Who knew blueberries could teach us about healthy cells? 🫐😲. Today’s
#IntroToPath
, I use 'em to explain metaplasia (🖤 blackberries), hyperplasia, and hypertrophy 💪🏽. It's like a berry-licious journey through the world of pathology! 🌎
#Path4People
#BerriesForEducation
🍓🍒🔬
👩🔬👏 Mary Papanikolaou deserves as much praise as her better known husband. She underwent almost daily Pap smears 🔬~ 21 years for her husband's cervical cancer research 😧. Her dedication to advancing women's health is unprecedented + remarkable!
#funfactsofpathology
#path4people
A pineapple🍍 is basically what a liver looks like under the microscope 🔬 🤷🏻
Blueberry- hepatic vein
Strawberry -hepatic artery
Lime skin - bile duct
Pineapple Core - central vein
#pathpoetrythursday
Grab your ☕️ or 🍵
Today’s Subject: Placenta
Placenta, oh placenta, a remarkable thing, 🤩
From embryo to baby 👶, it provides a crucial link. ⛓️
It feeds and it filters, it helps life to thrive,
A temporary wonder, that keeps us all alive. 🤗
Pathology is like a detective work for doctors. They use it to figure out what's causing your symptoms and find the best treatment. Think of it as a medical Sherlock Holmes! 🔍🩸
#Pathology
#MedicalMystery
#Healthcare
Endocervical Curettage in a 45 y/o F
Please don’t miss this (as I had 😣)
Because with this Dx, there’s a change in management:
Cold Knife Cone or Hysterectomy.
Key Phrase: “Tall, Dark, and Dirty”
Dx?
#gynpath
#pathtwitter
#obgyn
#hpv
#medpath
🩺💡 Rudolf Virchow, the father of pathology, recognized the importance of both cellular pathology and social medicine. His legacy inspires us to prioritize health and advocate for social justice. Let's continue his path for a healthier, more equitable world🙌🏼
#Path4People
🌍👨⚕️💉
Did you know that up to 70% of medical decisions are based on pathology? Join me every Monday for
#introtopath
on
#path4people
and discover the crucial role pathology plays in healthcare. Let's learn together about these unsung heroes and the impact they have!
#healthcarestats
🥦🌿 Cancer pathology simplified: cauliflower represents a gross specimen, cilantro as cancer. If cancer is at the stalk, it's not good news and requires further evaluation. Accurate diagnoses are critical.
#Path4People
#introtopath
💙🧬🩺
Once you see Barrett’s Esophagus, the next thing you automatically need to think:
• Neg for Dysplasia
• Indefinite for Dysplasia
• Low grade Dysplasia
• High grade Dysplasia
I find this extremely tricky.
Here are some tips my staff have told me👇
#pathagonia
#path4people
p53: The "North Star"⭐️ of IHCs
Uses:
-Dysplasia in both Barrett esophagus and SSL
-Pancreatobiliary neoplasia (esp small biopsy)
-Urothelial CIS v. reactive
-High grade serous carcinoma
-dVIN
-Neuroendocrine carcinoma
-Diffuse astrocytoma
and MORE!
Credit:
@IHC_guy
link👇
Here’s a general overview of stomach histology. Remember pits and glands? 😅.
There are much more specialized cells that I did not label (eg other types of enteroendocrine cells besides G cells).
#pathagonia
#medstudents
#gi
#pathx
I always/still get confused on moles.
Complete v Partial Mole
- Complete mole has greater risk of Choriocarcinoma
- p57 (maternally imprinted gene) IHC can help differentiate
- partial mole (XXY generally) and complete mole (XX or XY)
#pathtwitter
#medtwitter
#obgyn
#med
Chronic Endometritis
Potential cause of pregnancy loss and infertility.
Unclear etiology but some bacteria might be implicated in it.
Diagnose: plasma cells in endometrial stroma
Treatment: antibiotics like doxycycline
#pathtwitter
#gyntwitter
#obtwitter
#gyntwitter
Have you ever wondered how surgeons know if they've removed all of a tumor? Pathologists look under the microscope to check if the edges of the removed tissue are clear or still have tumor. Clear margins mean better chances of success! 🔬👨⚕️👩⚕️
#Pathology
#Histology
#Surgery
#Tumor
Foveolar Metaplasia of Duodenum
• Something I feel can be easily missed if not in the back of your mind
• Considered a reparative/reactive process
• May be associated with H Pylori gastritis, NSAID use, and Duodenal polyp.
#pathagonia
#pathx
#pathtwitter
#gipath
#gi
#medx
🔬Dr. Dorothy Reed, a trailblazer in the early 20th century, rocked cancer research! She found special cells 🦉(Reed Sternberg cells) in Hodgkin's lymphoma, helping Drs. diagnose it better. She broke many barriers 🛑, and is a true pioneer in medicine 🧫🥼🧍🏻♀️💪🏽
Psoriasis:
-A common presentation is well defined red plaques with silvery scales.
- Etiology involves genetic, autoimmune, and environmental factors
- Psoriatic arthritis affects~ 5-30% pts w/ psoriasis
Factoid credit👇
Image credit: Kelly Hall, MD
#pathagonia
#psoriasis
Toxoplasma lymphadenitis
• Localized presentation of acute infection by Toxoplasma gondii in lymph node
🔬
- 1) Follicular Hyperplasia
- 2) Small clusters of epithelioid histiocytes in Cortex and Paracortex w. germinal center infiltration
- 3) Prominent monocytoid B cells
Immature Teratoma
Grade based on how many Immature neuroepithelial elements you see on low power field
Immature neuroepithelium is okay in a products of conception. NOT ok in Teratoma.
High grade immature Teratoma requires surgery and chemotherapy
#pathtwitter
#obgyn
#peds
#Hashimoto
's is a risk factor for Papillary Thyroid Carcinoma (PTC)
Warthin Tumor is the 2nd most common benign salivary tumor.
There's a subtype of PTC that looks like Warthin Tumor. Associated more with Hashimoto's + Similar prognosis as conventional PTC
#pathagonia
Councilman Body
• Eosinophilic globule representing fragment of apoptotic hepatocyte
Mallory Denk Body
• Cytoplasmic hyaline inclusion made up of p62, ubiquitin, and intermediate filaments
Both can be seen in liver injury (of which there are many causes)
#pathagonia
#gipath
🔬 The Showdown Begins! 🥊 In the left corner, the sleek melanocyte🥹 with a gray cytoplasm. And in the red corner, the terrifying melanoma with a cherry-red nucleolus! 😱 Stay skin savvy and aware! 💪🏽🔍. Prevent this fight altogether with sunscreen 🧴☮️ ⛅️
#HistopathHighlight
I am a self-limited condition that may be mistaken for a more sinister process (epithelioid sarcoma->cytokeratin+)
I may appear as an annular plaque
I have granulomatous inflammation with mucin and necrobiosis (degraded collagen)
Who am I?
#pathagonia
#dermx
#dermpath
#pathx
This is one of the things I fear most as a pathology resident.
There’s a saying (I don’t know who it’s attributed to) that there are 2 kinds of pathologist:
Those who have missed this and those that have yet to.
#pathagonia
#pathx
#surgpath
#gipath
#hemeonc
#surgonc
#medx
The power of CK7 and 20🤯
40 y/o F with suspected low grade appendiceal mucinous neoplasm (LAMN) and incidental ovarian mucinous cystadenoma
However, both were CK7 - (not shown) and CK20 +
Dx: Metastatic LAMN
Credit: Dr. Melody Smith
#pathagonia
#pathx
#gynx
#medx
#surgx
Spironolactone Bodies
• Concentric lamellations 👇
• Seen in adrenal tissue of pts with primary hyperaldosteronism (Conn syndrome) treated with aldosterone anatogonists (eg. Spironolactone)
• Adrenalectomy done as medications were ineffective
#pathagonia
#pathx
#pathtwitter
Recently, I shared a post about testicular mesothelioma.
There were great questions asked and made me appreciate how histology -> understanding pathology
eg. Tunica vaginalis has a parietal and visceral layer made of mesothelial cells (which can give rise to mesothelioma!)
Rete Testis
• System transporting sperm🏊🏊🏊from which seminiferous tubules empty; then its delivers🏊to efferent ductules+epididymis where sperm🏊can mature
• Female analogue: Rete ovarii
• Pathology: Testicular tumors invading rete testis is still limited to testis (pT1)
Atypical Fibroxanthoma (AFX)
• Dermal based neoplasm w unknown histogenesis
• Generally behaves in low grade fashion
• Arises on sun-damaged skin in elderly, esp head+neck as single nodule
•🔬Cellular, pleomorphic, frequent mitoses, no necrosis, only in dermis
• IHC: CD10+
I am a rare skin cancer and may be associated with a polyoma virus
I may arise on head and neck, esp in > 60 y/o Caucasian males.
Sadly, one generational singer recently passed away from it
What am I?(Histo hint below)
#pathagonia
#dermx
#dermpath
#medx
#pathx
#medstudentx
😃Today’s
#clinicalpathologycorner
:
Behind every test result shared by your clinician, there's another team 🩺🔬 Pathologists and radiologists work behind the scenes to uncover vital insights. 🤓
Check out this informative article about pathologists!😄 🔬
Mycosis Fungoides
• Primary cutaneous T cell lymphoma
• Occurs in sun protected areas “bathing trunk” distribution
• Presents initially as patches to plaques
• CD2,3,4,5 +
• CD8 - and CD7 dim/partially lost.
#pathagonia
#dermpath
#pathx
#derm
Pilomatrichoma
• I will never forget this story 😦
• It’s a benign skin tumor that can differentiate toward basaloid matrical cells👇
• I heard an FNA showed only mainly those basaloid cells (which can have mites!) and a ddx was “small round blue cell tumor”😧
#pathagonia
Partial Mole
• Distinguishing partial mole from complete and nonmolar specimens may be difficult on histology alone (ref ⬇️)
• p57 can help differentiate complete mole
• Molecular testing is needed to diagnose partial mole (as per WHO5e)
#pathagonia
#path4people
#pathx
Fibrolamellar Hepatocellular Carcinoma
•Rare liver cancer (<1% of 1º liver cancers)
•Seen in younger patients (usu. 2-3rd decade).
•Occurs ONLY in non cirrhotic livers
•Average size on dx: 10 cm
•🧬: DNAJB1-PRKACA
•IHC: HepPar1, CK7, CD68+
•Trt: Surgery
• 🔬+DDx:⬇️
Trichoepithelioma
• Benign adnexal tumor
• Recapitulate features of germinative hair bulb and associated mesenchymal stroma
• May mimic basal cell carcinoma
• If multiple, may be associated with Brooke-Spiegler syndrome
Photo credit: Kelly Hall, MD
#pathagonia
#pathx
Non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP)
•👍 Prognosis
•🩺 Asymptomatic nodule detected during PE or imaging
•Mean Age is 5th decade; M:F 5:1
•🧬: RAS mutations (most common)
•🔬: Encapsulated with PTC-like nuclei
#pathagonia
Epithelioid Hemangioendothelioma
•Malignant vascular neoplasm
•Cords/nests of epithelioid cells against myxohyaline stroma
•Can occur in any organ but more common in soft tissue, lung, liver
•CD31, 34,D2-40, FLI1,ERG +
•Cytokeratin-/+
•👀for blister cells⬇️
#pathagonia
Tubular adenoma
• Is at least low grade dysplasia by definition and a precursor to invasive Adenocarcinoma
• Look for tubular adenoma with high grade dysplasia b/c changes management 👇
#pathagonia
#path4people
#gipath
#pathx
#pathtwitter
Tubulovillous Adenoma (TVA)
•👀 like a Tubular Adenoma (TA) but with Villous Architecture (20-80% Villosity)
• if >80% villosity ➡️ Villous
Adenoma
Why is it important?👇
1 TA < 10 mm: Post Surveillance in 7-10 yrs
1 TVA: in 3 yrs
#pathagonia
#path4people
#pathx
I am a rare uterine cervical cancer and highly malignant.
I am associated with HPV, particularly 18 subtype
Usually, you might see me in the lung. IHC:
Chromogranin and p16 +
Ki-67: “high”
CD45 -
Who am I? 🤔
#pathagonia
#path4people
#surgpathx
#obgyn
#gynpath
#pathx
This colon biopsy was a neat case for 2️⃣ reasons for me:
1) It illustrated importance of getting recuts 👇
2) Schwann Cell Hamartomas can look like polyps.
— arise in lamina propria
— S100+👇
Ddx: Neuroma, Ganglioneuroma, Schwannoma, Perineurioma, Vanek Tumor.
#pathagonia
15 Subtypes "Shades" of Meningiomas:
And can be CNS WHO Grades 1-3
Clear Cell and Chordoid subtype->WHO Grade 2
Papillary and Rhabdoid subtype->WHO Grade 3
Other criteria exist that may get you to Grade 2 or 3 (eg. Mitotic Count, Brain Invasion, Molecular, Histo)
#pathagonia
When I started residency, I thought GATA3 was specific for metastatic breast cancer
Little did I know about GATA3...cue Nelly Furtado's song, Promiscuous 😹
GATA3 is + in
BCC
Choriocarcinoma
Mesothelioma
Paraganglioma
Parathyroid
Urothelial Ca.
+ MORE!
#pathagonia