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[[Image:Tonsillectomy tonsils.JPEG|thumb|right|220px|Tonsils (at [[cut-up]]) are a common ditzel. ([[WC]]/Katotomichelakis ''et al.'')]] | |||
This article collects '''ditzels''', which are, in the context of [[pathology]], little specimens that are typically one or two slides and usually of little interest.<ref>{{Ref TPoSP|37}}</ref> | This article collects '''ditzels''', which are, in the context of [[pathology]], little specimens that are typically one or two slides and usually of little interest.<ref>{{Ref TPoSP|37}}</ref> | ||
The challenge in ditzels is not falling asleep... so one misses the unexpected (subtle) tumour. | The challenge in ditzels is not falling asleep... so one misses the unexpected (subtle) tumour. | ||
= | =The big table of ditzels= | ||
= | {| class="wikitable sortable" | ||
! Specimen | |||
! Typical context (diagnosis) | |||
! System | |||
|- | |||
| [[Hernia sac]] | |||
| hernia | |||
| [[Gastrointestinal pathology]] | |||
|- | |||
| [[Stoma]] (reversal) | |||
| bowel obstruction, perforated viscus ([[peritonitis]]) | |||
| [[Gastrointestinal pathology]] | |||
|- | |||
| [[Sleeve gastrectomy]] | |||
| [[obesity]] | |||
| [[Gastrointestinal pathology]] | |||
|- | |||
| [[Vertebral disc]] | |||
| herniated disc | |||
| [[Neuropathology]] | |||
|- | |||
| [[Bands of Ladd]] | |||
| [[bands of Ladd]] | |||
| [[Paediatric pathology]] | |||
|- | |||
| [[Cholesteatoma]] | |||
| [[cholesteatoma]] | |||
| [[Paediatric pathology]] | |||
|- | |||
| [[Femoral head]] | |||
| [[hip fracture]], hip [[osteoarthritis|OA]] | |||
| Orthopaedic | |||
|- | |||
| [[Bone reamings]] | |||
| [[hip fracture]] | |||
| Orthopaedic | |||
|- | |||
| [[Tonsil]] | |||
| [[tonsillitis]] | |||
| [[Head and neck pathology]] | |||
|- | |||
| [[Leg amputation]] | |||
| [[atherosclerotic peripheral vascular disease]], trauma | |||
| [[Cardiovascular pathology]] | |||
|- | |||
| [[Lipoma]] | |||
| lipoma | |||
| [[Soft tissue pathology]] | |||
|- | |||
| [[Heterotopic ossification]] | |||
| contractures | |||
| [[Soft tissue pathology]] | |||
|- | |||
| Uterine tubes ([[tubal ligation]]) | |||
| completed family | |||
| [[Gynecologic pathology]] | |||
|- | |||
| [[Pressure ulcer]] ([[AKA]] decubitus ulcer) | |||
| [[ulcer]], immobility | |||
| [[Dermatopathology]] | |||
|- | |||
| Vas deferens ([[vasectomy]]) | |||
| completed family | |||
| [[Genitourinary pathology]] | |||
|- | |||
| [[Uvula]] | |||
| [[obstructive sleep apnea]] | |||
| [[Head and neck pathology]] | |||
|- | |||
| [[Stapes]] | |||
| [[otosclerosis]] | |||
| [[Head and neck pathology]] | |||
|- | |||
| [[Abdominal pannus]] | |||
| [[obesity]] | |||
| [[Dermatopathology]] (?) | |||
|- | |||
| [[Abdominal fat pad biopsy|Abdominal fat]] | |||
| query [[amyloidosis]] | |||
| [[Haematopathology]] (?) | |||
|- | |||
| [[Breast prosthesis]] | |||
| breast cancer/cosmesis | |||
| [[Breast pathology]] | |||
|- | |||
| [[Empyema peel]] | |||
| decortication for [[pneumonia]] | |||
| [[Pulmonary pathology]] | |||
|- | |||
| [[Bursa]] | |||
| [[bursitis]] | |||
| Orthopaedic | |||
|- | |||
| [[Gastric band]] | |||
| [[obesity]] | |||
| [[Gastrointestinal pathology]] | |||
|- | |||
| Small bowel excised during [[Roux-en-Y gastric bypass]] | |||
| [[obesity]] | |||
| [[Gastrointestinal pathology]] | |||
|- | |||
| [[Uterine isthmocele]]/cesarean scar defect | |||
| post-cesarean section | |||
| [[Gynecologic pathology]] | |||
|- | |||
| [[Distal interosseous nerve]] (''[[posterior interosseous nerve]] of wrist'' and ''[[anterior interosseous nerve]] of wrist'') | |||
| chronic hand pain, as may be seen in [[rheumatoid arthritis]] | |||
| [[Neuropathology]] | |||
|- | |||
| [[Palmar fascia]] | |||
| [[palmar fibromatosis]] (Dupuytren's contracture) | |||
| Plastic surgery | |||
|- | |||
| Soft tissue of hand or wrist | |||
| [[Ganglion cyst]] | |||
| Plastic surgery | |||
|- <!-- | |||
| Specimen | |||
| Typical context (diagnosis) | |||
| System --> | |||
|} | |||
= | =Gastrointestinal pathology= | ||
==Hernia sac== | ==Hernia sac== | ||
:''Inguinal hernia'' redirects here. | |||
===General=== | ===General=== | ||
*Hernia repair. | *Hernia repair (herniorrhaphy). | ||
*Pathologic findings are very unusual and if present known to the surgeon. | *Pathologic findings are very unusual and if present known to the surgeon. | ||
**Thus, it has been advocated that one ought not examine 'em.<ref name=pmid14986035>{{cite journal |author=Siddiqui K, Nazir Z, Ali SS, Pervaiz S |title=Is routine histological evaluation of pediatric hernial sac necessary? |journal=Pediatr. Surg. Int. |volume=20 |issue=2 |pages=133–5 |year=2004 |month=February |pmid=14986035 |doi=10.1007/s00383-003-1106-2 |url=}}</ref><ref name=pmid9694100>{{cite journal |author=Partrick DA, Bensard DD, Karrer FM, Ruyle SZ |title=Is routine pathological evaluation of pediatric hernia sacs justified? |journal=J. Pediatr. Surg. |volume=33 |issue=7 |pages=1090–2; discussion 1093–4 |year=1998 |month=July |pmid=9694100 |doi= |url=}}</ref> | **Thus, it has been advocated that one ought not examine 'em.<ref name=pmid14986035>{{cite journal |author=Siddiqui K, Nazir Z, Ali SS, Pervaiz S |title=Is routine histological evaluation of pediatric hernial sac necessary? |journal=Pediatr. Surg. Int. |volume=20 |issue=2 |pages=133–5 |year=2004 |month=February |pmid=14986035 |doi=10.1007/s00383-003-1106-2 |url=}}</ref><ref name=pmid9694100>{{cite journal |author=Partrick DA, Bensard DD, Karrer FM, Ruyle SZ |title=Is routine pathological evaluation of pediatric hernia sacs justified? |journal=J. Pediatr. Surg. |volume=33 |issue=7 |pages=1090–2; discussion 1093–4 |year=1998 |month=July |pmid=9694100 |doi= |url=}}</ref> | ||
Line 46: | Line 146: | ||
===Sign out=== | ===Sign out=== | ||
====Incarcerated without mesothelium==== | |||
<pre> | <pre> | ||
SOFT TISSUE ("HERNIA SAC"), RESECTION: | SOFT TISSUE ("HERNIA SAC"), RESECTION/HERNIA REPAIR: | ||
- FIBROADIPOSE TISSUE -- CONSISTENT WITH HERNIA SAC. | - FIBROADIPOSE TISSUE WITH FAT NECROSIS -- CONSISTENT WITH HERNIA SAC. | ||
- NEGATIVE FOR MALIGNANCY. | - NEGATIVE FOR MALIGNANCY. | ||
</pre> | </pre> | ||
====Micro==== | =====Micro===== | ||
The sections show fibrofatty tissue with hemosiderin-laden macrophages, plump activated fibroblasts with pale staining nuclei, histiocytes with small nuclei and abundant grey vacuolated cytoplasm, fat necrosis and focal necrosis of the fibrous tissue. | The sections show fibrofatty tissue with hemosiderin-laden macrophages, plump activated fibroblasts with pale staining nuclei, histiocytes with small nuclei and abundant grey vacuolated cytoplasm, fat necrosis and focal necrosis of the fibrous tissue. | ||
====Mesothelial lining present==== | |||
<pre> | |||
Submitted as "Hernia Sac", Excision: | |||
- Benign fibroadipose tissue partially covered by mesothelium, consistent | |||
with hernia sac. | |||
- NEGATIVE for malignancy. | |||
</pre> | |||
======Block letters====== | |||
<pre> | |||
SOFT TISSUE ("HERNIA SAC"), RESECTION/HERNIA REPAIR: | |||
- FIBROADIPOSE TISSUE PARTIALLY COVERED BY MESOTHELIUM -- CONSISTENT WITH HERNIA SAC. | |||
- NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
=====Inflamed===== | |||
<pre> | |||
SOFT TISSUE ("HERNIA SAC"), LEFT, RESECTION/HERNIA REPAIR: | |||
- FIBROADIPOSE TISSUE PARTIALLY COVERED BY MESOTHELIUM WITH FOCAL CHRONIC | |||
INFLAMMATION AND REACTIVE CHANGES -- CONSISTENT WITH HERNIA SAC. | |||
- NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
=====Gross only===== | |||
<pre> | |||
SOFT TISSUE, RIGHT INGUINAL, HERNIA REPAIR: | |||
- HERNIA SAC (GROSS ONLY). | |||
</pre> | |||
<pre> | |||
SOFT TISSUE, LEFT INGUINAL, HERNIA REPAIR: | |||
- HERNIA SAC (GROSS ONLY). | |||
</pre> | |||
==Stoma== | ==Stoma== | ||
:''Ostomy'', ''ileostomy'' and ''colostomy'' redirect here. | |||
===General=== | |||
:See: ''[[Colon]]'' and ''[[Small intestine]]''. | :See: ''[[Colon]]'' and ''[[Small intestine]]''. | ||
*Reversal of ''ileostomy'' or ''colostomy''. | |||
*Reversal of ileostomy or colostomy. | **The (generic) encompassing term for ''ileostomy'' and ''colostomy'' is ''ostomy''.<ref>URL: [http://www.nlm.nih.gov/medlineplus/ostomy.html http://www.nlm.nih.gov/medlineplus/ostomy.html]. Accessed on: 27 January 2013.</ref> | ||
Stomas are created for a number of reasons: | |||
*Perforated viscous/peritonitis. | |||
**Trauma. | |||
**[[Colorectal adenocarcinoma]]. | |||
*[[Diverticulosis]]. | |||
===Microscopic=== | ===Microscopic=== | ||
Line 66: | Line 209: | ||
**+/-Fibromuscular hyperplasia of the lamina propria and submucosa. | **+/-Fibromuscular hyperplasia of the lamina propria and submucosa. | ||
*Skin. | *Skin. | ||
**Typically has findings of mild irritation: | |||
***Mild dermal inflammation (usu. lymphocyte predominant). | |||
***[[Acanthosis]] (thickened ''[[stratum spinosum]]''). | |||
***Hypergranulosis (thickened ''[[stratum granulosum]]''). | |||
***Hyperkeratosis (thickened ''[[stratum corneum]]''). | |||
Notes: | Notes: | ||
*One is looking for malignancy (e.g. [[colorectal carcinoma]]), especially if that is in the history. | *One is looking for malignancy (e.g. [[colorectal carcinoma]]), especially if that is in the history. | ||
DDx: | |||
*[[Colorectal adenocarcinoma]]. | |||
*[[Crohn's disease]]. | |||
===Sign out=== | |||
====Colostomy==== | |||
<pre> | |||
COLOSTOMY, COLOSTOMY REVERSAL: | |||
- LARGE BOWEL WALL WITH SUBMUCOSAL FIBROSIS -- OTHERWISE WITHIN NORMAL LIMITS. | |||
- SKIN WITHOUT SIGNIFICANT PATHOLOGY. | |||
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
====Ileostomy==== | |||
<pre> | |||
Submitted as "Ileostomy", Excision: | |||
- Small bowel with submucosal fibrosis, otherwise within normal limits. | |||
- Skin without significant pathology. | |||
- NEGATIVE for dysplasia and NEGATIVE for malignancy. | |||
</pre> | |||
=====Alternate===== | |||
<pre> | |||
Submitted As "Ileostomy", Excision: | |||
- Consistent with ileostomy (small bowel, skin) without significant pathology. | |||
- NEGATIVE for dysplasia and NEGATIVE for malignancy. | |||
</pre> | |||
=====Block letters===== | |||
<pre> | |||
ILEOSTOMY, ILEOSTOMY REVERSAL: | |||
- SMALL BOWEL WALL WITH SUBMUCOSAL FIBROSIS -- OTHERWISE WITHIN NORMAL LIMITS. | |||
- SKIN WITHOUT SIGNIFICANT PATHOLOGY. | |||
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
==Vagus nerve== | |||
===General=== | |||
*Seen from ''vagotomy''. | |||
Typical indication: | |||
*Gastric outlet obstruction.<ref>{{Cite journal | last1 = Okawada | first1 = M. | last2 = Okazaki | first2 = T. | last3 = Takahashi | first3 = T. | last4 = Lane | first4 = GJ. | last5 = Yamataka | first5 = A. | title = Gastric outlet obstruction possibly secondary to ulceration in a 2-year-old girl: a case report. | journal = Cases J | volume = 2 | issue = 1 | pages = 8 | month = | year = 2009 | doi = 10.1186/1757-1626-2-8 | PMID = 19123936 }}</ref> | |||
Notes: | |||
*Left vagus nerve -> anterior vagal trunk. | |||
*Right vagus nerve -> posterior vagal trunk. | |||
===Microscopic=== | |||
Features: | |||
*Peripheral nerve. | |||
DDx: | |||
*Smooth muscle. | |||
===IHC=== | |||
*S-100 +ve. | |||
*Desmin -ve. | |||
===Sign out=== | |||
<pre> | |||
A. VAGUS NERVE, POSTERIOR, VAGOTOMY: | |||
- PERIPHERAL NERVE WITHIN NORMAL LIMITS. | |||
B. VAGUS NERVE, ANTERIOR, VAGOTOMY: | |||
- SMOOTH MUSCLE WITHIN NORMAL LIMITS. | |||
- PERIPHERAL NERVE NOT IDENTIFIED, SEE COMMENT. | |||
COMMENT: | |||
The tissue was stained with desmin and S-100; it is positive for desmin. S-100 marks only | |||
small nerves fibres that innervate the muscle. | |||
</pre> | |||
=Pediatric= | =Pediatric= | ||
Line 75: | Line 295: | ||
*Associated with intestinal malrotation. | *Associated with intestinal malrotation. | ||
*Removed by ''Ladd's procedure''. | *Removed by ''Ladd's procedure''. | ||
*Usually associated with [[duodenal]] and (other) [[small bowel obstruction]]s.<ref name=pmid20223332>{{Cite journal | last1 = Raphaeli | first1 = T. | last2 = Parimi | first2 = C. | last3 = Mattix | first3 = K. | last4 = Javid | first4 = PJ. | title = Acute colonic obstruction from Ladd bands: a unique complication from intestinal malrotation. | journal = J Pediatr Surg | volume = 45 | issue = 3 | pages = 630-1 | month = Mar | year = 2010 | doi = 10.1016/j.jpedsurg.2009.12.026 | PMID = 20223332 }} | |||
</ref> | |||
===Microscopic=== | ===Microscopic=== | ||
Features: | Features: | ||
*Benign fibrous tissue. | *Benign fibrous tissue. | ||
===Sign out=== | |||
<pre> | |||
Adhesive band, Ladd's procedure: | |||
- Vascular fibrous tissue consistent with bands of Ladd. | |||
</pre> | |||
==Cholesteatoma== | ==Cholesteatoma== | ||
{{Main|Cholesteatoma}} | |||
=Genitourinary pathology= | =Genitourinary pathology= | ||
Line 106: | Line 322: | ||
*[[Lichen sclerosus]], [[AKA]] ''balanitis xerotica obliterans''. | *[[Lichen sclerosus]], [[AKA]] ''balanitis xerotica obliterans''. | ||
*[[Lichen planus]]. | *[[Lichen planus]]. | ||
*Infection, e.g. [[syphilis]]. | *Infection, e.g. [[syphilis]], [[candidiasis]]. | ||
*[[Zoon balanitis]] - abundant [[plasma cell]]s. | |||
===Microscopic=== | ===Microscopic=== | ||
Line 115: | Line 332: | ||
DDx: | DDx: | ||
*See ''[[Penis]]. | *See ''[[Penis]]. | ||
===Sign out=== | |||
<pre> | |||
Foreskin, Circumcision: | |||
- Benign squamous mucosa within normal limits, consistent with foreskin. | |||
</pre> | |||
<pre> | |||
Foreskin, Circumcision: | |||
- Benign squamous mucosa with mild patchy chronic inflammation at the epidermal-dermal interface. | |||
- NEGATIVE for dysplasia and NEGATIVE for malignancy. | |||
</pre> | |||
<pre> | |||
Foreskin, Circumcision: | |||
- Squamous mucosa with mild-to-moderate acute and chronic | |||
(lymphocytic) lichenoid inflammation. | |||
- NEGATIVE for evidence of lichen sclerosus. | |||
- NEGATIVE for dysplasia and NEGATIVE for malignancy. | |||
Comment: | |||
A PASD stain is NEGATIVE for micro-organisms. | |||
</pre> | |||
==Paraurethral cyst== | ==Paraurethral cyst== | ||
{{Main|Paraurethral cyst}} | |||
==Labia== | |||
===General=== | ===General=== | ||
* | *Operation ''labioplasty''. | ||
===Microscopic=== | ===Microscopic=== | ||
Features: | Features: | ||
* | *Squamous epithelium with compact keratin. | ||
*Fibrous stroma. | |||
===Sign out=== | |||
<pre> | |||
LABIA MINORA, RIGHT, LABIOPLASTY: | |||
- BENIGN SKIN WITH A THIN LAYER OF COMPACT KERATIN FIBROTIC STROMA -- CONSISTENT | |||
WITH LABIA MINORA. | |||
</pre> | |||
=Head and neck pathology= | =Head and neck pathology= | ||
==Tonsillitis== | ==Tonsillitis== | ||
{{Main|Tonsillitis}} | |||
{{Main|Tonsil}} | |||
==Obstructive sleep apnea== | |||
:''Uvula'' redirects here. | |||
*Abbreviated ''OSA''. | |||
===General=== | ===General=== | ||
* | *Clinical diagnosis. | ||
*May be treated with a resection of the uvula.<ref name=pmid19467416>{{Cite journal | last1 = Shin | first1 = SH. | last2 = Ye | first2 = MK. | last3 = Kim | first3 = CG. | title = Modified uvulopalatopharyngoplasty for the treatment of obstructive sleep apnea-hypopnea syndrome: resection of the musculus uvulae. | journal = Otolaryngol Head Neck Surg | volume = 140 | issue = 6 | pages = 924-9 | month = Jun | year = 2009 | doi = 10.1016/j.otohns.2009.01.020 | PMID = 19467416 }}</ref> | |||
*Associated with [[obesity]].<ref name=pmid23299507>{{Cite journal | last1 = Sarkhosh | first1 = K. | last2 = Switzer | first2 = NJ. | last3 = El-Hadi | first3 = M. | last4 = Birch | first4 = DW. | last5 = Shi | first5 = X. | last6 = Karmali | first6 = S. | title = The Impact of Bariatric Surgery on Obstructive Sleep Apnea: A Systematic Review. | journal = Obes Surg | volume = | issue = | pages = | month = Jan | year = 2013 | doi = 10.1007/s11695-012-0862-2 | PMID = 23299507 }}</ref> | |||
===Microscopic=== | ===Microscopic=== | ||
Features: | Features: | ||
* | *Benign oropharyneal mucosa (stratified squamous epithelium). | ||
*+/- | *+/-Skeletal muscle. | ||
*+/-[[Salivary gland]]s (minor) - mucinous. | |||
===Sign out=== | |||
<pre> | |||
UVULA, RESECTION: | |||
- OROPHARYNGEAL MUCOSA, CONSISTENT WITH UVULA. | |||
</pre> | |||
=Cardiovascular pathology= | |||
{{Main|Cardiovascular pathology}} | |||
==Vascular thrombus== | |||
{{Main|Vascular thrombus}} | |||
==Leg amputation== | ==Leg amputation== | ||
{{Main|Leg amputation}} | |||
==Toe amputation== | |||
===General - overview=== | |||
*Like leg ampuations. | |||
===Sign out=== | |||
:See ''[[Ditzels#Atherosclerotic peripheral vascular disease]]''. | |||
==Finger amputation== | |||
===General - overview=== | |||
*Similar to [[toe amputation]]s. | |||
May be done due to: | |||
*Contractures leading to ulcerations. | |||
*[[Scleroderma]] - leading to ischemia.<ref name=pmid3584887>{{Cite journal | last1 = Jones | first1 = NF. | last2 = Imbriglia | first2 = JE. | last3 = Steen | first3 = VD. | last4 = Medsger | first4 = TA. | title = Surgery for scleroderma of the hand. | journal = J Hand Surg Am | volume = 12 | issue = 3 | pages = 391-400 | month = May | year = 1987 | doi = | PMID = 3584887 }}</ref> | |||
===Sign out=== | |||
:See ''[[Ditzels#Atherosclerotic peripheral vascular disease]]''. | |||
==Atherosclerotic peripheral vascular disease== | |||
:''Diabetic foot'' redirects here. | |||
*[[AKA]] ''peripheral vascular disease''. | |||
{{Main|Atherosclerosis}} | |||
===General=== | ===General=== | ||
*Very strong association with [[diabetes mellitus]]. | |||
* | |||
===Gross=== | ===Gross=== | ||
*+/-Ulceration. | *+/-Ulceration. | ||
*+/-Gangrene - black skin - subclassified: | *+/-[[Gangrene]] - black skin - subclassified: | ||
**"Wet" = moist/oozing fluid. | **"Wet" = moist/oozing fluid. | ||
**"Dry" = shriveled, no moisture apparent. | **"Dry" = shriveled, no moisture apparent. | ||
*+/-Loss of hair. | *+/-Loss of hair. | ||
DDx - gross: | |||
*[[Malignant melanoma]]. | |||
Image: | Image: | ||
Line 180: | Line 454: | ||
===Microscopic=== | ===Microscopic=== | ||
Features: | Features: | ||
* | *[[Atherosclerosis]]. | ||
** | *Coagulative [[necrosis]] (gangrene). | ||
* | *Inflammation (wet gangrene). | ||
**Neutrophils. | |||
**Lymphocytes. | |||
**Plasma cells. | |||
*+/-[[Thrombosis]]. | *+/-[[Thrombosis]]. | ||
*+/-[[Chronic osteomyelitis]]. | *+/-[[Chronic osteomyelitis]]. | ||
*+/-Reactive fibroblasts. | |||
Note: | Note: | ||
*Ischemia may be associated with marked nuclear changes. | *Ischemia may be associated with marked nuclear changes. Uninitiated eyes may think they are seeing a [[sarcoma]]. | ||
DDx: | |||
*[[Vasculitis]] associated with a [[connective tissue disorder]]. | |||
*Drug use, e.g. [[cocaine]].<ref name=pmid17059855>{{Cite journal | last1 = Dhawan | first1 = SS. | last2 = Wang | first2 = BW. | title = Four-extremity gangrene associated with crack cocaine abuse. | journal = Ann Emerg Med | volume = 49 | issue = 2 | pages = 186-9 | month = Feb | year = 2007 | doi = 10.1016/j.annemergmed.2006.08.001 | PMID = 17059855 }}</ref> | |||
*[[Chronic osteomyelitis]]. | |||
*[[Cholesterol embolism]]. | |||
===Sign out=== | ===Sign out=== | ||
====Forefoot amputation==== | |||
<pre> | |||
RIGHT FOREFOOT, AMPUTATION: | |||
- ULCERATED SKIN. | |||
- MODERATE-TO-SEVERE ATHEROSCLEROSIS. | |||
- BLOOD VESSEL WITH RECANALIZATION. | |||
- NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
====Leg amputation==== | |||
<pre> | <pre> | ||
LEFT LEG, BELOW KNEE AMPUTATION: | LEFT LEG, BELOW KNEE AMPUTATION: | ||
- MODERATE-TO-SEVERE ATHEROSCLEROSIS. | |||
- COAGULATIVE NECROSIS OF SOFT TISSUE. | |||
- NECROTIC BONE. | |||
- MARROW CAVITY FIBROSIS WITH SIDEROPHAGES. | |||
- RESECTION MARGIN WITH VIABLE TISSUE. | |||
</pre> | |||
=====Revision===== | |||
<pre> | |||
SKIN AND SOFT TISSUE, RIGHT UPPER LEG, REVISION OF AMPUTATION: | |||
- ULCERATED SKIN WITH NECROTIC SOFT TISSUE WITH IMPETIGINIZATION, AND MICROABSCESS | |||
FORMATION. | |||
- SEVERE ATHEROSCLEROSIS. | |||
- NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
=====Leg amputation - gross only===== | |||
<pre> | |||
LOWER EXTREMITY, LEFT, BELOW THE KNEE AMPUTATION: | |||
- ULCERS AND ISCHEMIC CHANGES WITH FOCAL COMPLETE ARTERIAL OCCLUSION (GROSS ONLY). | |||
</pre> | |||
<pre> | |||
LEG, RIGHT, ABOVE THE KNEE AMPUTATION: | |||
- ULCERS AND ISCHEMIC CHANGES WITH EXTENSIVE ARTERIAL DISEASE (GROSS ONLY). | |||
</pre> | |||
<pre> | |||
LEG, RIGHT, ABOVE THE KNEE AMPUTATION: | |||
- EXTENSIVE ISCHEMIC CHANGES WITH SEVERE ARTERIAL DISEASE (GROSS ONLY). | |||
</pre> | |||
====Toe amputation==== | |||
=====Mild===== | |||
<pre> | |||
THIRD TOE, RIGHT, AMPUTATION: | |||
- SKIN WITH MARKED DERMAL FIBROSIS. | |||
- MILD ATHEROSCLEROSIS. | |||
- NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
<pre> | |||
SECOND TOE, RIGHT, AMPUTATION: | |||
- SKIN WITH MARKED DERMAL FIBROSIS AND ULCERATION WITH IMPETIGINIZATION. | |||
- MILD ATHEROSCLEROSIS. | |||
- NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
=====Moderate===== | |||
<pre> | |||
SECOND TOE, LEFT, AMPUTATION: | |||
- MODERATE ATHEROSCLEROSIS. | |||
- BONE WITH A FATTY BONE MARROW CAVITY WITH FOCAL FAT NECROSIS AND RARE PLASMA CELLS. | |||
- SKIN WITH FIBROUS DERMIS AND A NON-SPECIFIC DERMAL PERIVASCULAR LYMPHOPLASMACYTIC | |||
INFILTRATE. | |||
</pre> | |||
<pre> | |||
SECOND TOE, LEFT, AMPUTATION: | |||
- MODERATE ATHEROSCLEROSIS. | |||
- BONE WITH A FATTY BONE MARROW CAVITY WITH FOCAL FAT NECROSIS AND RARE PLASMA CELLS. | |||
- SKIN WITH FIBROUS DERMIS AND NON-SPECIFIC PERIVASCULAR LYMPHOPLASMACYTIC DERMAL INFILTRATE. | |||
</pre> | |||
=====Severe===== | |||
<pre> | |||
SECOND AND THIRD TOE, LEFT, AMPUTATION: | |||
- SEVERE ATHEROSCLEROSIS. | |||
- ACUTE AND CHRONIC OSTEOMYELITIS. | |||
- GANGRENE. | |||
</pre> | |||
<pre> | |||
GREAT TOE, LEFT, AMPUTATION: | |||
- GANGRENE. | - GANGRENE. | ||
- | - SEVERE ATHEROSCLEROSIS. | ||
- MARROW CAVITY | - ULCERATED SKIN AND CHRONIC ISCHEMIC CHANGES. | ||
- BONE WITH NO SIGNIFICANT PATHOLOGY. | |||
- NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
<pre> | |||
GREAT TOE, RIGHT, AMPUTATION: | |||
- GANGRENE. | |||
- ATHEROSCLEROSIS. | |||
- NECROTIC BONE WITH ABUNDANT COCCI ORGANISMS AND NEUTROPHILS | |||
WITHIN THE MARROW CAVITY. | |||
- NEGATIVE FOR MALIGNANCY. | |||
</pre> | </pre> | ||
Line 209: | Line 589: | ||
===Microscopic=== | ===Microscopic=== | ||
Features:<ref name=pmid3548454>{{Cite journal | last1 = Tydings | first1 = JD. | last2 = Martino | first2 = LJ. | last3 = Kircher | first3 = M. | last4 = Alfred | first4 = RH. | last5 = Lozman | first5 = J. | title = Viability of intramedullary canal bone reamings for continued calcification. | journal = Am J Surg | volume = 153 | issue = 3 | pages = 306-9 | month = Mar | year = 1987 | doi = | PMID = 3548454 }}</ref> | Features:<ref name=pmid3548454>{{Cite journal | last1 = Tydings | first1 = JD. | last2 = Martino | first2 = LJ. | last3 = Kircher | first3 = M. | last4 = Alfred | first4 = RH. | last5 = Lozman | first5 = J. | title = Viability of intramedullary canal bone reamings for continued calcification. | journal = Am J Surg | volume = 153 | issue = 3 | pages = 306-9 | month = Mar | year = 1987 | doi = | PMID = 3548454 }}</ref> | ||
*Fragments of bone | *Fragments of bone (scattered trabeculae). | ||
**Necrotic bone = bone with empty lacunae, i.e. lacunae missing osteocytes. | |||
*[[Bone marrow]]. | *[[Bone marrow]]. | ||
**Megakaryocytes. | **Megakaryocytes - large cells, multinucleated, eosinophilic cytoplasm. | ||
**Nucleated [[RBC]]s. | **Nucleated [[RBC]]s - perfectly round, dense nucleus, bright red cytoplasm. | ||
**Myeloid cells and precursors. | **Myeloid cells and precursors. | ||
**Adipocytes. | **Adipocytes. | ||
Line 225: | Line 606: | ||
- NEGATIVE FOR MALIGNANCY. | - NEGATIVE FOR MALIGNANCY. | ||
</pre> | </pre> | ||
==Heterotopic ossification== | |||
*Abbreviated ''HO''. | |||
{{Main|Heterotopic ossification}} | |||
==Lumbar bone== | |||
===General=== | |||
*May be seen in the context of laminectomies to treat cauda equina syndrome. | |||
===Microscopic=== | |||
Features: | |||
*Degenerative fibrocartilage: | |||
**Multiple chondrocytes in one pocket (lacuna) - regenerative change. | |||
**Degenerative cartilage. | |||
*Non-vital bone: | |||
**Empty lacuna. | |||
DDx: | |||
*Occult malignancy. | |||
===Sign out=== | |||
<pre> | |||
LUMBAR BONE, DECOMPRESSION: | |||
- BONE AND VERTEBRAL DISC FRAGMENTS WITH DEGENERATIVE CHANGES. | |||
- UNREMARKABLE BONE MARROW. | |||
- NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
==Bursa== | |||
:''Bursitis'' redirects here. | |||
===General=== | |||
*Uncommon specimen. | |||
*Septic bursitis is usually due to ''S. aureus''.<ref name=pmid23933823>{{Cite journal | last1 = Hanrahan | first1 = JA. | title = Recent developments in septic bursitis. | journal = Curr Infect Dis Rep | volume = 15 | issue = 5 | pages = 421-5 | month = Oct | year = 2013 | doi = 10.1007/s11908-013-0353-1 | PMID = 23933823 }}</ref> | |||
**Usually associated with trauma to the overlying skin.<ref name=pmid439118>{{Cite journal | last1 = Canoso | first1 = JJ. | last2 = Sheckman | first2 = PR. | title = Septic subcutaneous bursitis. Report of sixteen cases. | journal = J Rheumatol | volume = 6 | issue = 1 | pages = 96-102 | month = | year = | doi = | PMID = 439118 }}</ref> | |||
Indication: | |||
*Bursitis - may be treated with bursectomy.<ref>{{Cite journal | last1 = Dillon | first1 = JP. | last2 = Freedman | first2 = I. | last3 = Tan | first3 = JS. | last4 = Mitchell | first4 = D. | last5 = English | first5 = S. | title = Endoscopic bursectomy for the treatment of septic pre-patellar bursitis: a case series. | journal = Arch Orthop Trauma Surg | volume = 132 | issue = 7 | pages = 921-5 | month = Jul | year = 2012 | doi = 10.1007/s00402-012-1494-7 | PMID = 22426936 }}</ref> | |||
Note: | |||
*Most bursitis is managed conservatively.<ref name=pmid21814140>{{Cite journal | last1 = Lustenberger | first1 = DP. | last2 = Ng | first2 = VY. | last3 = Best | first3 = TM. | last4 = Ellis | first4 = TJ. | title = Efficacy of treatment of trochanteric bursitis: a systematic review. | journal = Clin J Sport Med | volume = 21 | issue = 5 | pages = 447-53 | month = Sep | year = 2011 | doi = 10.1097/JSM.0b013e318221299c | PMID = 21814140 }}</ref> | |||
===Microscopic=== | |||
Features: | |||
*Dense connective tissue. | |||
*Fibroadipose tissue. | |||
===Sign out=== | |||
====No apparent inflammation==== | |||
<pre> | |||
BURSA, RIGHT HIP, BURSECTOMY: | |||
- BENIGN DENSE CONNECTIVE TISSUE WITH CALCIFICATIONS, AND FIBROADIPOSE TISSUE. | |||
- NO SIGNIFICANT INFLAMMATION. | |||
- NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
<pre> | |||
BURSA, LEFT TROCHANTERIC, BURSECTOMY: | |||
- BENIGN DENSE CONNECTIVE TISSUE AND BENIGN FIBROADIPOSE TISSUE. | |||
- NO SIGNIFICANT INFLAMMATION. | |||
- NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
==Rotator cuff tear== | |||
===General=== | |||
*Surgically repaired. | |||
*[[Clinical diagnosis]]. | |||
===Microscopic=== | |||
Features:<ref>{{Cite journal | last1 = Longo | first1 = UG. | last2 = Berton | first2 = A. | last3 = Khan | first3 = WS. | last4 = Maffulli | first4 = N. | last5 = Denaro | first5 = V. | title = Histopathology of rotator cuff tears. | journal = Sports Med Arthrosc | volume = 19 | issue = 3 | pages = 227-36 | month = Sep | year = 2011 | doi = 10.1097/JSA.0b013e318213bccb | PMID = 21822106 }}</ref> | |||
*Collagen degeneration. | |||
*Disordered arrangement of collagen fibres. | |||
**Wavy fibres. | |||
**Separation of the fibres. | |||
*+/-Inflammation - associated with smaller tears. | |||
*+/-Decreased cellularity - associated with larger tears. | |||
*+/-Fatty replacement.<ref name=pmid24084435>{{Cite journal | last1 = Kuzel | first1 = BR. | last2 = Grindel | first2 = S. | last3 = Papandrea | first3 = R. | last4 = Ziegler | first4 = D. | title = Fatty infiltration and rotator cuff atrophy. | journal = J Am Acad Orthop Surg | volume = 21 | issue = 10 | pages = 613-23 | month = Oct | year = 2013 | doi = 10.5435/JAAOS-21-10-613 | PMID = 24084435 }}</ref> | |||
===Sign out=== | |||
<pre> | |||
RIGHT SHOULDER ACROMIOM AND BURSAE, EXCISION: | |||
- UNREMARKABLE BONE (GROSS ONLY). | |||
- BENIGN SOFT TISSUE. | |||
</pre> | |||
<pre> | |||
"BURSA AND ACROMION", LEFT SHOULDER, ROTATOR CUFF REPAIR: | |||
- BENIGN DENSE CONNECTIVE TISSUE AND BENIGN FIBROADIPOSE TISSUE. | |||
- NO SIGNIFICANT INFLAMMATION. | |||
- NO BONE IDENTIFIED. | |||
- NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
<pre> | |||
"BURSA AND ACROMION", LEFT SHOULDER, ROTATOR CUFF REPAIR: | |||
- BENIGN DENSE WAVY CONNECTIVE TISSUE WITH FIBRE SEPARATION. | |||
- BENIGN FIBROADIPOSE TISSUE. | |||
- NO SIGNIFICANT INFLAMMATION. | |||
- NO BONE IDENTIFIED. | |||
- NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
=Other= | |||
==Breast prosthesis== | |||
*[[AKA]] ''breast implants''. | |||
{{Main|Breast prostheses}} | |||
==De Quervain syndrome== | |||
:Should ''not'' be confused with ''[[De Quervain's thyroiditis]]'' (subacute granulomatous thryoiditis). | |||
*[[AKA]] ''de Quervain tenosynovitis'',<ref name=pmid23405595>{{Cite journal | last1 = Gigante | first1 = MR. | last2 = Martinotti | first2 = I. | last3 = Cirla | first3 = PE. | title = [Computer work and De Quervain's tenosynovitis: an evidence based approach]. | journal = G Ital Med Lav Ergon | volume = 34 | issue = 3 Suppl | pages = 116-8 | month = | year = | doi = | PMID = 23405595 }}</ref> and ''de Quervain disease''. | |||
===General=== | |||
*Benign. | |||
*[[Tenosynovitis]] of the thumb. | |||
*Clinical diagnosis.<ref name=pmid18063716>{{Cite journal | last1 = Ilyas | first1 = AM. | last2 = Ilyas | first2 = A. | last3 = Ast | first3 = M. | last4 = Schaffer | first4 = AA. | last5 = Thoder | first5 = J. | title = De quervain tenosynovitis of the wrist. | journal = J Am Acad Orthop Surg | volume = 15 | issue = 12 | pages = 757-64 | month = Dec | year = 2007 | doi = | PMID = 18063716 }}</ref> | |||
Clinical: | |||
*Pain. | |||
Treatment:<ref name=pmid18063716/> | |||
*Steroid. | |||
*Surgery. | |||
===Microscopic=== | |||
Features: | |||
*Dense connective tissue consistent with tendon. | |||
===Sign out=== | |||
====Not apparent==== | |||
<pre> | |||
FIRST EXTENSOR COMPARTMENT, RIGHT HAND, BIOPSY: | |||
- DENSE CONNECTIVE TISSUE CONSISTENT WITH TENDON. | |||
- FIBROUS TISSUE. | |||
</pre> | |||
==Tenosynovitis== | |||
{{Main|Tenosynovitis}} | |||
==Otosclerosis== | |||
:''Stapes'' redirects here. | |||
===General=== | |||
*Clinical diagnosis. | |||
*Causes conductive hearing loss.<ref name=pmid17245017>{{Cite journal | last1 = Declau | first1 = F. | last2 = van Spaendonck | first2 = M. | last3 = Timmermans | first3 = JP. | last4 = Michaels | first4 = L. | last5 = Liang | first5 = J. | last6 = Qiu | first6 = JP. | last7 = van de Heyning | first7 = P. | title = Prevalence of histologic otosclerosis: an unbiased temporal bone study in Caucasians. | journal = Adv Otorhinolaryngol | volume = 65 | issue = | pages = 6-16 | month = | year = 2007 | doi = 10.1159/000098663 | PMID = 17245017 }}</ref> | |||
*Etiology - genetic. | |||
**Over half a dozen genes have been identified.<ref name=omim166800>{{OMIM|166800}}</ref><ref name=omim605727>{{OMIM|605727}}</ref> | |||
**Classically described as ''autosomal dominant''. | |||
Treatment: | |||
*Stapedectomy (removal of the stapes).<ref name=pmid22771999>{{Cite journal | last1 = Redfors | first1 = YD. | last2 = Gröndahl | first2 = HG. | last3 = Hellgren | first3 = J. | last4 = Lindfors | first4 = N. | last5 = Nilsson | first5 = I. | last6 = Möller | first6 = C. | title = Otosclerosis: anatomy and pathology in the temporal bone assessed by multi-slice and cone-beam CT. | journal = Otol Neurotol | volume = 33 | issue = 6 | pages = 922-7 | month = Aug | year = 2012 | doi = 10.1097/MAO.0b013e318259b38c | PMID = 22771999 }}</ref> | |||
===Microscopic=== | |||
Features (temporal bone):<ref name=pmid620199>{{Cite journal | title = Otosclerosis. | journal = Br Med J | volume = 1 | issue = 6105 | pages = 63-4 | month = Jan | year = 1978 | doi = | PMID = 620199 | PMC = 1602666 | URL = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1602666/?page=1 }}</ref> | |||
*Classically divided into four phases: | |||
*#Osteoclastic phase: | |||
*#*Large spaces form in bone marrow. | |||
*#Replacement phase: | |||
*#*Bone replaced by basophilic web-like tissue. | |||
*#Fibril phase: | |||
*#*Fibrils deposited. | |||
*#Lamellar phase: | |||
*#*[[Lamellar bone]] forms around the blood vessels. | |||
Features - (stapes): | |||
*Unremarkable bone.{{fact}} | |||
DDx: | |||
*[[Avascular necrosis]] ~ 25% of cases diagnosed as ''otosclerosis''.<ref name=pmid620199/> | |||
**May be due to [[fat embolism]]. | |||
Note: | |||
*Avascular necrosis of the stapes crura and otosclerosis together is considered rare.<ref>{{Cite journal | last1 = Erdoglija | first1 = M. | last2 = Sotirovic | first2 = J. | last3 = Jacimovic | first3 = V. | last4 = Vukomanovic | first4 = B. | title = Avascular necrosis of stapes crura in one case of operated otosclerosis. | journal = Acta Medica (Hradec Kralove) | volume = 55 | issue = 4 | pages = 193-7 | month = | year = 2012 | doi = | PMID = 23631292 | URL = ftp://orbis.lfhk.cuni.cz/Acta_Medica/2012/2012_193.pdf}}</ref> | |||
Images: | |||
*[http://commons.wikimedia.org/wiki/File:Gray918.png Stapes - sketch (WC)]. | |||
===Sign out=== | |||
<pre> | |||
STAPES, RIGHT, STAPEDECTOMY: | |||
- BENIGN BONE CONSISTENT WITH STAPES. | |||
</pre> | |||
<pre> | |||
STAPES, RIGHT, STAPEDECTOMY: | |||
- UNREMARKABLE BONE CONSISTENT WITH STAPES. | |||
</pre> | |||
====Missed stapes==== | |||
<pre> | |||
STAPES, RIGHT, STAPEDECTOMY: | |||
- BENIGN FIBROFATTY TISSUE. | |||
- NO BONE IDENTIFIED. | |||
</pre> | |||
===External links=== | |||
*[http://otopathologynetwork.org/tbimages/chapter15/?page=3 Otosclerosis (otopathologynetwork.org)]. | |||
==Abdominal pannus== | |||
*[[AKA]] ''pannus'', ''panniculus'' and ''pannona''. | |||
{{Main|Abdominal pannus}} | |||
==Empyema== | |||
:''Empyema peel'' and ''pleural peel'' redirect here. | |||
===General=== | |||
*Empyemas are often managed surgically.<ref name=pmid10197399>{{Cite journal | last1 = Ferguson | first1 = MK. | title = Surgical management of intrapleural infections. | journal = Semin Respir Infect | volume = 14 | issue = 1 | pages = 73-81 | month = Mar | year = 1999 | doi = | PMID = 10197399 }}</ref> | |||
*Classically, divided into three stages.<ref name=pmid20628845>{{Cite journal | last1 = Shiraishi | first1 = Y. | title = Surgical treatment of chronic empyema. | journal = Gen Thorac Cardiovasc Surg | volume = 58 | issue = 7 | pages = 311-6 | month = Jul | year = 2010 | doi = 10.1007/s11748-010-0599-6 | PMID = 20628845 }}</ref><ref>{{Cite journal | last1 = Hamm | first1 = H. | last2 = Light | first2 = RW. | title = Parapneumonic effusion and empyema. | journal = Eur Respir J | volume = 10 | issue = 5 | pages = 1150-6 | month = May | year = 1997 | doi = | PMID = 9163661 | url = http://erj.ersjournals.com/content/10/5/1150.long }}</ref> | |||
**I - ''exudative stage'' (acute). | |||
**II - ''fibropurulent stage'' (acute). | |||
**III - ''organizational stage'' (chronic). | |||
Etiologies - common: | |||
*[[Pneumonia]] - most common. | |||
*Iatrogenic. | |||
*Trauma. | |||
===Microscopic=== | |||
Features: | |||
*Neutrophils (pus) - '''key feature'''. | |||
*Lymphocytes. | |||
*Plasma cells. | |||
*Reactive fibroblasts. | |||
*Reactive mesothelial cells - not common. | |||
DDx: | |||
*[[Malignant mesothelioma]] - should have infiltrative growth. | |||
*[[Fibrosing pleuritis]]. | |||
===Sign out=== | |||
<pre> | |||
A. Right Pleural, Pleural Peel: | |||
- Proliferative fibroblasts with marked reactive changes. | |||
- Necro-inflammatory debris. | |||
- NEGATIVE for evidence of malignancy. | |||
B. Right Lung, Biopsy: | |||
- Necro-inflammatory debris and reactive pleural changes. | |||
- Infarcted lung parenchyma. | |||
- NEGATIVE for evidence of malignancy. | |||
</pre> | |||
====Block letters==== | |||
<pre> | |||
PLEURA, LEFT, DECORTICATION: | |||
- MIXED INFLAMMATORY INFILTRATE WITH ABUNDANT NEUTROPHILS. | |||
- REACTIVE FIBROBLASTS AND FIBRIN. | |||
- NO MICROORGANISMS APPARENT WITH H&E STAINING. | |||
- NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
====Not labelled as a peel==== | |||
<pre> | |||
Left Lung, Biopsy: | |||
- Fibrin, neutrophils, necrotic tissue and a fibroblastic | |||
response, compatible with empyema peel. | |||
- NO viable lung parenchyma identified. | |||
- NEGATIVE for evidence of malignancy. | |||
</pre> | |||
==Toenail== | |||
===General=== | |||
*Relatively common. | |||
Indications for removal: | |||
*Ingrown<ref name=pmid23227941>{{Cite journal | last1 = Küçüktaş | first1 = M. | last2 = Kutlubay | first2 = Z. | last3 = Yardimci | first3 = G. | last4 = Khatib | first4 = R. | last5 = Tüzün | first5 = Y. | title = Comparison of effectiveness of electrocautery and cryotherapy in partial matrixectomy after partial nail extraction in the treatment of ingrown nails. | journal = Dermatol Surg | volume = 39 | issue = 2 | pages = 274-80 | month = Feb | year = 2013 | doi = 10.1111/dsu.12068 | PMID = 23227941 }}</ref> - typically great toe.<ref name=pmid24063180>{{Cite journal | last1 = Jia | first1 = C. | last2 = Li | first2 = P. | last3 = Wu | first3 = Y. | last4 = Qiu | first4 = Y. | last5 = Cao | first5 = L. | last6 = Chang | first6 = C. | last7 = Zhang | first7 = Y. | title = [Modified surgical repair of severe ingrown toenail]. | journal = Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi | volume = 27 | issue = 7 | pages = 869-71 | month = Jul | year = 2013 | doi = | PMID = 24063180 }}</ref> | |||
*Onychomycosis - [[fungus|fungal]] infection.<ref name=pmid12752134>{{Cite journal | last1 = Reisberger | first1 = EM. | last2 = Abels | first2 = C. | last3 = Landthaler | first3 = M. | last4 = Szeimies | first4 = RM. | title = Histopathological diagnosis of onychomycosis by periodic acid-Schiff-stained nail clippings. | journal = Br J Dermatol | volume = 148 | issue = 4 | pages = 749-54 | month = Apr | year = 2003 | doi = | PMID = 12752134 }}</ref> | |||
*Pigmented lesion. | |||
**Exclude melanoma.<ref name=pmid23153047>{{Cite journal | last1 = Fanti | first1 = PA. | last2 = Dika | first2 = E. | last3 = Misciali | first3 = C. | last4 = Vaccari | first4 = S. | last5 = Barisani | first5 = A. | last6 = Piraccini | first6 = BM. | last7 = Cavrin | first7 = G. | last8 = Maibach | first8 = HI. | last9 = Patrizi | first9 = A. | title = Nail apparatus melanoma: is trauma a coincidence? Is this peculiar tumor a real acral melanoma? | journal = Cutan Ocul Toxicol | volume = 32 | issue = 2 | pages = 150-3 | month = Jun | year = 2013 | doi = 10.3109/15569527.2012.740118 | PMID = 23153047 }}</ref> | |||
===Microscopic=== | |||
Features: | |||
*Nail plate - paucicellular, dense connective tissue. | |||
*Keratinized squamous epithelium. | |||
*+/-Cocci organisms. | |||
DDx: | |||
*[[Malignant melanoma]]. | |||
*Trauma. | |||
*[[Fungus|Fungal infection]] ([[candidiasis]]). | |||
*Bacteria infection, e.g. [[Pseudomonas]] (causes green nails). | |||
===Stains=== | |||
For pigmented lesion: | |||
*[[Prussian blue stain]] - trauma +ve, melanocytic lesion -ve. | |||
*[[Fontana-Masson stain]] - trauma -ve, melanocytic lesion usu. +ve. | |||
Query fungal infection: | |||
*[[PAS]] +ve for fungal organisms.<ref name=pmid12752134>{{Cite journal | last1 = Reisberger | first1 = EM. | last2 = Abels | first2 = C. | last3 = Landthaler | first3 = M. | last4 = Szeimies | first4 = RM. | title = Histopathological diagnosis of onychomycosis by periodic acid-Schiff-stained nail clippings. | journal = Br J Dermatol | volume = 148 | issue = 4 | pages = 749-54 | month = Apr | year = 2003 | doi = | PMID = 12752134 }}</ref> | |||
===Sign out=== | |||
====Pigmented nail==== | |||
<pre> | |||
PARTIAL NAIL PLATE, RIGHT THIRD TOE, SCISSOR EXCISION: | |||
- NAIL PLATE AND THIN LAYER OF KERATINIZED SQUAMOUS EPITHELIUM WITH | |||
PARAKERATOSIS AND FIBRIN. | |||
- NO APPARENT PIGMENT. | |||
- NO EVIDENCE OF MALIGNANCY. | |||
</pre> | |||
=====Micro===== | |||
The sections show a paucicellular nail plate, and a thin layer of squamous epithelium with | |||
keratinization and partial retention of the nuclei (parakeratosis). There is also a small | |||
amount of fibrin. No pigmentation is apparent with Prussian blue and Fontana-Masson | |||
staining. No melanocytes are apparent. No nuclear atypia is apparent. No mitotic activity | |||
is identified. No microorganisms are apparent. No significant inflammation is apparent. | |||
====Query infection==== | |||
<pre> | |||
GREAT TOENAIL, RIGHT, EXCISION: | |||
- NAIL PLATE AND THIN LAYER OF KERATINIZED SQUAMOUS EPITHELIUM. | |||
- SMALL CLUSTERS OF COCCI, FOCAL. | |||
- NO APPARENT FUNGAL ORGANISMS WITH PASF STAIN. | |||
- NO EVIDENCE OF MALIGNANCY. | |||
</pre> | |||
====Fungal organisms present==== | |||
<pre> | |||
GREAT TOE NAIL, RIGHT, REMOVAL: | |||
- NAIL PLATE AND THIN LAYER OF KERATINIZED SQUAMOUS EPITHELIUM WITH | |||
PARAKERATOSIS AND SCANT SUBEPITHELIAL TISSUE. | |||
- FUNGAL ORGANISMS CONSISTENT WITH CANDIDA, DEMONSTRATED WITH PASF STAIN. | |||
- SMALL CLUSTERS OF COCCI, FOCAL. | |||
- NO EVIDENCE OF MALIGNANCY. | |||
</pre> | |||
==Canal of Nuck cyst== | |||
===General=== | |||
*Canal of Nuck is the female equivalent of the male ''processus vaginalis''.<ref name=pmid36295514/> | |||
*Women/girls only pathology - can be thought of as inguinal hernia in women. | |||
*Very rare pathology.<ref name=pmid36295514>{{cite journal |authors=Kohlhauser M, Pirsch JV, Maier T, Viertler C, Fegerl R |title=The Cyst of the Canal of Nuck: Anatomy, Diagnostic and Treatment of a Very Rare Diagnosis-A Case Report of an Adult Woman and Narrative Review of the Literature |journal=Medicina (Kaunas) |volume=58 |issue=10 |pages= |date=September 2022 |pmid=36295514 |pmc=9609622 |doi=10.3390/medicina58101353 |url=}}</ref> | |||
===Sign out=== | |||
<pre> | |||
A. Submitted as "Canal of Nuck Cyst", Excision:: | |||
- Benign fibroadipose tissue partially covered by mesothelium with inflammation, | |||
compatible with clinical impression of canal of Nuck cyst. | |||
- NEGATIVE for malignancy. | |||
</pre> | |||
==Palmar fascia== | |||
{{Main|Palmar fascia}} | |||
=See also= | =See also= | ||
Line 234: | Line 953: | ||
[[Category:Basics]] | [[Category:Basics]] | ||
[[Category:Ditzels]] |
edits