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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>
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| **''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>
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| *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>
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| **Theories include migration/hyperplasia, and metaplasia.<ref name=pmid20156369/>
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| *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>
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| | |
| ====Classification====
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| May be subdivided into:<ref name=pmid20860924/>
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| *Acquired - due to trauma, surgery or infection.
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| *Congenital.
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| ===Gross===
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| *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>
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| | |
| Image:
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| <gallery>
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| Image:Cholesteatom_kuppelraum_1a.jpg | Cholesteatoma. (WC)
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| </gallery>
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| | |
| ===Microscopic===
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| 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>
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| *Keratinaceous debris - '''key feature'''.
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| *Squamous epithelium.
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| *Macrophages +/- giant cell (containing keratinceous debris).
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| *Chronic inflammation (lymphocytes).
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| DDx:
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| *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>
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| *[[Squamous cell carcinoma]].<ref name=pmid19563937/>
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| | |
| ===Sign out===
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| <pre>
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| SOFT TISSUE (CHOLESTEATOMA), SITE NOT FURTHER SPECIFIED, REMOVAL:
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| - KERATINACEOUS DEBRIS, COMPATIBLE WITH CHOLESTEATOMA.
| |
| </pre>
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| | |
| <pre>
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| Soft tissue, left ear ("left ear keratosis"), excision:
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| - Keratinaceous debris, squamous epithelium and bone (consistent with cholesteatoma).
| |
| </pre>
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| | |
| <pre>
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| TISSUE ("CHOLESTEATOMA"), LEFT, REMOVAL:
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| - KERATINACEOUS DEBRIS AND GIANT CELLS, COMPATIBLE WITH CHOLESTEATOMA.
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| </pre>
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| =Genitourinary pathology= | | =Genitourinary pathology= |
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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>
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| | |
| ===Gross===
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| *Symmetrical and equal size.
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| | |
| Note:
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| *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>
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| | |
| ===Microscopic===
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| Features:
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| *Follicular hyperplasia - see ''[[lymph node pathology]]''.
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| *+/-Colonies (clusters) of [[actinomycetes]] in the tonsillar crypts.
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| DDx:
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| *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>
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| *Others - see ''[[tonsil]]''.
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| | |
| ===IHC===
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| If there is a clinical suspicion - a panel to exclude (small cell) non-Hodgkin lymphomas:
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| *CD3.
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| *CD20.
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| *CD5.
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| *CD10.
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| *CD23.
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| *Cyclin D1.
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| | |
| ===Sign out===
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| <pre>
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| A. TONSIL, LEFT, TONSILLECTOMY:
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| - REACTIVE FOLLICULAR HYPERPLASIA.
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| - REACTIVE SQUAMOUS MUCOSA.
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| B. TONSIL, RIGHT, TONSILLECTOMY:
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| - REACTIVE FOLLICULAR HYPERPLASIA.
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| - REACTIVE SQUAMOUS MUCOSA.
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| </pre>
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| | |
| ====Without squamous mucosa====
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| <pre>
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| A. TONSIL, LEFT, TONSILLECTOMY:
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| - REACTIVE FOLLICULAR HYPERPLASIA.
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| B. TONSIL, RIGHT, TONSILLECTOMY:
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| - REACTIVE FOLLICULAR HYPERPLASIA.
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| </pre>
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| ==Obstructive sleep apnea== | | ==Obstructive sleep apnea== |