Difference between revisions of "Ditzels"

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*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>
*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]].
*[[Chronic osteomyelitis]].
*[[Cholesterol embolism]].


===Sign out===
===Sign out===

Revision as of 17:42, 18 June 2014

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.[1]

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
Tubal ligation completed family Gynecologic pathology
Pressure ulcer (AKA decubitus ulcer) ulcer, immobility Dermatopathology
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

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.[2][3]

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

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.[4]

Stomas are created for a number of reasons:

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.

Notes:

DDx:

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

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.[5]

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

Microscopic

Features:

  • Benign fibrous tissue.

Sign out

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

Cholesteatoma

General

  • Squamous epithelium in the middle ear - leading to accumulation of keratinaceous debris.[7]
    • Keratosis obturans - accumulation in the external ear canal - is considered to be a different process;[8] though some consider it a synonym.[9]
  • The etiology is not well understood.[10][11]
    • Theories include migration/hyperplasia, and metaplasia.[11]
  • Rarely transforms into squamous cell carcinoma.[12][13]

Classification

May be subdivided into:[10]

  • Acquired - due to trauma, surgery or infection.
  • Congenital.

Gross

  • Whitish mass in the middle ear.[14]

Image:

  • Cholesteatoma. (WC)

Microscopic

Features:[15]

  • Keratinaceous debris - key feature.
  • Squamous epithelium.
  • Macrophages +/- giant cell (containing keratinceous debris).
  • Chronic inflammation (lymphocytes).

DDx:

Sign out

SOFT TISSUE (CHOLESTEATOMA), SITE NOT FURTHER SPECIFIED, REMOVAL:
- KERATINACEOUS DEBRIS, COMPATIBLE WITH CHOLESTEATOMA.

Soft tissue, left ear ("left ear keratosis"), excision:
- Keratinaceous debris, squamous epithelium and bone (consistent with cholesteatoma). 

TISSUE ("CHOLESTEATOMA"), LEFT, REMOVAL:
- KERATINACEOUS DEBRIS AND GIANT CELLS, COMPATIBLE WITH CHOLESTEATOMA.

Genitourinary pathology

Foreskin

Main article: Penis

General

Indications:

Main considerations:

Microscopic

Features:

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

DDx:

Paraurethral cyst

General

  • Rare.
  • Benign.

Clinical:[17]

  • Presentation: mass lesion, dyspareunia or dysuria.
  • Multipareous.

Microscopic

Features:

  • Cystic space with epithelial lining - diagnosis based on epithelial lining.

Subclassification:[18][19]

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

Tonsil redirects here.

General

  • Commonly removed (tonsillectomy) when enlarged.
  • Very low probability of malignancy (<0.2%) in tonsilectomies in individuals <19 years old if no clinical suspicion.[21]

Gross

  • Symmetrical and equal size.

Note:

  • Gross exam is considered sufficient if there is no asymmetry.[22]

Microscopic

Features:

DDx:

IHC

If there is a clinical suspicion - a panel to exclude (small cell) non-Hodgkin lymphomas:

  • CD3.
  • CD20.
  • CD5.
  • CD10.
  • CD23.
  • Cyclin D1.

Sign out

A. TONSIL, LEFT, TONSILLECTOMY:
- REACTIVE FOLLICULAR HYPERPLASIA.
- REACTIVE SQUAMOUS MUCOSA.

B. TONSIL, RIGHT, TONSILLECTOMY:
- REACTIVE FOLLICULAR HYPERPLASIA.
- REACTIVE SQUAMOUS MUCOSA.

Without squamous mucosa

A. TONSIL, LEFT, TONSILLECTOMY:
- REACTIVE FOLLICULAR HYPERPLASIA.

B. TONSIL, RIGHT, TONSILLECTOMY:
- REACTIVE FOLLICULAR HYPERPLASIA.

Obstructive sleep apnea

Uvula redirects here.
  • Abbreviated OSA.

General

  • Clinical diagnosis.
  • May be treated with a resection of the uvula.[24]
  • Associated with obesity.[25]

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

Venous thrombus and arterial thrombus redirect here.

General

  • Uncommonly comes to pathology.

Risk factors - think Virchow's triad:

Gross

See pulmonary embolism.

Features:

  • Dull appearance.
  • Laminations.

Microscopic

Features:

  • Layers consisting of platelets and fibrin.
    • Classically alternating with layers of RBCs - known as Lines of Zahn.[26]

Note:

  • Multiple laminations (layers), in general, suggest that clot was formed in a dynamic environment, i.e. in the context of blood flow.

DDx:

  • Tumour embolus - malignant cells.
  • Thromboembolus - may require clinical history.
  • Fat embolism.
  • Amniotic fluid embolus - in the context of pregnancy/postpartum.
  • Foreign body.

Images:

Sign out

BLOOD CLOT, LEFT ILIAC ARTERY, THROMBECTOMY:
- THROMBUS.
- NEGATIVE FOR MALIGNANCY.

BLOOD CLOT, LEFT ARM - BRACHIAL ARTERY, THROMBECTOMY/EMBOLECTOMY:
- THROMBUS.
- NEGATIVE FOR MALIGNANCY.

Micro

The sections show layers of red blood cells alternating with fibrin and white blood cells (Lines of Zahn).

Leg amputation

General - overview

Comes in two basic flavours:

  • Above the knee ampuation (AKA).
  • Below the knee ampuation (BKA).

Etiology:

Sign out

See Ditzels#Atherosclerotic peripheral vascular disease.

Toe amputation

General - overview

  • Like leg ampuations.

Sign out

See Ditzels#Atherosclerotic peripheral vascular disease.

Finger amputation

General - overview

May be done due to:

  • Contractures leading to ulcerations.
  • Scleroderma - leading to ischemia.[28]

Sign out

See Ditzels#Atherosclerotic peripheral vascular disease.

Atherosclerotic peripheral vascular disease

Diabetic foot redirects here.
  • AKA peripheral vascular disease.
Main article: Atherosclerosis

General

Gross

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

DDx - gross:

Image:

Sections - grossing:

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

Microscopic

Features:

Note:

  • Ischemia may be associated with marked nuclear changes. Uninitiated eyes may think they are seeing a sarcoma.

DDx:

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.[29]
    • Hassan et al.[30] advocate against their use, suggesting the yield is low and a biopsy should be preferred.

Microscopic

Features:[31]

  • 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:

Sign out

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

Heterotopic ossification

  • Abbreviated HO.

General

  • Definition of heterotopic ossification: bone formation in soft tissue.[32]
  • Injury at site.
  • May be seen in the context of tetraplegia.

Clinical:[32]

  • +/-Joint stiffness.
  • +/-Swelling.
  • +/-Pain.

Microscopic

Features:

  • Lamellar bone - has layering/lines (best seen with polarized light).
  • +/-Skeletal muscle (within the marrow space).

DDx:

Sign out

LESION ("HETEROTOPIC OSSIFICATION"), RIGHT FEMUR, EXCISION:
- BONE -- CONSISTENT WITH MUSCLE HETEROTOPIC OSSIFICATION.
- NEGATIVE FOR MALIGNANCY.

Micro

The sections show laminar bone with a marrow space containing adipose tissue and benign skeletal muscle. The osteocytes show no nuclear atypia. No mitotic activity is appreciated.

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.[33]
    • Usually associated with trauma to the overlying skin.[34]

Indication:

  • Bursitis - may be treated with bursectomy.[35]

Note:

  • Most bursitis is managed conservatively.[36]

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

Microscopic

Features:[37]

  • 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.[38]

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

Breast expander redirects here.

General

Gross

Specimen received in formalin labelled "right breast prosthesis" consists of a breast prosthesis measuring 13.5 x 12.5 x 4.5 cm. Seen on one side the number 356 is seen. The prosthesis is intact. No tissue is identified. No sections are submitted.

Images

  • Breast implants. (WC)

WP:

Sign out

BREAST PROSTHESIS, RIGHT, REMOVAL:
- INTACT BREAST PROSTHESIS (GROSS ONLY).

Not intact

BREAST PROSTHESIS, LEFT, REMOVAL:
- BREAST PROSTHESIS WITH EVIDENCE OF PERFORATION AND LEAKAGE (GROSS ONLY).

De Quervain syndrome

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

General

  • Benign.
  • Clinical diagnosis.[39]

Clinical:

  • Pain.

Treatment:[39]

  • Steroid.
  • Surgery.

Microscopic

Features:

  • Dense connective tissue consistent with tendon.

Sign out

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

Tenosynovitis

Stenosing tenosynovitis directs here.

General

  • Uncommon pathology specimen.
  • May cause trigger finger.[40]

Microscopic

Features:[41]

DDx:

IHC

Features:

  • CD68 +ve.
  • Beta-catenin -ve.

Note:

  • Immunostains are usually not required for the diagnosis.

Sign out

TENOSYNOVIUM, LEFT MIDDLE FINGER, EXCISION:
- DENSE CONNECTIVE TISSUE (CONSISTENT WITH TENDON) WITH LYMPHOHISTIOCYTIC INFILTRATE.
- NEGATIVE FOR GIANT CELLS. 
- NEGATIVE FOR MALIGNANCY.

Micro

The sections show dense connective tissue (tendon) containing a cluster of cells with indistinct cellular borders, abundant foamy grey cytoplasm, and round/oval pale-staining nuclei with small nucleoli (histiocytes). The cell cluster has a small number of interspersed lymphocytes, and the centre of the cell cluster has acellular hyaline material (degenerative tendon).

No calcification is identified. No giant cells are seen.

No nuclear atypia is apparent and no mitotic activity is appreciated.

Alternate

The sections show dense connective tissue (tendon) containing rare histiocytes and lymphocytes. No calcification is identified. No giant cells are seen. No nuclear atypia is apparent and no mitotic activity is appreciated.

Otosclerosis

Stapes redirects here.

General

  • Clinical diagnosis.
  • Causes conductive hearing loss.[42]
  • Etiology - genetic.
    • Over half a dozen genes have been identified.[43][44]
    • Classically described as autosomal dominant.

Treatment:

  • Stapedectomy (removal of the stapes).[45]

Microscopic

Features (temporal bone):[46]

  • 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:

Features - (stapes):

DDx:

Note:

  • Avascular necrosis of the stapes crura and otosclerosis together is considered rare.[47]

Images:

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

Abdominal pannus

Main article: Obesity
Pannus redirects here.

General

  • An apron-like excess of skin - following weight loss.[48]
  • Seen in obesity.

Gross

  • Skin with abundant fat.
    • Pieces usually triangular.
    • Stretch marks (striae) are very common.

Note:

  • The gross pathology section of the report should say something like: On sectioning no lesions were identified.

Microscopic

Features:

  • Adipose tissue.

DDx:

Sign out

ABDOMINAL PANNUS, EXCISION:
- BENIGN SKIN AND ADIPOSE TISSUE.

ABDOMINAL PANNUS, EXCISION:
- DERMAL SCAR, BENIGN SKIN AND ADIPOSE TISSUE.

Gross only

ABDOMINAL PANNUS, EXCISION:
- BENIGN SKIN AND ADIPOSE TISSUE (GROSS ONLY).

Empyema

Empyema peel redirects here.

General

  • Empyemas are often managed surgically.[49]
  • Classically, divided into three stages.[50][51]
    • I - exudative stage (acute).
    • II - fibropurulent stage (acute).
    • III - organizational stage (chronic).

Etiologies - common:

Microscopic

Features:

  • Neutrophils (pus) - key feature.
  • Lymphocytes.
  • Plasma cells.
  • Reactive fibroblasts.
  • Reactive mesothelial cells - not common.

DDx:

Sign out

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

Toenail

General

  • Relatively common.

Indications for removal:

  • Ingrown[52] - typically great toe.[53]
  • Onychomycosis - fungal infection.[54]
  • Pigmented lesion.
    • Exclude melanoma.[55]

Microscopic

Features:

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

DDx:

Stains

For pigmented lesion:

Query fungal infection:

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.

See also

References

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