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Ditzels (view source)

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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=
=The big table of ditzels=
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| [[Soft tissue pathology]]
| [[Soft tissue pathology]]
|-
|-
| [[Tubal ligation]]
| Uterine tubes ([[tubal ligation]])
| completed family
| completed family
| [[Gynecologic pathology]]
| [[Gynecologic pathology]]
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| [[Dermatopathology]]
| [[Dermatopathology]]
|-
|-
| [[Vasectomy]]
| Vas deferens ([[vasectomy]])
| completed family
| completed family
| [[Genitourinary pathology]]
| [[Genitourinary pathology]]
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| [[bursitis]]
| [[bursitis]]
| Orthopaedic
| 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]]
|- <!--
|- <!--
| Specimen  
| Specimen  
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====Mesothelial lining present====
====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>
<pre>
SOFT TISSUE ("HERNIA SAC"), RESECTION/HERNIA REPAIR:  
SOFT TISSUE ("HERNIA SAC"), RESECTION/HERNIA REPAIR:  
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====Ileostomy====
====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>
<pre>
ILEOSTOMY, ILEOSTOMY REVERSAL:
ILEOSTOMY, ILEOSTOMY REVERSAL:
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==Cholesteatoma==
==Cholesteatoma==
===General===
{{Main|Cholesteatoma}}
*Squamous epithelium in the middle ear - leading to accumulation of keratinaceous debris.<ref>URL: [http://www.harrisonspractice.com/practice/ub/view/Harrisons%20Practice/141015/all/otitis_media_and_mastoiditis http://www.harrisonspractice.com/practice/ub/view/Harrisons%20Practice/141015/all/otitis_media_and_mastoiditis]. Accessed on: 16 March 2011.</ref>
**''Keratosis obturans'' - accumulation in the external ear canal - is considered to be a different process;<ref>{{cite journal |author=Piepergerdes MC, Kramer BM, Behnke EE |title=Keratosis obturans and external auditory canal cholesteatoma |journal=Laryngoscope |volume=90 |issue=3 |pages=383–91 |year=1980 |month=March |pmid=7359960 |doi= |url=}}</ref> though some consider it a synonym.<ref>{{cite journal |author=Shire JR, Donegan JO |title=Cholesteatoma of the external auditory canal and keratosis obturans |journal=Am J Otol |volume=7 |issue=5 |pages=361–4 |year=1986 |month=September |pmid=3538893 |doi= |url=}}</ref>
*The etiology is ''not'' well understood.<ref name=pmid20860924>{{Cite journal  | last1 = Nevoux | first1 = J. | last2 = Lenoir | first2 = M. | last3 = Roger | first3 = G. | last4 = Denoyelle | first4 = F. | last5 = Ducou Le Pointe | first5 = H. | last6 = Garabédian | first6 = EN. | title = Childhood cholesteatoma. | journal = Eur Ann Otorhinolaryngol Head Neck Dis | volume = 127 | issue = 4 | pages = 143-50 | month = Sep | year = 2010 | doi = 10.1016/j.anorl.2010.07.001 | PMID = 20860924 }}</ref><ref name=pmid20156369>{{Cite journal  | last1 = Louw | first1 = L. | title = Acquired cholesteatoma pathogenesis: stepwise explanations. | journal = J Laryngol Otol | volume = 124 | issue = 6 | pages = 587-93 | month = Jun | year = 2010 | doi = 10.1017/S0022215109992763 | PMID = 20156369 }}</ref>
**Theories include migration/hyperplasia, and metaplasia.<ref name=pmid20156369/>
*Rarely transforms into [[squamous cell carcinoma]].<ref name=pmid19563937>{{Cite journal  | last1 = Rothschild | first1 = S. | last2 = Ciernik | first2 = IF. | last3 = Hartmann | first3 = M. | last4 = Schuknecht | first4 = B. | last5 = Lütolf | first5 = UM. | last6 = Huber | first6 = AM. | title = Cholesteatoma triggering squamous cell carcinoma: case report and literature review of a rare tumor. | journal = Am J Otolaryngol | volume = 30 | issue = 4 | pages = 256-60 | month =  | year =  | doi = 10.1016/j.amjoto.2008.06.011 | PMID = 19563937 }}</ref><ref name=pmid15699729>{{Cite journal  | last1 = Takahashi | first1 = K. | last2 = Yamamoto | first2 = Y. | last3 = Sato | first3 = K. | last4 = Sato | first4 = Y. | last5 = Takahashi | first5 = S. | title = Middle ear carcinoma originating from a primary acquired cholesteatoma: a case report. | journal = Otol Neurotol | volume = 26 | issue = 1 | pages = 105-8 | month = Jan | year = 2005 | doi =  | PMID = 15699729 }}</ref>
 
====Classification====
May be subdivided into:<ref name=pmid20860924/>
*Acquired - due to trauma, surgery or infection.
*Congenital.
 
===Gross===
*Whitish mass in the middle ear.<ref name=pmid23217274>{{Cite journal  | last1 = Al Balushi | first1 = T. | last2 = Naik | first2 = JZ. | last3 = Al Khabori | first3 = M. | title = Congenital cholesteatoma in identical twins. | journal = J Laryngol Otol | volume = 127 | issue = 1 | pages = 67-9 | month = Jan | year = 2013 | doi = 10.1017/S0022215112002757 | PMID = 23217274 }}</ref>
 
Image:
<gallery>
Image:Cholesteatom_kuppelraum_1a.jpg | Cholesteatoma. (WC)
</gallery>
 
===Microscopic===
Features:<ref name=pmid1694387>{{cite journal |author=Iino Y, Toriyama M, Ohmi S, Kanegasaki S |title=Activation of peritoneal macrophages with human cholesteatoma debris and alpha-keratin |journal=Acta Otolaryngol. |volume=109 |issue=5-6 |pages=444–9 |year=1990 |pmid=1694387 |doi= |url=}}</ref>
*Keratinaceous debris - '''key feature'''.
*Squamous epithelium.
*Macrophages +/- giant cell (containing keratinceous debris).
*Chronic inflammation (lymphocytes).
 
DDx:
*Cholesterol granuloma.<ref>URL: [http://path.upmc.edu/cases/case273/dx.html http://path.upmc.edu/cases/case273/dx.html]. Accessed on: 14 January 2012.</ref>
*[[Squamous cell carcinoma]].<ref name=pmid19563937/>
 
===Sign out===
<pre>
SOFT TISSUE (CHOLESTEATOMA), SITE NOT FURTHER SPECIFIED, REMOVAL:
- KERATINACEOUS DEBRIS, COMPATIBLE WITH CHOLESTEATOMA.
</pre>
 
<pre>
Soft tissue, left ear ("left ear keratosis"), excision:
- Keratinaceous debris, squamous epithelium and bone (consistent with cholesteatoma).
</pre>


=Genitourinary pathology=
=Genitourinary pathology=
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*[[Lichen planus]].
*[[Lichen planus]].
*Infection, e.g. [[syphilis]], [[candidiasis]].
*Infection, e.g. [[syphilis]], [[candidiasis]].
*[[Zoon balantitis]] - abundant plasma cells.
*[[Zoon balanitis]] - abundant [[plasma cell]]s.


===Microscopic===
===Microscopic===
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*See ''[[Penis]].
*See ''[[Penis]].


==Paraurethral cyst==
===Sign out===
===General===
<pre>
*Rare.
Foreskin, Circumcision:
*Benign.
- Benign squamous mucosa within normal limits, consistent with foreskin.  
</pre>


Clinical:<ref>{{Cite journal  | last1 = Isen | first1 = K. | last2 = Utku | first2 = V. | last3 = Atilgan | first3 = I. | last4 = Kutun | first4 = Y. | title = Experience with the diagnosis and management of paraurethral cysts in adult women. | journal = Can J Urol | volume = 15 | issue = 4 | pages = 4169-73 | month = Aug | year = 2008 | doi =  | PMID = 18706145 }}</ref>
<pre>
*Presentation: mass lesion, dyspareunia or dysuria.
Foreskin, Circumcision:
*Multipareous.
- 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.  


===Microscopic===
Comment:  
Features:
A PASD stain is NEGATIVE for micro-organisms.  
*Cystic space with epithelial lining - diagnosis based on epithelial lining.
</pre>


Subclassification:<ref>{{Cite journal  | last1 = Satani | first1 = H. | last2 = Yoshimura | first2 = N. | last3 = Hayashi | first3 = N. | last4 = Arima | first4 = K. | last5 = Yanagawa | first5 = M. | last6 = Kawamura | first6 = J. | title = [A case of female paraurethral cyst diagnosed as epithelial inclusion cyst]. | journal = Hinyokika Kiyo | volume = 46 | issue = 3 | pages = 205-7 | month = Mar | year = 2000 | doi =  | PMID = 10806582 }}</ref><ref name=pmid7195943>{{Cite journal  | last1 = Das | first1 = SP. | title = Paraurethral cysts in women. | journal = J Urol | volume = 126 | issue = 1 | pages = 41-3 | month = Jul | year = 1981 | doi =  | PMID = 7195943 }}</ref>
==Paraurethral cyst==
*[[Epithelial inclusion cyst]].
{{Main|Paraurethral cyst}}
*Müllerian cyst.
*[[Gartner duct cyst]] ([[AKA]] [[mesonephric duct cyst]] [[AKA]] Wolffian duct cyst).<ref>URL: [http://webpathology.com/image.asp?n=3&Case=540 http://webpathology.com/image.asp?n=3&Case=540]. Accessed on: 5 February 2012.</ref>
*Skene duct cyst.


==Labia==
==Labia==
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=Head and neck pathology=
=Head and neck pathology=
==Tonsillitis==
==Tonsillitis==
:''Tonsil'' redirects here.
{{Main|Tonsillitis}}
===General===
{{Main|Tonsil}}
*Commonly removed (tonsillectomy) when enlarged.
*Very low probability of malignancy (<0.2%) in tonsilectomies in individuals <19 years old if no clinical suspicion.<ref name=pmid15963574>{{Cite journal  | last1 = Erdag | first1 = TK. | last2 = Ecevit | first2 = MC. | last3 = Guneri | first3 = EA. | last4 = Dogan | first4 = E. | last5 = Ikiz | first5 = AO. | last6 = Sutay | first6 = S. | title = Pathologic evaluation of routine tonsillectomy and adenoidectomy specimens in the pediatric population: is it really necessary? | journal = Int J Pediatr Otorhinolaryngol | volume = 69 | issue = 10 | pages = 1321-5 | month = Oct | year = 2005 | doi = 10.1016/j.ijporl.2005.05.005 | PMID = 15963574 }}</ref>
 
===Gross===
*Symmetrical and equal size.
 
Note:
*Gross exam is considered sufficient if there is no asymmetry.<ref name=pmid14608541>{{Cite journal  | last1 = Williams | first1 = MD. | last2 = Brown | first2 = HM. | title = The adequacy of gross pathological examination of routine tonsils and adenoids in patients 21 years old and younger. | journal = Hum Pathol | volume = 34 | issue = 10 | pages = 1053-7 | month = Oct | year = 2003 | doi =  | PMID = 14608541 }}</ref>
 
===Microscopic===
Features:
*Follicular hyperplasia - see ''[[lymph node pathology]]''.
*+/-Colonies (clusters) of [[actinomycetes]] in the tonsillar crypts.
 
DDx:
*Non-Hodgkin [[lymphoma]].<ref name=pmid20426908>{{Cite journal  | last1 = Wang | first1 = XY. | last2 = Wu | first2 = N. | last3 = Zhu | first3 = Z. | last4 = Zhao | first4 = YF. | title = Computed tomography features of enlarged tonsils as a first symptom of non-Hodgkin's lymphoma. | journal = Chin J Cancer | volume = 29 | issue = 5 | pages = 556-60 | month = May | year = 2010 | doi =  | PMID = 20426908 }}</ref>
 
===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===
<pre>
A. TONSIL, LEFT, TONSILLECTOMY:
- REACTIVE FOLLICULAR HYPERPLASIA.
- REACTIVE SQUAMOUS MUCOSA.
 
B. TONSIL, RIGHT, TONSILLECTOMY:
- REACTIVE FOLLICULAR HYPERPLASIA.
- REACTIVE SQUAMOUS MUCOSA.
</pre>
 
====Without squamous mucosa====
<pre>
A. TONSIL, LEFT, TONSILLECTOMY:
- REACTIVE FOLLICULAR HYPERPLASIA.
 
B. TONSIL, RIGHT, TONSILLECTOMY:
- REACTIVE FOLLICULAR HYPERPLASIA.
</pre>


==Obstructive sleep apnea==
==Obstructive sleep apnea==
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{{Main|Cardiovascular pathology}}
{{Main|Cardiovascular pathology}}
==Vascular thrombus==
==Vascular thrombus==
:''Venous thrombus'' and ''arterial thrombus'' redirect here.
{{Main|Vascular thrombus}}
===General===
*Uncommonly comes to pathology.
 
Risk factors - think [[Virchow's triad]]:
*Stasis, e.g. atrial fibrillation.
*Hypercoagulable states, e.g. cancer - see ''[[risks factors venous thromboembolism]]''.
*Endothelial injury.
 
===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''.<ref name=Ref_PBoD8_124>{{Ref PBoD8|124}}</ref>
 
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:
*www:
**[http://library.med.utah.edu/WebPath/ATHHTML/ATH031.html Lines of Zahn (utah.edu)].
**[http://pathhsw5m54.ucsf.edu/case9/image94.html Lines of Zahn (ucsf.edu)].
*[[WC]]:
**[http://commons.wikimedia.org/wiki/File:Laminations_in_a_thrombus_-_low_mag.jpg Laminated thrombus - low mag. (WC)].
**[http://commons.wikimedia.org/wiki/File:Laminations_in_a_thrombus_-_high_mag.jpg Laminated thrombus - high mag. (WC)].
 
===Sign out===
<pre>
BLOOD CLOT, LEFT ILIAC ARTERY, THROMBECTOMY:
- THROMBUS.
- NEGATIVE FOR MALIGNANCY.
</pre>
 
====Micro====
The sections show layers of red blood cells alternating with fibrin and white blood cells (Lines of Zahn).


==Leg amputation==
==Leg amputation==
===General - overview===
{{Main|Leg amputation}}
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]].<ref name=pmid17059855/>
 
===Sign out===
:See ''[[Ditzels#Atherosclerotic peripheral vascular disease]]''.


==Toe amputation==
==Toe amputation==
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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===
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==Heterotopic ossification==
==Heterotopic ossification==
*Abbreviated ''HO''.
*Abbreviated ''HO''.
===General===
{{Main|Heterotopic ossification}}
*Definition of ''heterotopic ossification'': bone formation in soft tissue.<ref name=pmid21611960>{{Cite journal  | last1 = Leblanc | first1 = E. | last2 = Trensz | first2 = F. | last3 = Haroun | first3 = S. | last4 = Drouin | first4 = G. | last5 = Bergeron | first5 = E. | last6 = Penton | first6 = CM. | last7 = Montanaro | first7 = F. | last8 = Roux | first8 = S. | last9 = Faucheux | first9 = N. | title = BMP-9-induced muscle heterotopic ossification requires changes to the skeletal muscle microenvironment. | journal = J Bone Miner Res | volume = 26 | issue = 6 | pages = 1166-77 | month = Jun | year = 2011 | doi = 10.1002/jbmr.311 | PMID = 21611960 }}
</ref>
*Injury at site.
*May be seen in the context of tetraplegia.
 
Clinical:<ref name=pmid21611960/>
*+/-Joint stiffness.
*+/-Swelling.
*+/-Pain.
 
===Microscopic===
Features:
*[[Lamellar bone]] - has layering/lines (best seen with polarized light).
*+/-Skeletal muscle (within the marrow space).
 
DDx:
*[[Myositis ossificans]] - inflammation, cellular.
*[[Osteosarcoma]], extraskeletal.
 
===Sign out===
<pre>
LESION ("HETEROTOPIC OSSIFICATION"), RIGHT FEMUR, EXCISION:
- BONE -- CONSISTENT WITH MUSCLE HETEROTOPIC OSSIFICATION.
- NEGATIVE FOR MALIGNANCY.
</pre>
 
====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==
==Lumbar bone==
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=Other=
=Other=
==Breast prosthesis==
==Breast prosthesis==
:''Breast expander'' redirects here.
*[[AKA]] ''breast implants''.
===General===
{{Main|Breast prostheses}}
*Commonly used for cosmesis in the context of [[breast cancer]].
 
===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====
<gallery>
Image:Saline-filled_breast_implants.jpeg | Breast implants. (WC)
</gallery>
WP:
*[http://en.wikipedia.org/wiki/File:Ruptured_implant.JPG Ruptured breast implant (WP)].
 
===Sign out===
<pre>
BREAST PROSTHESIS, RIGHT, REMOVAL:
- INTACT BREAST PROSTHESIS (GROSS ONLY).
</pre>
 
====Not intact====
<pre>
BREAST PROSTHESIS, LEFT, REMOVAL:
- BREAST PROSTHESIS WITH EVIDENCE OF PERFORATION AND LEAKAGE (GROSS ONLY).
</pre>


==De Quervain syndrome==
==De Quervain syndrome==
:Should ''not'' be confused with ''[[De Quervain's thyroiditis]]'' (subacute granulomatous thryoiditis).
:Should ''not'' be confused with ''[[De Quervain's thyroiditis]]'' (subacute granulomatous thryoiditis).
*[[AKA]] ''de Quervain disease''.
*[[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===
===General===
*Benign.
*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 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>


Line 869: Line 714:


===Sign out===
===Sign out===
====Not apparent====
<pre>
<pre>
FIRST EXTENSOR COMPARTMENT, RIGHT HAND, BIOPSY:
FIRST EXTENSOR COMPARTMENT, RIGHT HAND, BIOPSY:
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==Tenosynovitis==
==Tenosynovitis==
:''Stenosing tenosynovitis'' directs here.
{{Main|Tenosynovitis}}
===General===
*Uncommon pathology specimen.
*May cause ''trigger finger''.<ref name=pmid23396894>{{Cite journal  | last1 = Vuillemin | first1 = V. | last2 = Guerini | first2 = H. | last3 = Bard | first3 = H. | last4 = Morvan | first4 = G. | title = Stenosing tenosynovitis. | journal = J Ultrasound | volume = 15 | issue = 1 | pages = 20-8 | month = Feb | year = 2012 | doi = 10.1016/j.jus.2012.02.002 | PMID = 23396894 }}</ref>
 
===Microscopic===
Features:<ref name=pmid20442645>{{Cite journal  | last1 = Shon | first1 = W. | last2 = Folpe | first2 = AL. | title = Tenosynovitis with psammomatous calcification: a poorly recognized pseudotumor related to repetitive tendinous injury. | journal = Am J Surg Pathol | volume = 34 | issue = 6 | pages = 892-5 | month = Jun | year = 2010 | doi = 10.1097/PAS.0b013e3181d95a36 | PMID = 20442645 }}</ref>
*Dense connective tissue (tendon).
*Histiocytes.
*+/-[[Psammoma bodies]].
 
DDx:
*Calcific tendinitis.
*[[Giant cell tumour of the tendon sheath]].
*[[Palmar fibromatosis]].
 
===IHC===
Features:
*CD68 +ve.
*Beta-catenin -ve.
 
Note:
*Immunostains are usually not required for the diagnosis.
 
===Sign out===
<pre>
TENOSYNOVIUM, LEFT MIDDLE FINGER, EXCISION:
- DENSE CONNECTIVE TISSUE (CONSISTENT WITH TENDON) WITH LYMPHOHISTIOCYTIC INFILTRATE.
- NEGATIVE FOR GIANT CELLS.
- NEGATIVE FOR MALIGNANCY.
</pre>
 
====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==
==Otosclerosis==
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==Abdominal pannus==
==Abdominal pannus==
{{Main|Obesity}}
*[[AKA]] ''pannus'', ''panniculus'' and ''pannona''.
:''Pannus'' redirects here.
{{Main|Abdominal pannus}}
===General===
*An apron-like excess of skin - following weight loss.<ref>URL: [http://plasticsurgery.about.com/od/glossary/g/panniculectomy.htm http://plasticsurgery.about.com/od/glossary/g/panniculectomy.htm]. Accessed on: 18 July 2012.</ref>
*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:
*[[Lipoma]].
*[[Liposarcoma]].
 
===Sign out===
<pre>
ABDOMINAL PANNUS, EXCISION:
- BENIGN SKIN AND ADIPOSE TISSUE.
</pre>
 
<pre>
ABDOMINAL PANNUS, EXCISION:
- DERMAL SCAR, BENIGN SKIN AND ADIPOSE TISSUE.
</pre>
 
====Gross only====
<pre>
ABDOMINAL PANNUS, EXCISION:
- BENIGN SKIN AND ADIPOSE TISSUE (GROSS ONLY).
</pre>


==Empyema==
==Empyema==
:''Empyema peel'' redirects here.
:''Empyema peel'' and ''pleural peel'' redirect here.
===General===
===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>
*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>
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DDx:
DDx:
*[[Malignant mesothelioma]].
*[[Malignant mesothelioma]] - should have infiltrative growth.
*[[Fibrosing pleuritis]].
*[[Fibrosing pleuritis]].


===Sign out===
===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>
<pre>
PLEURA, LEFT, DECORTICATION:
PLEURA, LEFT, DECORTICATION:
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- NO MICROORGANISMS APPARENT WITH H&E STAINING.
- NO MICROORGANISMS APPARENT WITH H&E STAINING.
- NEGATIVE FOR MALIGNANCY.
- 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>
</pre>


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[[Category:Basics]]
[[Category:Basics]]
[[Category:Ditzels]]
Michael
48,436

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