Ditzels

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Tonsils (at cut-up) are a common ditzel. (WC)

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
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

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

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.[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

Submitted as "Ileostomy", Excision:
- Small bowel with submucosal fibrosis, otherwise within normal limits.
- 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.[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:

Sign out

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

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.

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

General

  • Commonly removed (tonsillectomy) when enlarged.
  • Very low probability of malignancy (<0.2%) in tonsilectomies in individuals <19 years old if no clinical suspicion.[17]

Gross

  • Symmetrical and equal size.

Note:

  • Gross exam is considered sufficient if there is no asymmetry.[18]

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.[20]
  • Associated with obesity.[21]

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.[22]

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

Main article: Leg amputation

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.[23]

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.[25]
    • Hassan et al.[26] advocate against their use, suggesting the yield is low and a biopsy should be preferred.

Microscopic

Features:[27]

  • 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.[28]
  • Injury at site.
  • May be seen in the context of tetraplegia.

Clinical:[28]

  • +/-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, Distal Phalanx of Right Little Finger, Excision:
- Dermal ossification without cartilage in benign skin with a thick keratin layer.
- NEGATIVE for evidence of malignancy.

Block letters

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.[29]
    • Usually associated with trauma to the overlying skin.[30]

Indication:

  • Bursitis - may be treated with bursectomy.[31]

Note:

  • Most bursitis is managed conservatively.[32]

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:[33]

  • 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.[34]

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,[35] and de Quervain disease.

General

Clinical:

  • Pain.

Treatment:[36]

  • 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.[37]
  • Etiology - genetic.
    • Over half a dozen genes have been identified.[38][39]
    • Classically described as autosomal dominant.

Treatment:

  • Stapedectomy (removal of the stapes).[40]

Microscopic

Features (temporal bone):[41]

  • 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.[42]

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.[43]
  • Seen in obesity.

Gross

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

Notes:

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 and pleural peel redirect here.

General

  • Empyemas are often managed surgically.[44]
  • Classically, divided into three stages.[45][46]
    • 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

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[47] - typically great toe.[48]
  • Onychomycosis - fungal infection.[49]
  • Pigmented lesion.
    • Exclude melanoma.[50]

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

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ URL: http://www.nlm.nih.gov/medlineplus/ostomy.html. Accessed on: 27 January 2013.
  5. ↑ Okawada, M.; Okazaki, T.; Takahashi, T.; Lane, GJ.; Yamataka, A. (2009). "Gastric outlet obstruction possibly secondary to ulceration in a 2-year-old girl: a case report.". Cases J 2 (1): 8. doi:10.1186/1757-1626-2-8. PMID 19123936.
  6. ↑ Raphaeli, T.; Parimi, C.; Mattix, K.; Javid, PJ. (Mar 2010). "Acute colonic obstruction from Ladd bands: a unique complication from intestinal malrotation.". J Pediatr Surg 45 (3): 630-1. doi:10.1016/j.jpedsurg.2009.12.026. PMID 20223332.
  7. ↑ URL: http://www.harrisonspractice.com/practice/ub/view/Harrisons%20Practice/141015/all/otitis_media_and_mastoiditis. Accessed on: 16 March 2011.
  8. ↑ Piepergerdes MC, Kramer BM, Behnke EE (March 1980). "Keratosis obturans and external auditory canal cholesteatoma". Laryngoscope 90 (3): 383–91. PMID 7359960.
  9. ↑ Shire JR, Donegan JO (September 1986). "Cholesteatoma of the external auditory canal and keratosis obturans". Am J Otol 7 (5): 361–4. PMID 3538893.
  10. ↑ 10.0 10.1 Nevoux, J.; Lenoir, M.; Roger, G.; Denoyelle, F.; Ducou Le Pointe, H.; Garabédian, EN. (Sep 2010). "Childhood cholesteatoma.". Eur Ann Otorhinolaryngol Head Neck Dis 127 (4): 143-50. doi:10.1016/j.anorl.2010.07.001. PMID 20860924.
  11. ↑ 11.0 11.1 Louw, L. (Jun 2010). "Acquired cholesteatoma pathogenesis: stepwise explanations.". J Laryngol Otol 124 (6): 587-93. doi:10.1017/S0022215109992763. PMID 20156369.
  12. ↑ 12.0 12.1 Rothschild, S.; Ciernik, IF.; Hartmann, M.; Schuknecht, B.; Lütolf, UM.; Huber, AM.. "Cholesteatoma triggering squamous cell carcinoma: case report and literature review of a rare tumor.". Am J Otolaryngol 30 (4): 256-60. doi:10.1016/j.amjoto.2008.06.011. PMID 19563937.
  13. ↑ Takahashi, K.; Yamamoto, Y.; Sato, K.; Sato, Y.; Takahashi, S. (Jan 2005). "Middle ear carcinoma originating from a primary acquired cholesteatoma: a case report.". Otol Neurotol 26 (1): 105-8. PMID 15699729.
  14. ↑ Al Balushi, T.; Naik, JZ.; Al Khabori, M. (Jan 2013). "Congenital cholesteatoma in identical twins.". J Laryngol Otol 127 (1): 67-9. doi:10.1017/S0022215112002757. PMID 23217274.
  15. ↑ 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.
  16. ↑ URL: http://path.upmc.edu/cases/case273/dx.html. Accessed on: 14 January 2012.
  17. ↑ Erdag, TK.; Ecevit, MC.; Guneri, EA.; Dogan, E.; Ikiz, AO.; Sutay, S. (Oct 2005). "Pathologic evaluation of routine tonsillectomy and adenoidectomy specimens in the pediatric population: is it really necessary?". Int J Pediatr Otorhinolaryngol 69 (10): 1321-5. doi:10.1016/j.ijporl.2005.05.005. PMID 15963574.
  18. ↑ Williams, MD.; Brown, HM. (Oct 2003). "The adequacy of gross pathological examination of routine tonsils and adenoids in patients 21 years old and younger.". Hum Pathol 34 (10): 1053-7. PMID 14608541.
  19. ↑ 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.
  20. ↑ Shin, SH.; Ye, MK.; Kim, CG. (Jun 2009). "Modified uvulopalatopharyngoplasty for the treatment of obstructive sleep apnea-hypopnea syndrome: resection of the musculus uvulae.". Otolaryngol Head Neck Surg 140 (6): 924-9. doi:10.1016/j.otohns.2009.01.020. PMID 19467416.
  21. ↑ Sarkhosh, K.; Switzer, NJ.; El-Hadi, M.; Birch, DW.; Shi, X.; Karmali, S. (Jan 2013). "The Impact of Bariatric Surgery on Obstructive Sleep Apnea: A Systematic Review.". Obes Surg. doi:10.1007/s11695-012-0862-2. PMID 23299507.
  22. ↑ Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; Aster, Jon (2009). Robbins and Cotran pathologic basis of disease (8th ed.). Elsevier Saunders. pp. 124. ISBN 978-1416031215.
  23. ↑ Jones, NF.; Imbriglia, JE.; Steen, VD.; Medsger, TA. (May 1987). "Surgery for scleroderma of the hand.". J Hand Surg Am 12 (3): 391-400. PMID 3584887.
  24. ↑ 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.
  25. ↑ 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.
  26. ↑ 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.
  27. ↑ 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.
  28. ↑ 28.0 28.1 Leblanc, E.; Trensz, F.; Haroun, S.; Drouin, G.; Bergeron, E.; Penton, CM.; Montanaro, F.; Roux, S. et al. (Jun 2011). "BMP-9-induced muscle heterotopic ossification requires changes to the skeletal muscle microenvironment.". J Bone Miner Res 26 (6): 1166-77. doi:10.1002/jbmr.311. PMID 21611960.
  29. ↑ Hanrahan, JA. (Oct 2013). "Recent developments in septic bursitis.". Curr Infect Dis Rep 15 (5): 421-5. doi:10.1007/s11908-013-0353-1. PMID 23933823.
  30. ↑ Canoso, JJ.; Sheckman, PR.. "Septic subcutaneous bursitis. Report of sixteen cases.". J Rheumatol 6 (1): 96-102. PMID 439118.
  31. ↑ Dillon, JP.; Freedman, I.; Tan, JS.; Mitchell, D.; English, S. (Jul 2012). "Endoscopic bursectomy for the treatment of septic pre-patellar bursitis: a case series.". Arch Orthop Trauma Surg 132 (7): 921-5. doi:10.1007/s00402-012-1494-7. PMID 22426936.
  32. ↑ Lustenberger, DP.; Ng, VY.; Best, TM.; Ellis, TJ. (Sep 2011). "Efficacy of treatment of trochanteric bursitis: a systematic review.". Clin J Sport Med 21 (5): 447-53. doi:10.1097/JSM.0b013e318221299c. PMID 21814140.
  33. ↑ Longo, UG.; Berton, A.; Khan, WS.; Maffulli, N.; Denaro, V. (Sep 2011). "Histopathology of rotator cuff tears.". Sports Med Arthrosc 19 (3): 227-36. doi:10.1097/JSA.0b013e318213bccb. PMID 21822106.
  34. ↑ Kuzel, BR.; Grindel, S.; Papandrea, R.; Ziegler, D. (Oct 2013). "Fatty infiltration and rotator cuff atrophy.". J Am Acad Orthop Surg 21 (10): 613-23. doi:10.5435/JAAOS-21-10-613. PMID 24084435.
  35. ↑ Gigante, MR.; Martinotti, I.; Cirla, PE.. "[Computer work and De Quervain's tenosynovitis: an evidence based approach].". G Ital Med Lav Ergon 34 (3 Suppl): 116-8. PMID 23405595.
  36. ↑ 36.0 36.1 Ilyas, AM.; Ilyas, A.; Ast, M.; Schaffer, AA.; Thoder, J. (Dec 2007). "De quervain tenosynovitis of the wrist.". J Am Acad Orthop Surg 15 (12): 757-64. PMID 18063716.
  37. ↑ Declau, F.; van Spaendonck, M.; Timmermans, JP.; Michaels, L.; Liang, J.; Qiu, JP.; van de Heyning, P. (2007). "Prevalence of histologic otosclerosis: an unbiased temporal bone study in Caucasians.". Adv Otorhinolaryngol 65: 6-16. doi:10.1159/000098663. PMID 17245017.
  38. ↑ Online 'Mendelian Inheritance in Man' (OMIM) 166800
  39. ↑ Online 'Mendelian Inheritance in Man' (OMIM) 605727
  40. ↑ Redfors, YD.; Gröndahl, HG.; Hellgren, J.; Lindfors, N.; Nilsson, I.; Möller, C. (Aug 2012). "Otosclerosis: anatomy and pathology in the temporal bone assessed by multi-slice and cone-beam CT.". Otol Neurotol 33 (6): 922-7. doi:10.1097/MAO.0b013e318259b38c. PMID 22771999.
  41. ↑ 41.0 41.1 "Otosclerosis.". Br Med J 1 (6105): 63-4. Jan 1978. PMC 1602666. PMID 620199. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1602666/.
  42. ↑ Erdoglija, M.; Sotirovic, J.; Jacimovic, V.; Vukomanovic, B. (2012). "Avascular necrosis of stapes crura in one case of operated otosclerosis.". Acta Medica (Hradec Kralove) 55 (4): 193-7. PMID 23631292.
  43. ↑ URL: http://plasticsurgery.about.com/od/glossary/g/panniculectomy.htm. Accessed on: 18 July 2012.
  44. ↑ Ferguson, MK. (Mar 1999). "Surgical management of intrapleural infections.". Semin Respir Infect 14 (1): 73-81. PMID 10197399.
  45. ↑ Shiraishi, Y. (Jul 2010). "Surgical treatment of chronic empyema.". Gen Thorac Cardiovasc Surg 58 (7): 311-6. doi:10.1007/s11748-010-0599-6. PMID 20628845.
  46. ↑ Hamm, H.; Light, RW. (May 1997). "Parapneumonic effusion and empyema.". Eur Respir J 10 (5): 1150-6. PMID 9163661. http://erj.ersjournals.com/content/10/5/1150.long.
  47. ↑ Küçüktaş, M.; Kutlubay, Z.; Yardimci, G.; Khatib, R.; Tüzün, Y. (Feb 2013). "Comparison of effectiveness of electrocautery and cryotherapy in partial matrixectomy after partial nail extraction in the treatment of ingrown nails.". Dermatol Surg 39 (2): 274-80. doi:10.1111/dsu.12068. PMID 23227941.
  48. ↑ Jia, C.; Li, P.; Wu, Y.; Qiu, Y.; Cao, L.; Chang, C.; Zhang, Y. (Jul 2013). "[Modified surgical repair of severe ingrown toenail].". Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 27 (7): 869-71. PMID 24063180.
  49. ↑ 49.0 49.1 Reisberger, EM.; Abels, C.; Landthaler, M.; Szeimies, RM. (Apr 2003). "Histopathological diagnosis of onychomycosis by periodic acid-Schiff-stained nail clippings.". Br J Dermatol 148 (4): 749-54. PMID 12752134.
  50. ↑ Fanti, PA.; Dika, E.; Misciali, C.; Vaccari, S.; Barisani, A.; Piraccini, BM.; Cavrin, G.; Maibach, HI. et al. (Jun 2013). "Nail apparatus melanoma: is trauma a coincidence? Is this peculiar tumor a real acral melanoma?". Cutan Ocul Toxicol 32 (2): 150-3. doi:10.3109/15569527.2012.740118. PMID 23153047.
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