Difference between revisions of "Ditzels"
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| Line 153: | Line 153: | ||
=Cardiovascular pathology= | =Cardiovascular pathology= | ||
==Leg amputation== | ==Leg amputation== | ||
=== | ===Overview=== | ||
Comes in two basic flavours: | Comes in two basic flavours: | ||
*Above the knee ampuation (AKA). | *Above the knee ampuation (AKA). | ||
| Line 159: | Line 159: | ||
Etiology: | Etiology: | ||
*Diabetes mellitus - most common. | *Diabetes mellitus - most common - see ''[[atherosclerotic peripheral vascular disease]]''. | ||
*Trauma. | *Trauma. | ||
*Infection - see ''[[chronic osteomyelitis]]''. | |||
*Drug use, e.g. [[cocaine]].<ref name=pmid17059855/> | |||
==Atherosclerotic peripheral vascular disease== | |||
{{Main|Atherosclerosis}} | |||
===General=== | |||
*Very strong association with [[diabetes mellitus]]. | |||
===Gross=== | ===Gross=== | ||
| Line 180: | Line 187: | ||
===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> | |||
===Sign out=== | ===Sign out=== | ||
<pre> | <pre> | ||
LEFT LEG, BELOW KNEE AMPUTATION: | LEFT LEG, BELOW KNEE AMPUTATION: | ||
- MODERATE-TO-SEVERE ATHEROSCLEROSIS. | |||
- COAGULATIVE NECROSIS OF SOFT TISSUE. | - COAGULATIVE NECROSIS OF SOFT TISSUE. | ||
- NECROTIC BONE. | - NECROTIC BONE. | ||
- MARROW CAVITY FIBROSIS WITH SIDEROPHAGES. | - MARROW CAVITY FIBROSIS WITH SIDEROPHAGES. | ||
Revision as of 21:31, 24 October 2012
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.
A list of ditzels
Gastrointestinal
Neuropathology
- Vertebral disc - see spine.
Pediatric
- Bands of Ladd.
- Cholesteatoma.
Orthopaedic
Head and neck pathology
- Tonsil.
Cardiovascular pathology
Soft tissue
Gastrointestinal
Hernia sac
General
- Hernia repair.
- Pathologic findings are very unusual and if present known to the surgeon.
Microscopic
Features:
- Fibrous tissue.
- +/-Adipose tissue.
- +/-Mesothelial cells.
Notes:
- One should not see vas deferens.
- Things worthy of some comment: granulation tissue, inflammation.
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SOFT TISSUE ("HERNIA SAC"), RESECTION:
- FIBROADIPOSE TISSUE -- 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.
Stoma
- See: Colon and Small intestine.
General
- Reversal of ileostomy or colostomy.
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:
- One is looking for malignancy (e.g. colorectal carcinoma), especially if that is in the history.
Pediatric
Bands of Ladd
General
- Associated with intestinal malrotation.
- Removed by Ladd's procedure.
Microscopic
Features:
- Benign fibrous tissue.
Cholesteatoma
General
- Squamous epithelium in the middle ear - leading to accumulation of keratinaceous debris.[4]
Microscopic
Features:[7]
- Keratinaceous debris - key feature.
- Squamous epithelium.
- Macrophages +/- giant cell (containing keratinceous debris).
- Chronic inflammation (lymphocytes).
DDx:
- Cholesterol granuloma.[8]
Genitourinary pathology
Foreskin
Main article: Penis
General
Indications:
Main considerations:
- Squamous cell carcinoma.
- Lichen sclerosus, AKA balanitis xerotica obliterans.
- Lichen planus.
- Infection, e.g. syphilis.
Microscopic
Features:
- Usu. fibrotic dermis.
- +/-Inflammation.
DDx:
- See Penis.
Paraurethral cyst
General
- Rare.
- Benign.
Clinical:[9]
- Presentation: mass lesion, dyspareunia or dysuria.
- Multipareous.
Microscopic
Features:
- Cystic space with epithelial lining - diagnosis based on epithelial lining.
- Epithelial inclusion cyst.
- Müllerian cyst.
- Gartner duct cyst (AKA mesonephric duct cyst AKA Wolffian duct cyst).[12]
- Skene duct cyst.
Head and neck pathology
Tonsillitis
General
- Commonly removed (tonsillectomy) when enlarged.
Microscopic
Features:
- Follicular hyperplasia - see lymph node pathology.
- +/-Colonies (clusters) of actinomycetes in the tonsillar crypts.
Note:
- Signed-out as reactive lymphoid hyperplasia.
DDx:
Cardiovascular pathology
Leg amputation
Overview
Comes in two basic flavours:
- Above the knee ampuation (AKA).
- Below the knee ampuation (BKA).
Etiology:
- Diabetes mellitus - most common - see atherosclerotic peripheral vascular disease.
- Trauma.
- Infection - see chronic osteomyelitis.
- Drug use, e.g. cocaine.[14]
Atherosclerotic 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.
Image:
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.[14]
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LEFT LEG, BELOW KNEE AMPUTATION: - MODERATE-TO-SEVERE ATHEROSCLEROSIS. - COAGULATIVE NECROSIS OF SOFT TISSUE. - NECROTIC BONE. - MARROW CAVITY FIBROSIS WITH SIDEROPHAGES. - RESECTION MARGINS WITH VIABLE TISSUE PRESENT.
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.[15]
- Hassan et al.[16] advocate against their use, suggesting the yield is low and a biopsy should be preferred.
Microscopic
Features:[17]
- 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.
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BONE, LEFT FEMUR, REAMINGS: - FEATURES CONSISTENT WITH A RECENT FRACTURE. - NEGATIVE FOR MALIGNANCY.
See also
References
- ↑ Weedman Molavi, Diana (2008). The Practice of Surgical Pathology: A Beginner's Guide to the Diagnostic Process (1st ed.). Springer. pp. 37. ISBN 978-0387744858.
- ↑ Siddiqui K, Nazir Z, Ali SS, Pervaiz S (February 2004). "Is routine histological evaluation of pediatric hernial sac necessary?". Pediatr. Surg. Int. 20 (2): 133–5. doi:10.1007/s00383-003-1106-2. PMID 14986035.
- ↑ Partrick DA, Bensard DD, Karrer FM, Ruyle SZ (July 1998). "Is routine pathological evaluation of pediatric hernia sacs justified?". J. Pediatr. Surg. 33 (7): 1090–2; discussion 1093–4. PMID 9694100.
- ↑ URL: http://www.harrisonspractice.com/practice/ub/view/Harrisons%20Practice/141015/all/otitis_media_and_mastoiditis. Accessed on: 16 March 2011.
- ↑ Piepergerdes MC, Kramer BM, Behnke EE (March 1980). "Keratosis obturans and external auditory canal cholesteatoma". Laryngoscope 90 (3): 383–91. PMID 7359960.
- ↑ Shire JR, Donegan JO (September 1986). "Cholesteatoma of the external auditory canal and keratosis obturans". Am J Otol 7 (5): 361–4. PMID 3538893.
- ↑ Iino Y, Toriyama M, Ohmi S, Kanegasaki S (1990). "Activation of peritoneal macrophages with human cholesteatoma debris and alpha-keratin". Acta Otolaryngol. 109 (5-6): 444–9. PMID 1694387.
- ↑ URL: http://path.upmc.edu/cases/case273/dx.html. Accessed on: 14 January 2012.
- ↑ Isen, K.; Utku, V.; Atilgan, I.; Kutun, Y. (Aug 2008). "Experience with the diagnosis and management of paraurethral cysts in adult women.". Can J Urol 15 (4): 4169-73. PMID 18706145.
- ↑ Satani, H.; Yoshimura, N.; Hayashi, N.; Arima, K.; Yanagawa, M.; Kawamura, J. (Mar 2000). "[A case of female paraurethral cyst diagnosed as epithelial inclusion cyst].". Hinyokika Kiyo 46 (3): 205-7. PMID 10806582.
- ↑ Das, SP. (Jul 1981). "Paraurethral cysts in women.". J Urol 126 (1): 41-3. PMID 7195943.
- ↑ URL: http://webpathology.com/image.asp?n=3&Case=540. Accessed on: 5 February 2012.
- ↑ Wang, XY.; Wu, N.; Zhu, Z.; Zhao, YF. (May 2010). "Computed tomography features of enlarged tonsils as a first symptom of non-Hodgkin's lymphoma.". Chin J Cancer 29 (5): 556-60. PMID 20426908.
- ↑ 14.0 14.1 Dhawan, SS.; Wang, BW. (Feb 2007). "Four-extremity gangrene associated with crack cocaine abuse.". Ann Emerg Med 49 (2): 186-9. doi:10.1016/j.annemergmed.2006.08.001. PMID 17059855.
- ↑ Clarke, AM.; Rogers, S.; Douglas, DL. (Dec 1993). "Closed intramedullary biopsy for metastatic disease.". J R Coll Surg Edinb 38 (6): 368-9. PMID 7509409.
- ↑ Hassan, K.; Kalra, S.; Moran, C. (Aug 2007). "Intramedullary reamings for the histological diagnosis of suspected pathological fractures.". Surgeon 5 (4): 202-4. PMID 17849954.
- ↑ Tydings, JD.; Martino, LJ.; Kircher, M.; Alfred, RH.; Lozman, J. (Mar 1987). "Viability of intramedullary canal bone reamings for continued calcification.". Am J Surg 153 (3): 306-9. PMID 3548454.