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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]])]]
[[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>


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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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- Skin without significant pathology.
- Skin without significant pathology.
- NEGATIVE for dysplasia and NEGATIVE for malignancy.
- 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>
</pre>


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


=Genitourinary pathology=
=Genitourinary pathology=
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</pre>
</pre>


==Paraurethral cyst==
<pre>
===General===
Foreskin, Circumcision:
*Rare.  
- Squamous mucosa with mild-to-moderate acute and chronic
*Benign.
  (lymphocytic) lichenoid inflammation.
- NEGATIVE for evidence of lichen sclerosus.  
- NEGATIVE for dysplasia and NEGATIVE for malignancy.  


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>
Comment:  
*Presentation: mass lesion, dyspareunia or dysuria.
A PASD stain is NEGATIVE for micro-organisms.  
*Multipareous.
</pre>


===Microscopic===
==Paraurethral cyst==
Features:
{{Main|Paraurethral cyst}}
*Cystic space with epithelial lining - diagnosis based on epithelial lining.
 
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>
*[[Epithelial inclusion 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==
===General===
{{Main|Tonsillitis}}
*Commonly removed (tonsillectomy) when enlarged.
{{Main|Tonsil}}
*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>
*Others - see ''[[tonsil]]''.
 
===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>
 
<pre>
BLOOD CLOT, LEFT ARM - BRACHIAL ARTERY, THROMBECTOMY/EMBOLECTOMY:
- 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==
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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.
*[[Osteochrondroma]] - at joint, has cartilage.{{fact}}
 
===Sign out===
<pre>
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.
</pre>
 
====Block letters====
<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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==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>


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===Sign out===
===Sign out===
====Not apparent====
<pre>
<pre>
FIRST EXTENSOR COMPARTMENT, RIGHT HAND, BIOPSY:
FIRST EXTENSOR COMPARTMENT, RIGHT HAND, BIOPSY:
Line 945: Line 783:


==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.
 
Notes:
*The [[gross pathology]] section of the report should say something like: ''On sectioning no lesions were identified''.
*The [[cut-up]] is described in ''[[abdominal pannus grossing]]''.
 
===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==
Michael
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