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Senior Consultant
Aster MedCity
Interviewed by Dr. Apoorva Pandit
“The bottom line is communication. Every diagnostic dilemma can be solved when clinicians and pathologists talk.”
Dr. Apoorva: "What drew you towards the field of pathology, specifically neuropathology?"
Dr. Vani: "My MBBS and MD training were both from Bangalore Medical College. During my second and third years, I was deeply intrigued by pathology—especially histopathology—because it revealed the hidden secrets behind diseases. Looking into the microscope, I felt as if the cells were talking to me. Around that time, I read The Final Diagnosis by Arthur Hailey, a novel about a young pathologist striving to bring credibility and reform into laboratory practice. It left a deep impression and inspired me to pursue pathology for my postgraduation. After my MD, I wished to super-specialize—either in molecular pathology or neuropathology. A visit to the Department of Neuropathology at NIMHANS captivated me. I saw how neuropathology bridges clinical and research disciplines, defining nervous system diseases through macro-, micro-, and ultrastructural study. Rooted in general pathology yet inseparable from clinical context, neuropathology felt the perfect field for my curiosity and passion."
Dr. Apoorva: "Neuropathology is a demanding field. How did you balance your administrative roles, diagnostic work, and family life?"
Dr. Vani: "I joined the Department of Neuropathology at NIMHANS in 1989 as a senior resident, at a time when there were no formal courses in the subject. Professor Sarladas was the Head of the Department, and Professor Shankar was the senior professor. When he asked whether I preferred neoplastic or non-neoplastic neuropathology, I honestly said I would like to work for a while before deciding. My autopsy experience during MD had been limited, but my willingness to learn was appreciated, and that marked the beginning of my training. In those days, we performed more than 350 autopsies a year. I went to the mortuary almost every day, learning brain removal, fixation, and cutting techniques from experienced faculty and technicians like Mr. Vishwamaran, affectionately known as Mr. Mani. Our weekly brain-cutting sessions, attended by clinicians, radiologists, and faculty, were lively and intellectually stimulating. I later assisted in surgical sign-outs and grossing, mentored by excellent teachers like Dr. Vasudev and Dr. Asha, whose guidance deepened my love for neuropathology. When my residency ended, I stayed on until a faculty position opened in 1993, beginning a lifelong association with NIMHANS that lasted until my retirement in 2022. My family’s constant support made balancing professional and personal responsibilities possible."
“The future lies in the fusion of histopathology, molecular science, imaging, and AI—it will redefine diagnostic pathology.”
Dr. Apoorva: "Clinicians often return to pathologists with doubts when reports differ from their expectations. How do you handle such situations?"
Dr. Vani: "That’s something every pathologist faces! Clinicians often return when our diagnosis doesn’t match their clinical or radiological impression. I explain this through two kinds of complexity—patient-related and tissue-related. Patient-related complexity includes atypical presentations and treatment-related changes. For instance, we once received a dural-based firm lesion clinically thought to be a meningioma. It turned out to be an aspergilloma! Such infections can mimic tumors radiologically and histologically. Our department even published a review in Seminars in Diagnostic Pathology (2010) titled “Infections and Infectious Lesions Mimicking CNS Neoplasms.” Another example is primary CNS lymphoma. These patients are often treated upfront with steroids, which alter morphology—cells appear crushed, mimicking inflammatory lesions. I tell clinicians, “Stop steroids and re-biopsy later—you’ll then see the true pathology.” Tissue-related complexity involves sampling errors and tumor heterogeneity. Stereotactic biopsies may miss the main lesion or sample only infiltrating zones, showing few abnormal cells. Likewise, gliomas can show both low- and high-grade areas; if the biopsy comes from a low-grade region, it won’t reflect the tumor’s true nature. Ultimately, the solution is dialogue. Pathologists and clinicians must communicate openly. Once there’s conversation, most confusion resolves."
Dr. Apoorva: "You’ve seen neuropathology at a global level and are a visionary in the field. How do we bring neuropathology care to the Indian subcontinent?"
Dr. Vani: "In India, there remains a clear gap between scientific advances and available diagnostic resources. While some centers can perform molecular tests, many cannot. To bridge this, within the Asian–Oceanian Society of Neuropathology, we initiated ADAPTER—Adapting Diagnostic Approaches for Practical Taxonomy in Resource-Restrained Regions. Its goal is to provide practical recommendations aligned with WHO CNS guidelines, tailored to five resource levels (RL1–RL5): from basic histopathology (RL1) to advanced molecular testing (RL5). We surveyed 19 countries, including 52 centers in India, where over 70% ranged between RL1 and RL3, with RL4 limited and RL5 almost absent. Accordingly, we proposed histology-oriented integrated diagnostic formats and flowcharts suited to each level, emphasizing morphology and immunohistochemistry while recommending molecular testing only when necessary. Our first set of recommendations, focusing on adult-type diffuse gliomas, has been accepted for publication in Brain Pathology and will appear soon on PubMed."
“I may have superannuated from NIMHANS, but not from neuropathology.”
Dr. Apoorva: "How are you bringing neuropathology knowledge within the country?"
Dr. Vani: "Neuropathology in India goes back to the 1950s—Prof. Dasur was a pioneer. In 2015, we started the Neuropathology Society of India because many general pathologists needed structured exposure to neuropathology. I’m a founder member; from a small beginning we now have 250+ members. Over the years, several stalwarts have led the society—Prof. Sarladas, Late Prof. A.K. Banerjee, Prof. V. Radhakrishnan, Late Prof. Shankar, Prof. Sundaram, Prof. Chitra Sarkar, myself, and currently Prof. Adotra. Our goal is to educate pathologists and clinicians: national conferences, a traveling school (now a national CME), webinars, joint programs with clinical societies, and state-chapter workshops. We want to spread awareness so neuropathology isn’t seen as an untouchable niche. Even without RL4–RL5, diagnosis is possible with the right approach. I’m proud our members contribute globally—we have authors in the WHO “Blue Book,” Greenfield, and other major neuropathology texts."
Dr. Apoorva: "What inspires you to keep going in neuropathology?"
Dr. Vani: "Three things: Purpose, Joy, Growth. Purpose: Even one meaningful report that improves patient care inspires me. Joy: I’m passionate about my work. I love going back to it—no “Monday blues.” Growth: Work must bring professional growth—and it has. You must be passionate about what you do—then you’ll stay inspired."
Dr. Apoorva: "Having delved into the complexities of the human brain, what advice would you give the younger generation to keep the brain safe?"
Dr. Vani: "Keep your brain actively engaged and keep your body healthy. For the brain: read, learn new skills, solve puzzles, enjoy music, converse—stay mentally active. For the body: adopt a healthy lifestyle, balanced diet, sound sleep, and strong social connections. Combine both—your brain will be strong and safe."
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