Ditzels

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.

The challenge in ditzels is not falling asleep... so one misses the unexpected (subtle) tumour.

The big table of ditzels

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 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	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

Gastrointestinal pathology

Hernia sac

Inguinal hernia redirects here.

General

• Hernia repair (herniorrhaphy).
• Pathologic findings are very unusual and if present known to the surgeon.
  • Thus, it has been advocated that one ought not examine 'em.

Microscopic

Features:

• Fibrous tissue.
• +/-Adipose tissue.
• +/-Mesothelial cells.

Notes:

• One should not see vas deferens.
• Things worthy of some comment: granulation tissue, inflammation.

Sign out

Incarcerated without mesothelium

SOFT TISSUE ("HERNIA SAC"), RESECTION/HERNIA REPAIR: 
- FIBROADIPOSE TISSUE WITH FAT NECROSIS -- CONSISTENT WITH HERNIA SAC. 
- NEGATIVE FOR MALIGNANCY.

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.

Mesothelial lining present

Submitted as "Hernia Sac", Excision:
- Benign fibroadipose tissue partially covered by mesothelium, consistent 
  with hernia sac.
- NEGATIVE for malignancy.

Block letters

SOFT TISSUE ("HERNIA SAC"), RESECTION/HERNIA REPAIR: 
- FIBROADIPOSE TISSUE PARTIALLY COVERED BY MESOTHELIUM -- CONSISTENT WITH HERNIA SAC. 
- NEGATIVE FOR MALIGNANCY.

Inflamed

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.

Gross only

SOFT TISSUE, RIGHT INGUINAL, HERNIA REPAIR:
- HERNIA SAC (GROSS ONLY).

SOFT TISSUE, LEFT INGUINAL, HERNIA REPAIR:
- HERNIA SAC (GROSS ONLY).

Stoma

Ostomy, ileostomy and colostomy redirect here.

General

See: Colon and Small intestine.

• Reversal of ileostomy or colostomy.
  • The (generic) encompassing term for ileostomy and colostomy is ostomy.

Stomas are created for a number of reasons:

• Perforated viscous/peritonitis.
  • Trauma.
  • Colorectal adenocarcinoma.
• Diverticulosis.

Microscopic

Features:

• Colonic-type or small intestinal-type bowel wall.
  • Lymphoid hyperplasia (abundant lymphocytes) - very common.
  • +/-Fibromuscular hyperplasia of the lamina propria and submucosa.
• 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:

• 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

COLOSTOMY, COLOSTOMY REVERSAL:
- LARGE BOWEL WALL WITH SUBMUCOSAL FIBROSIS -- OTHERWISE WITHIN NORMAL LIMITS.
- SKIN WITHOUT SIGNIFICANT PATHOLOGY.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

Ileostomy

Submitted as "Ileostomy", Excision:
- Small bowel with submucosal fibrosis, otherwise within normal limits.
- Skin without significant pathology.
- NEGATIVE for dysplasia and NEGATIVE for malignancy.

Alternate

Submitted As "Ileostomy", Excision:
     - Consistent with ileostomy (small bowel, skin) without significant pathology.
     - NEGATIVE for dysplasia and NEGATIVE for malignancy.

Block letters

ILEOSTOMY, ILEOSTOMY REVERSAL:
- SMALL BOWEL WALL WITH SUBMUCOSAL FIBROSIS -- OTHERWISE WITHIN NORMAL LIMITS.
- SKIN WITHOUT SIGNIFICANT PATHOLOGY.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

Vagus nerve

General

• Seen from vagotomy.

Typical indication:

• Gastric outlet obstruction.

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

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.

Pediatric

Bands of Ladd

General

• Associated with intestinal malrotation.
• Removed by Ladd's procedure.
• Usually associated with duodenal and (other) small bowel obstructions.

Microscopic

Features:

• Benign fibrous tissue.

Sign out

Adhesive band, Ladd's procedure:
- Vascular fibrous tissue consistent with bands of Ladd.

Cholesteatoma

Main article: Cholesteatoma

Genitourinary pathology

Foreskin

Main article: Penis

General

Indications:

• Phimosis.

Main considerations:

• Squamous cell carcinoma.
• Lichen sclerosus, AKA balanitis xerotica obliterans.
• Lichen planus.
• Infection, e.g. syphilis, candidiasis.
• Zoon balanitis - abundant plasma cells.

Microscopic

Features:

• Usu. fibrotic dermis.
• +/-Inflammation.

DDx:

• See Penis.

Sign out

Foreskin, Circumcision: 
- Benign squamous mucosa within normal limits, consistent with foreskin. 

A. Foreskin, Circumcision: 
- Benign squamous mucosa without significant histopathology, consistent with foreskin. 

Foreskin, Circumcision: 
- Benign squamous mucosa with mild patchy chronic inflammation at the epidermal-dermal interface.
- NEGATIVE for dysplasia and NEGATIVE for malignancy.

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. 

Micro

The section shows squamous mucosa with mild basal pigmentation and subepithelial fibrous tissue. The epithelium matures to the surface. Significant inflammation is ABSENT. Atypia is ABSENT.

Paraurethral cyst

Main article: Paraurethral cyst

Labia

General

• Operation labioplasty.

Microscopic

Features:

• Squamous epithelium with compact keratin.
• Fibrous stroma.

Sign out

LABIA MINORA, RIGHT, LABIOPLASTY:
- BENIGN SKIN WITH A THIN LAYER OF COMPACT KERATIN FIBROTIC STROMA -- CONSISTENT
  WITH LABIA MINORA.

Head and neck pathology

Tonsillitis

Main article: Tonsillitis

Main article: Tonsil

Obstructive sleep apnea

Uvula redirects here.

• Abbreviated OSA.

General

• Clinical diagnosis.
• May be treated with a resection of the uvula.
• Associated with obesity.

Microscopic

Features:

• Benign oropharyneal mucosa (stratified squamous epithelium).
• +/-Skeletal muscle.
• +/-Salivary glands (minor) - mucinous.

Sign out

UVULA, RESECTION:
- OROPHARYNGEAL MUCOSA, CONSISTENT WITH UVULA.

Cardiovascular pathology

Main article: Cardiovascular pathology

Vascular thrombus

Main article: Vascular thrombus

Leg amputation

Main article: Leg amputation

Toe amputation

General - overview

• Like leg ampuations.

Sign out

See Ditzels#Atherosclerotic peripheral vascular disease.

Finger amputation

General - overview

• Similar to toe amputations.

May be done due to:

• Contractures leading to ulcerations.
• Scleroderma - leading to ischemia.

Sign out

See Ditzels#Atherosclerotic peripheral vascular disease.

Atherosclerotic peripheral vascular disease

Diabetic foot redirects here.

• AKA peripheral vascular disease.

Main article: Atherosclerosis

General

• Very strong association with diabetes mellitus.

Gross

• +/-Ulceration.
• +/-Gangrene - black skin - subclassified:
  • "Wet" = moist/oozing fluid.
  • "Dry" = shriveled, no moisture apparent.
• +/-Loss of hair.

DDx - gross:

• Malignant melanoma.

Image:

• Gangrenous foot (WC).

Sections - grossing:

• Resection margin (check for viability).
• Gangrenous area.
• Blood vessels.
• Bone (check for osteomyelitis).

Microscopic

Features:

• Atherosclerosis.
• Coagulative necrosis (gangrene).
• Inflammation (wet gangrene).
  • Neutrophils.
  • Lymphocytes.
  • Plasma cells.
• +/-Thrombosis.
• +/-Chronic osteomyelitis.
• +/-Reactive fibroblasts.

Note:

• 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.
• Chronic osteomyelitis.
• Cholesterol embolism.

Sign out

Forefoot amputation

RIGHT FOREFOOT, AMPUTATION:
- ULCERATED SKIN. 
- MODERATE-TO-SEVERE ATHEROSCLEROSIS.
- BLOOD VESSEL WITH RECANALIZATION.
- NEGATIVE FOR MALIGNANCY. 

Leg 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.

Revision

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.

Leg amputation - gross only

LOWER EXTREMITY, LEFT, BELOW THE KNEE AMPUTATION:
- ULCERS AND ISCHEMIC CHANGES WITH FOCAL COMPLETE ARTERIAL OCCLUSION (GROSS ONLY).

LEG, RIGHT, ABOVE THE KNEE AMPUTATION:
- ULCERS AND ISCHEMIC CHANGES WITH EXTENSIVE ARTERIAL DISEASE (GROSS ONLY).

LEG, RIGHT, ABOVE THE KNEE AMPUTATION:
- EXTENSIVE ISCHEMIC CHANGES WITH SEVERE ARTERIAL DISEASE (GROSS ONLY).

Toe amputation

Mild

THIRD TOE, RIGHT, AMPUTATION:
- SKIN WITH MARKED DERMAL FIBROSIS.
- MILD ATHEROSCLEROSIS.
- NEGATIVE FOR MALIGNANCY.

SECOND TOE, RIGHT, AMPUTATION:
- SKIN WITH MARKED DERMAL FIBROSIS AND ULCERATION WITH IMPETIGINIZATION.
- MILD ATHEROSCLEROSIS.
- NEGATIVE FOR MALIGNANCY.

Moderate

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.

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.

Severe

SECOND AND THIRD TOE, LEFT, AMPUTATION:
- SEVERE ATHEROSCLEROSIS.
- ACUTE AND CHRONIC OSTEOMYELITIS.
- GANGRENE.

GREAT TOE, LEFT, AMPUTATION:
- GANGRENE.
- SEVERE ATHEROSCLEROSIS.
- ULCERATED SKIN AND CHRONIC ISCHEMIC CHANGES.
- BONE WITH NO SIGNIFICANT PATHOLOGY.
- NEGATIVE FOR MALIGNANCY.

GREAT TOE, RIGHT, AMPUTATION:
- GANGRENE.
- ATHEROSCLEROSIS.
- NECROTIC BONE WITH ABUNDANT COCCI ORGANISMS AND NEUTROPHILS 
  WITHIN THE MARROW CAVITY.
- NEGATIVE FOR MALIGNANCY.

Orthopaedic

Femoral head

Main article: Femoral head

Bone reamings

General

• Taken during the surgical repair of a fracture, e.g. intramedullary nail placement.
• Done to rule-out a pathologic fracture; considered reliable for detecting malignancy.
  • Hassan et al. advocate against their use, suggesting the yield is low and a biopsy should be preferred.

Microscopic

Features:

• Fragments of bone (scattered trabeculae).
  • Necrotic bone = bone with empty lacunae, i.e. lacunae missing osteocytes.
• Bone marrow.
  • Megakaryocytes - large cells, multinucleated, eosinophilic cytoplasm.
  • Nucleated RBCs - perfectly round, dense nucleus, bright red cytoplasm.
  • Myeloid cells and precursors.
  • Adipocytes.

DDx:

• Metastatic carcinoma.

Sign out

BONE, LEFT FEMUR, REAMINGS:
- FEATURES CONSISTENT WITH A RECENT FRACTURE.
- NEGATIVE FOR MALIGNANCY.

Heterotopic ossification

• Abbreviated HO.

Main article: 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

LUMBAR BONE, DECOMPRESSION:
- BONE AND VERTEBRAL DISC FRAGMENTS WITH DEGENERATIVE CHANGES.
- UNREMARKABLE BONE MARROW.
- NEGATIVE FOR MALIGNANCY.

Bursa

Bursitis redirects here.

General

• Uncommon specimen.
• Septic bursitis is usually due to S. aureus.
  • Usually associated with trauma to the overlying skin.

Indication:

• Bursitis - may be treated with bursectomy.

Note:

• Most bursitis is managed conservatively.

Microscopic

Features:

• Dense connective tissue.
• Fibroadipose tissue.

Sign out

No apparent inflammation

BURSA, RIGHT HIP, BURSECTOMY:
- BENIGN DENSE CONNECTIVE TISSUE WITH CALCIFICATIONS, AND FIBROADIPOSE TISSUE.
- NO SIGNIFICANT INFLAMMATION.
- NEGATIVE FOR MALIGNANCY.

BURSA, LEFT TROCHANTERIC, BURSECTOMY:
- BENIGN DENSE CONNECTIVE TISSUE AND BENIGN FIBROADIPOSE TISSUE.
- NO SIGNIFICANT INFLAMMATION.
- NEGATIVE FOR MALIGNANCY.

Rotator cuff tear

General

• Surgically repaired.
• Clinical diagnosis.

Microscopic

Features:

• 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.

Sign out

RIGHT SHOULDER ACROMIOM AND BURSAE, EXCISION:
- UNREMARKABLE BONE (GROSS ONLY).
- BENIGN SOFT TISSUE.

"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.

"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.

Other

Breast prosthesis

• AKA breast implants.

Main article: Breast prostheses

De Quervain syndrome

Should not be confused with De Quervain's thyroiditis (subacute granulomatous thryoiditis).

• AKA de Quervain tenosynovitis, and de Quervain disease.

General

• Benign.
• Tenosynovitis of the thumb.
• Clinical diagnosis.

Clinical:

• Pain.

Treatment:

• Steroid.
• Surgery.

Microscopic

Features:

• Dense connective tissue consistent with tendon.

Sign out

Not apparent

FIRST EXTENSOR COMPARTMENT, RIGHT HAND, BIOPSY:
- DENSE CONNECTIVE TISSUE CONSISTENT WITH TENDON.
- FIBROUS TISSUE.

Tenosynovitis

Main article: Tenosynovitis

Otosclerosis

Stapes redirects here.

General

• Clinical diagnosis.
• Causes conductive hearing loss.
• Etiology - genetic.
  • Over half a dozen genes have been identified.
  • Classically described as autosomal dominant.

Treatment:

• Stapedectomy (removal of the stapes).

Microscopic

Features (temporal bone):

• Classically divided into four phases:
  1. Osteoclastic phase:
     • Large spaces form in bone marrow.
  2. Replacement phase:
     • Bone replaced by basophilic web-like tissue.
  3. Fibril phase:
     • Fibrils deposited.
  4. Lamellar phase:
     • Lamellar bone forms around the blood vessels.

Features - (stapes):

• Unremarkable bone.^{[citation needed]}

DDx:

• Avascular necrosis ~ 25% of cases diagnosed as otosclerosis.
  • May be due to fat embolism.

Note:

• Avascular necrosis of the stapes crura and otosclerosis together is considered rare.

Images:

• Stapes - sketch (WC).

Sign out

STAPES, RIGHT, STAPEDECTOMY:
- BENIGN BONE CONSISTENT WITH STAPES.

STAPES, RIGHT, STAPEDECTOMY:
- UNREMARKABLE BONE CONSISTENT WITH STAPES.

Missed stapes

STAPES, RIGHT, STAPEDECTOMY:
- BENIGN FIBROFATTY TISSUE.
- NO BONE IDENTIFIED.

External links

• Otosclerosis (otopathologynetwork.org).

Abdominal pannus

• AKA pannus, panniculus and pannona.

Main article: Abdominal pannus

Empyema

Empyema peel and pleural peel redirect here.

General

• Empyemas are often managed surgically.

• Classically, divided into three stages.
  • 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

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.

Block letters

PLEURA, LEFT, DECORTICATION:
- MIXED INFLAMMATORY INFILTRATE WITH ABUNDANT NEUTROPHILS.
- REACTIVE FIBROBLASTS AND FIBRIN.
- NO MICROORGANISMS APPARENT WITH H&E STAINING.
- NEGATIVE FOR MALIGNANCY.

Not labelled as a peel

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.

Toenail

General

• Relatively common.

Indications for removal:

• Ingrown - typically great toe.
• Onychomycosis - fungal infection.
• Pigmented lesion.
  • Exclude melanoma.

Microscopic

Features:

• Nail plate - paucicellular, dense connective tissue.
• Keratinized squamous epithelium.
• +/-Cocci organisms.

DDx:

• Malignant melanoma.
• Trauma.
• 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.

Sign out

Pigmented nail

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.

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

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.

Fungal organisms present

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.

Canal of Nuck cyst

General

• Canal of Nuck is the female equivalent of the male processus vaginalis.
• Women/girls only pathology - can be thought of as inguinal hernia in women.
• Very rare pathology.

Sign out

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.

Palmar fascia

Main article: Palmar fascia

See also

• Basics.
• Spine.