 627 (abstract 143).  91st Annual Meeting of the American-Association-of-Neuropathologists-Inc, JUN 11-14, 2015, Denver, CO.

Punsoni M, Rogg J, Stopa E, “Neoplastic, Inflammatory or Demyelinating, a Persistent Diagnostic Dilemma,” J Neuropathol Exp Neurol 2015; 74: 629 (abstract 149).  91st Annual Meeting of the American-Association-of-Neuropathologists-Inc, JUN 11-14, 2015, Denver, CO.

Lakis N, Brodsky A, Smith T, Yang DF, Wong I, Anthony D, “A Subset of Cells in Glioblastoma Multiforme Express Multiple Stem Cell Markers,” J Neuropathol Exp Neurol 2016; 75: 582 (abstract 56). 92nd Annual Meeting of the American-Association-of-Neuropathologist-Inc, JUN 16-19, 2016, Baltimore, MD.

Lakis N, Grada Z, Lombardo KA, Mangray S, Matoso A, “Loss of Expression of INSL3 by immunohistochemistry Predicts Leydig Cell Tumor,” Lab Invest 2016; 96 (Suppl 1): 244A (abstract 973). 105th Annual Meeting of the United-States-and-Canadian-Academy-of-Pathology MAR 12-18, 2016, Seattle, WA.

Lakis N, Matoso A, Mangray S, Resnick MB, Yakirevich E, “Expression of the Glucocorticoid Receptor in Prostatic Adenocarcinoma:  An Immunohistochemical and Clinicopathologic Study,” Lab Invest 2016; 96 (Suppl 1): 244A-245A (abstract 974). 105th Annual Meeting of the United-States-and-Canadian-Academy-of-Pathology MAR 12-18, 2016, Seattle, WA.

Groh D, Jolly G, Donahue J, “Correlation of intraepidermal nerve fiber area in formalin-fixed skin tissue with small unmyelinated fibers on sural nerve biopsies,” J Neuropathol Exp Neurol 2017; 76: 507-508 (abstract 66).  93rd Annual Meeting of the American-Association-of-Neuropathologists-Inc, JUN 08-11, 2017, Garden Grove, CA.

de la Monte SStopa EKhan G, Remer J, Dakay K, “Behcet's Disease of the Central Nervous System (CNS),” J Neuropathol Exp Neurol 2018; 77: 531 (abstract 205).  94th Annual Meeting of the American-Association-of-Neuropathologists-Inc, JUN 07-10, 2018, Louisville, KY.

Khan G, Boyajian M, Roussel L, Bhatt R, Stopa E, “Eosinophilic Myositis: A Rare Cause of Atraumatic Compartment Syndrome of the Forearm,” J Neuropathol Exp Neurol 2019; 78: 545 (abstract 98).  95th Annual Meeting of the American-Association-of-Neuropathologists-Inc, JUN 06-09, 2019, Atlanta, GA.

Stonebridge RDonahue JStopa E, “Inflammatory Myofibroblastic Tumor of the Right Tentorium,” J Neuropathol Exp Neurol 2019; 78: 566 (abstract 181).  95th Annual Meeting of the American-Association-of-Neuropathologists-Inc, JUN 06-09, 2019, Atlanta, GA.

Kanach C, James B, Anthony D, Treaba D, “Primary CNS Diffuse Large B-Cell Lymphoma Associated With A Demyelinating Lesion:  A Case Study,” , “Inflammatory Myofibroblastic Tumor of the Right Tentorium,” J Neuropathol Exp Neurol 2020; 79: 675 (abstract 83).  96th Annual Meeting of the American-Association-of-Neuropathologists-Inc, JUN 11-14, 2020, virtual.

Kanach C, Lala N, Delalle I, Montalvo M, Welsh S, Brown W, Bartolini L, Patil R, “Multilobar Focal Cortical Dysplasia Type IIA in a Child Presenting with Febrile Infection-Related Epilepsy Syndrome (FIRES),” J Neuropathol Exp Neurol 2021; 80: 581-582 (abstract 91).  97th Annual Meeting of the American-Association-of-Neuropathologists-Inc, JUN 10-13, 2019, St. Louis, MO (hybrid meeting).

Tubre TDonahue J, “Mixed Intramedullary Ependymoma and Hemangioblastoma of the Spinal Cord,” J Neuropathol Exp Neurol 2021; 80: 604-605 (abstract 181).  97th Annual Meeting of the American-Association-of-Neuropathologists-Inc, JUN 10-13, 2019, St. Louis, MO (hybrid meeting).

Alexander A, Massingham L, Lim S, Phillips O, Chambers M-K, Donahue J, “Pathologic Alexander Disease with Normal GFAP Sequencing,” J Neuropathol Exp Neurol 2021; 80: 565 (abstract 28).  97th Annual Meeting of the American-Association-of-Neuropathologists-Inc, JUN 10-13, 2019, St. Louis, MO (hybrid meeting).

Tubre T, Hacking S, Alexander A, Brickman A, Delalle I, Elinzano H, Donahue J, “Prostate-Specific Membrane Antigen (PSMA) expression in meningiomas increases with grade and recurrence,” J Neuropathol Exp Neurol 2022; 81: 494 (abstract 196).  [Poster Presentation, 98th Annual Meeting of the American-Association-of-Neuropathologists-Inc, JUN 9-12, 2022, Bonita Springs, FL (hybrid meeting).]

Alexander A, Alvarez VE, Huber BR, Alosco M, Mez J, Delalle I, McKee AC, Stein TD, “Cortical-sparing Chronic Traumatic Encephalopathy (CS-CTE): Categorizing a Distinct Pathological Subtype of CTE,” J Neuropathol Exp Neurol 2022; 81: 469 (abstract 110).  [Platform Presentation, 98th Annual Meeting of the American-Association-of-Neuropathologists-Inc, JUN 9-12, 2022, Bonita Springs, FL (hybrid meeting).]

Kritselis M, Alvarez VE, Huber BR, Nicks R, Alosco M, Mez J, Delalle I, McKee AC, Stein TD, “Neuropathology of Alzheimer disease associated with repetitive head impacts,” J Neuropathol Exp Neurol 2022; 81: 437 (abstract 1).  [Platform Presentation, 98th Annual Meeting of the American-Association-of-Neuropathologists-Inc, JUN 9-12, 2022, Bonita Springs, FL (hybrid meeting).]

Alexander A, Jackson D, Donahue J, Banerjee P, Chirkov A, “Bing-Neel Syndrome:  A Rare Contributing Factor of Psychosis and Suicidality.”  National Association of Medical Examiner’s Annual Meeting, Dallas, TX (10/22; received “John Smialek Best Resident Paper” award).

 

National/International Lectures:

John Donahue. “General Neuroanatomy/Staining:  An Introduction to Neuropathology for Neuropathologists.”  American Association of Neuropathologists (AANP) Teaching Rounds (virtual with national/international audience, 5/23/2022).

Ivana Delalle. MicroRNAs as diagnostic and prognostic biomarker of Alzheimer’s Disease. Mediterranean Neuroscience Society Meeting, May 29-June 2, Dubrovnik, Croatia. (invited key-note presentation)

John Donahue. “Neuropathology of Vascular Disease.”  AANP Teaching Rounds (virtual with national/international audience, 7/24/2023, scheduled).

Application Process

Send inquiries to:

John E. Donahue, MD
Associate Professor of Pathology and Laboratory Medicine
[email protected]

Alisha Lima
Residency and Fellowship Program Coordinator
[email protected]

Faculty

John E. Donahue, MD
Associate Professor of Pathology and Laboratory Medicine
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Douglas C. Anthony, MD, PhD
Professor of Pathology and Laboratory Medicine
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Ivana Delalle, MD, PhD 
Director of Neuropathology
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Michael Punsoni, MD 
Assistant Professor of Pathology and Laboratory Medicine
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Fellows

Alumni

Albert Klein, MD (1992-1994)
Michael Sikirica, MD (1994-1996)
Deviyani Lathi, MD (1995-1998)
Keith Brecher, MD (1995-1997)
Edward Famiglietti, MD (1995-1999)
John E. Donahue, MD (1996-1999)
William Taylor, MD (1998-2000)
Howard Chang, MD (1999-2001)
Aaron Gleckman, MD (1999-2001)
Jason Peck, MD (2001-2002)
Thomas Lee Chalker, MD (2001-2003)
Louis Neipris, MD (2002-2003)
Qian Wu, MD (2003-2005)
Lesli Tull, MD (2004-2005)
Brian E. Moore, MD, MEd (2003-2004, 2005-2006)
Robert Bagdasaryn, MD (2005-2007)
Carlos Chaves-Arias (2006-2007)
Victor Alvarez, MD (2007-2009)
Mirfrida Geller, MD (2007-2009)
Dorota Latusynski, MD (2009-2010)
Jason E. DeGregorio, MD (2009-2011)
Mohammad J. Mahboob, MD (2011-2013)
Anne H. Lee, MD, Ph.D. (2011-12, 2013-15)
Keyla Klyser-Sugrue, MD (2012-2014)
Michael Punsoni, MD (2014-2016)
Nelli S. Lakis, MD (2015-2017)
Darren Groh, MD (2016-2018)
Galam A. Khan, MD (2017-2019)
Renee Stonebridge, MD (2018-2020)
Colin Kanach, MD (2019-2021)
Teddi Tubre, MD (2020-2022)