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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>


=A list of ditzels=
The challenge in ditzels is not falling asleep... so one misses the unexpected (subtle) tumour.  
===Gastrointestinal===
*[[Hernia sac]].
*[[Stoma]].


===Neuropathology===
=The big table of ditzels=
*Vertebral disc - see ''[[spine]]''.
{| class="wikitable sortable"
! 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 [[osteoarthritis|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 pad biopsy|Abdominal fat]]
| query [[amyloidosis]]
| [[Haematopathology]] (?)
|-
| [[Breast prosthesis]]
| breast cancer/cosmesis
| [[Breast pathology]]
|-
| [[Empyema peel]]
| decortication for [[pneumonia]]
| [[Pulmonary pathology]]
|-
| [[Bursa]]
| [[bursitis]]
| 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]]
|-
| [[Distal interosseous nerve]] (''[[posterior interosseous nerve]] of wrist'' and ''[[anterior interosseous nerve]] of wrist'')
| chronic hand pain, as may be seen in [[rheumatoid arthritis]]
| [[Neuropathology]]
|-
| [[Palmar fascia]]
| [[palmar fibromatosis]] (Dupuytren's contracture)
| Plastic surgery
|-
| Soft tissue of hand or wrist
| [[Ganglion cyst]]
| Plastic surgery
|- <!--
| Specimen
| Typical context (diagnosis)
| System -->
|}


===Pediatric===
=Gastrointestinal pathology=
*Bands of Ladd.
*[[Cholesteatoma]].
 
===Orthopaedic===
*[[Femoral head]].
 
===Head and neck pathology===
*Tonsil.
 
=Gastrointestinal=
==Hernia sac==
==Hernia sac==
:''Inguinal hernia'' redirects here.
===General===
===General===
*Hernia repair.
*Hernia repair (herniorrhaphy).
*Pathologic findings are very usual and if present known to the surgeon.
*Pathologic findings are very unusual and if present known to the surgeon.
**Thus, it has been advocated that one ought not examine 'em.<ref name=pmid14986035>{{cite journal |author=Siddiqui K, Nazir Z, Ali SS, Pervaiz S |title=Is routine histological evaluation of pediatric hernial sac necessary? |journal=Pediatr. Surg. Int. |volume=20 |issue=2 |pages=133–5 |year=2004 |month=February |pmid=14986035 |doi=10.1007/s00383-003-1106-2 |url=}}</ref><ref name=pmid9694100>{{cite journal |author=Partrick DA, Bensard DD, Karrer FM, Ruyle SZ |title=Is routine pathological evaluation of pediatric hernia sacs justified? |journal=J. Pediatr. Surg. |volume=33 |issue=7 |pages=1090–2; discussion 1093–4 |year=1998 |month=July |pmid=9694100 |doi= |url=}}</ref>
**Thus, it has been advocated that one ought not examine 'em.<ref name=pmid14986035>{{cite journal |author=Siddiqui K, Nazir Z, Ali SS, Pervaiz S |title=Is routine histological evaluation of pediatric hernial sac necessary? |journal=Pediatr. Surg. Int. |volume=20 |issue=2 |pages=133–5 |year=2004 |month=February |pmid=14986035 |doi=10.1007/s00383-003-1106-2 |url=}}</ref><ref name=pmid9694100>{{cite journal |author=Partrick DA, Bensard DD, Karrer FM, Ruyle SZ |title=Is routine pathological evaluation of pediatric hernia sacs justified? |journal=J. Pediatr. Surg. |volume=33 |issue=7 |pages=1090–2; discussion 1093–4 |year=1998 |month=July |pmid=9694100 |doi= |url=}}</ref>


Line 35: Line 144:
*One should '''not''' see [[vas deferens]].
*One should '''not''' see [[vas deferens]].
*Things worthy of some comment: granulation tissue, inflammation.
*Things worthy of some comment: granulation tissue, inflammation.
===Sign out===
====Incarcerated without mesothelium====
<pre>
SOFT TISSUE ("HERNIA SAC"), RESECTION/HERNIA REPAIR:
- FIBROADIPOSE TISSUE WITH FAT NECROSIS -- CONSISTENT WITH HERNIA SAC.
- NEGATIVE FOR MALIGNANCY.
</pre>
=====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====
<pre>
Submitted as "Hernia Sac", Excision:
- Benign fibroadipose tissue partially covered by mesothelium, consistent
  with hernia sac.
- NEGATIVE for malignancy.
</pre>
======Block letters======
<pre>
SOFT TISSUE ("HERNIA SAC"), RESECTION/HERNIA REPAIR:
- FIBROADIPOSE TISSUE PARTIALLY COVERED BY MESOTHELIUM -- CONSISTENT WITH HERNIA SAC.
- NEGATIVE FOR MALIGNANCY.
</pre>
=====Inflamed=====
<pre>
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.
</pre>
=====Gross only=====
<pre>
SOFT TISSUE, RIGHT INGUINAL, HERNIA REPAIR:
- HERNIA SAC (GROSS ONLY).
</pre>
<pre>
SOFT TISSUE, LEFT INGUINAL, HERNIA REPAIR:
- HERNIA SAC (GROSS ONLY).
</pre>


==Stoma==
==Stoma==
:''Ostomy'', ''ileostomy'' and ''colostomy'' redirect here.
===General===
:See: ''[[Colon]]'' and ''[[Small intestine]]''.
:See: ''[[Colon]]'' and ''[[Small intestine]]''.
===General===
*Reversal of ''ileostomy'' or ''colostomy''.
*Reversal of ileostomy or colostomy.
**The (generic) encompassing term for ''ileostomy'' and ''colostomy'' is ''ostomy''.<ref>URL: [http://www.nlm.nih.gov/medlineplus/ostomy.html http://www.nlm.nih.gov/medlineplus/ostomy.html]. Accessed on: 27 January 2013.</ref>
 
Stomas are created for a number of reasons:
*Perforated viscous/peritonitis.
**Trauma.
**[[Colorectal adenocarcinoma]].
*[[Diverticulosis]].


===Microscopic===
===Microscopic===
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**+/-Fibromuscular hyperplasia of the lamina propria and submucosa.
**+/-Fibromuscular hyperplasia of the lamina propria and submucosa.
*Skin.
*Skin.
**Typically has findings of mild irritation:
***Mild dermal inflammation (usu. lymphocyte predominant).
***[[Acanthosis]] (thickened ''[[stratum spinosum]]'').
***Hypergranulosis (thickened ''[[stratum granulosum]]'').
***Hyperkeratosis (thickened ''[[stratum corneum]]'').


Notes:
Notes:
*One is looking for malignancy (e.g. [[colorectal carcinoma]]), especially if that is in the history.
*One is looking for malignancy (e.g. [[colorectal carcinoma]]), especially if that is in the history.
DDx:
*[[Colorectal adenocarcinoma]].
*[[Crohn's disease]].
===Sign out===
====Colostomy====
<pre>
COLOSTOMY, COLOSTOMY REVERSAL:
- LARGE BOWEL WALL WITH SUBMUCOSAL FIBROSIS -- OTHERWISE WITHIN NORMAL LIMITS.
- SKIN WITHOUT SIGNIFICANT PATHOLOGY.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
</pre>
====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>
ILEOSTOMY, ILEOSTOMY REVERSAL:
- SMALL BOWEL WALL WITH SUBMUCOSAL FIBROSIS -- OTHERWISE WITHIN NORMAL LIMITS.
- SKIN WITHOUT SIGNIFICANT PATHOLOGY.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
</pre>
==Vagus nerve==
===General===
*Seen from ''vagotomy''.
Typical indication:
*Gastric outlet obstruction.<ref>{{Cite journal  | last1 = Okawada | first1 = M. | last2 = Okazaki | first2 = T. | last3 = Takahashi | first3 = T. | last4 = Lane | first4 = GJ. | last5 = Yamataka | first5 = A. | title = Gastric outlet obstruction possibly secondary to ulceration in a 2-year-old girl: a case report. | journal = Cases J | volume = 2 | issue = 1 | pages = 8 | month =  | year = 2009 | doi = 10.1186/1757-1626-2-8 | PMID = 19123936 }}</ref>
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===
<pre>
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.
</pre>


=Pediatric=
=Pediatric=
Line 56: Line 295:
*Associated with intestinal malrotation.
*Associated with intestinal malrotation.
*Removed by ''Ladd's procedure''.
*Removed by ''Ladd's procedure''.
*Usually associated with [[duodenal]] and (other) [[small bowel obstruction]]s.<ref name=pmid20223332>{{Cite journal  | last1 = Raphaeli | first1 = T. | last2 = Parimi | first2 = C. | last3 = Mattix | first3 = K. | last4 = Javid | first4 = PJ. | title = Acute colonic obstruction from Ladd bands: a unique complication from intestinal malrotation. | journal = J Pediatr Surg | volume = 45 | issue = 3 | pages = 630-1 | month = Mar | year = 2010 | doi = 10.1016/j.jpedsurg.2009.12.026 | PMID = 20223332 }}
</ref>


===Microscopic===
===Microscopic===
Features:
Features:
*Benign fibrous tissue.
*Benign fibrous tissue.
===Sign out===
<pre>
Adhesive band, Ladd's procedure:
- Vascular fibrous tissue consistent with bands of Ladd.
</pre>


==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>
 
===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>


=Genitourinary pathology=
=Genitourinary pathology=
Line 81: Line 316:
===General===
===General===
Indications:
Indications:
*Phimosis.
*[[Phimosis]].


Main considerations:
Main considerations:
Line 87: Line 322:
*[[Lichen sclerosus]], [[AKA]] ''balanitis xerotica obliterans''.
*[[Lichen sclerosus]], [[AKA]] ''balanitis xerotica obliterans''.
*[[Lichen planus]].
*[[Lichen planus]].
*Infection, e.g. [[syphilis]].
*Infection, e.g. [[syphilis]], [[candidiasis]].
*[[Zoon balanitis]] - abundant [[plasma cell]]s.


===Microscopic===
===Microscopic===
Line 96: Line 332:
DDx:
DDx:
*See ''[[Penis]].
*See ''[[Penis]].
===Sign out===
<pre>
Foreskin, Circumcision:
- Benign squamous mucosa within normal limits, consistent with foreskin.
</pre>
<pre>
Foreskin, Circumcision:
- Benign squamous mucosa with mild patchy chronic inflammation at the epidermal-dermal interface.
- NEGATIVE for dysplasia and NEGATIVE for malignancy.
</pre>
<pre>
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.
</pre>


==Paraurethral cyst==
==Paraurethral cyst==
{{Main|Paraurethral cyst}}
==Labia==
===General===
===General===
*Rare.
*Operation ''labioplasty''.
*Benign.
 
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>
*Presentation: mass lesion, dyspareunia or dysuria.
*Multipareous.


===Microscopic===
===Microscopic===
Features:
Features:
*Cystic space with epithelial lining - diagnosis based on epithelial lining.
*Squamous epithelium with compact keratin.
*Fibrous stroma.


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>
===Sign out===
*[[Epithelial inclusion cyst]].
<pre>
*Müllerian cyst.
LABIA MINORA, RIGHT, LABIOPLASTY:
*Gartner duct cyst.
- BENIGN SKIN WITH A THIN LAYER OF COMPACT KERATIN FIBROTIC STROMA -- CONSISTENT
*Skene duct cyst.
  WITH LABIA MINORA.
</pre>


=Head and neck pathology=
=Head and neck pathology=
==Tonsillitis==
==Tonsillitis==
{{Main|Tonsillitis}}
{{Main|Tonsil}}
==Obstructive sleep apnea==
:''Uvula'' redirects here.
*Abbreviated ''OSA''.
===General===
*Clinical diagnosis.
*May be treated with a resection of the uvula.<ref name=pmid19467416>{{Cite journal  | last1 = Shin | first1 = SH. | last2 = Ye | first2 = MK. | last3 = Kim | first3 = CG. | title = Modified uvulopalatopharyngoplasty for the treatment of obstructive sleep apnea-hypopnea syndrome: resection of the musculus uvulae. | journal = Otolaryngol Head Neck Surg | volume = 140 | issue = 6 | pages = 924-9 | month = Jun | year = 2009 | doi = 10.1016/j.otohns.2009.01.020 | PMID = 19467416 }}</ref>
*Associated with [[obesity]].<ref name=pmid23299507>{{Cite journal  | last1 = Sarkhosh | first1 = K. | last2 = Switzer | first2 = NJ. | last3 = El-Hadi | first3 = M. | last4 = Birch | first4 = DW. | last5 = Shi | first5 = X. | last6 = Karmali | first6 = S. | title = The Impact of Bariatric Surgery on Obstructive Sleep Apnea: A Systematic Review. | journal = Obes Surg | volume =  | issue =  | pages =  | month = Jan | year = 2013 | doi = 10.1007/s11695-012-0862-2 | PMID = 23299507 }}</ref>
===Microscopic===
Features:
*Benign oropharyneal mucosa (stratified squamous epithelium).
*+/-Skeletal muscle.
*+/-[[Salivary gland]]s (minor) - mucinous.
===Sign out===
<pre>
UVULA, RESECTION:
- OROPHARYNGEAL MUCOSA, CONSISTENT WITH UVULA.
</pre>
=Cardiovascular pathology=
{{Main|Cardiovascular pathology}}
==Vascular thrombus==
{{Main|Vascular thrombus}}
==Leg amputation==
{{Main|Leg amputation}}
==Toe amputation==
===General - overview===
*Like leg ampuations.
===Sign out===
:See ''[[Ditzels#Atherosclerotic peripheral vascular disease]]''.
==Finger amputation==
===General - overview===
*Similar to [[toe amputation]]s.
May be done due to:
*Contractures leading to ulcerations.
*[[Scleroderma]] - leading to ischemia.<ref name=pmid3584887>{{Cite journal  | last1 = Jones | first1 = NF. | last2 = Imbriglia | first2 = JE. | last3 = Steen | first3 = VD. | last4 = Medsger | first4 = TA. | title = Surgery for scleroderma of the hand. | journal = J Hand Surg Am | volume = 12 | issue = 3 | pages = 391-400 | month = May | year = 1987 | doi =  | PMID = 3584887 }}</ref>
===Sign out===
:See ''[[Ditzels#Atherosclerotic peripheral vascular disease]]''.
==Atherosclerotic peripheral vascular disease==
:''Diabetic foot'' redirects here.
*[[AKA]] ''peripheral vascular disease''.
{{Main|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.
DDx - gross:
*[[Malignant melanoma]].
Image:
*[http://commons.wikimedia.org/wiki/File:GangreneFoot.JPG Gangrenous foot (WC)].
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]].<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]].
*[[Cholesterol embolism]].
===Sign out===
====Forefoot amputation====
<pre>
RIGHT FOREFOOT, AMPUTATION:
- ULCERATED SKIN.
- MODERATE-TO-SEVERE ATHEROSCLEROSIS.
- BLOOD VESSEL WITH RECANALIZATION.
- NEGATIVE FOR MALIGNANCY.
</pre>
====Leg amputation====
<pre>
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.
</pre>
=====Revision=====
<pre>
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.
</pre>
=====Leg amputation - gross only=====
<pre>
LOWER EXTREMITY, LEFT, BELOW THE KNEE AMPUTATION:
- ULCERS AND ISCHEMIC CHANGES WITH FOCAL COMPLETE ARTERIAL OCCLUSION (GROSS ONLY).
</pre>
<pre>
LEG, RIGHT, ABOVE THE KNEE AMPUTATION:
- ULCERS AND ISCHEMIC CHANGES WITH EXTENSIVE ARTERIAL DISEASE (GROSS ONLY).
</pre>
<pre>
LEG, RIGHT, ABOVE THE KNEE AMPUTATION:
- EXTENSIVE ISCHEMIC CHANGES WITH SEVERE ARTERIAL DISEASE (GROSS ONLY).
</pre>
====Toe amputation====
=====Mild=====
<pre>
THIRD TOE, RIGHT, AMPUTATION:
- SKIN WITH MARKED DERMAL FIBROSIS.
- MILD ATHEROSCLEROSIS.
- NEGATIVE FOR MALIGNANCY.
</pre>
<pre>
SECOND TOE, RIGHT, AMPUTATION:
- SKIN WITH MARKED DERMAL FIBROSIS AND ULCERATION WITH IMPETIGINIZATION.
- MILD ATHEROSCLEROSIS.
- NEGATIVE FOR MALIGNANCY.
</pre>
=====Moderate=====
<pre>
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.
</pre>
<pre>
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.
</pre>
=====Severe=====
<pre>
SECOND AND THIRD TOE, LEFT, AMPUTATION:
- SEVERE ATHEROSCLEROSIS.
- ACUTE AND CHRONIC OSTEOMYELITIS.
- GANGRENE.
</pre>
<pre>
GREAT TOE, LEFT, AMPUTATION:
- GANGRENE.
- SEVERE ATHEROSCLEROSIS.
- ULCERATED SKIN AND CHRONIC ISCHEMIC CHANGES.
- BONE WITH NO SIGNIFICANT PATHOLOGY.
- NEGATIVE FOR MALIGNANCY.
</pre>
<pre>
GREAT TOE, RIGHT, AMPUTATION:
- GANGRENE.
- ATHEROSCLEROSIS.
- NECROTIC BONE WITH ABUNDANT COCCI ORGANISMS AND NEUTROPHILS
  WITHIN THE MARROW CAVITY.
- NEGATIVE FOR MALIGNANCY.
</pre>
=Orthopaedic=
==Femoral head==
{{Main|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.<ref name =pmid7509409>{{Cite journal  | last1 = Clarke | first1 = AM. | last2 = Rogers | first2 = S. | last3 = Douglas | first3 = DL. | title = Closed intramedullary biopsy for metastatic disease. | journal = J R Coll Surg Edinb | volume = 38 | issue = 6 | pages = 368-9 | month = Dec | year = 1993 | doi =  | PMID = 7509409 }}</ref>
**Hassan ''et al.''<ref name=pmid17849954>{{Cite journal  | last1 = Hassan | first1 = K. | last2 = Kalra | first2 = S. | last3 = Moran | first3 = C. | title = Intramedullary reamings for the histological diagnosis of suspected pathological fractures. | journal = Surgeon | volume = 5 | issue = 4 | pages = 202-4 | month = Aug | year = 2007 | doi =  | PMID = 17849954 }}</ref> advocate against their use, suggesting the yield is low and a biopsy should be preferred.
===Microscopic===
Features:<ref name=pmid3548454>{{Cite journal  | last1 = Tydings | first1 = JD. | last2 = Martino | first2 = LJ. | last3 = Kircher | first3 = M. | last4 = Alfred | first4 = RH. | last5 = Lozman | first5 = J. | title = Viability of intramedullary canal bone reamings for continued calcification. | journal = Am J Surg | volume = 153 | issue = 3 | pages = 306-9 | month = Mar | year = 1987 | doi =  | PMID = 3548454 }}</ref>
*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 [[RBC]]s - perfectly round, dense nucleus, bright red cytoplasm.
**Myeloid cells and precursors.
**Adipocytes.
DDx:
*[[Metastasis|Metastatic]] carcinoma.
===Sign out===
<pre>
BONE, LEFT FEMUR, REAMINGS:
- FEATURES CONSISTENT WITH A RECENT FRACTURE.
- NEGATIVE FOR MALIGNANCY.
</pre>
==Heterotopic ossification==
*Abbreviated ''HO''.
{{Main|Heterotopic ossification}}
==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===
<pre>
LUMBAR BONE, DECOMPRESSION:
- BONE AND VERTEBRAL DISC FRAGMENTS WITH DEGENERATIVE CHANGES.
- UNREMARKABLE BONE MARROW.
- NEGATIVE FOR MALIGNANCY.
</pre>
==Bursa==
:''Bursitis'' redirects here.
===General===
===General===
*Commonly removed (tonsillectomy) when enlarged.
*Uncommon specimen.
*Septic bursitis is usually due to ''S. aureus''.<ref name=pmid23933823>{{Cite journal  | last1 = Hanrahan | first1 = JA. | title = Recent developments in septic bursitis. | journal = Curr Infect Dis Rep | volume = 15 | issue = 5 | pages = 421-5 | month = Oct | year = 2013 | doi = 10.1007/s11908-013-0353-1 | PMID = 23933823 }}</ref>
**Usually associated with trauma to the overlying skin.<ref name=pmid439118>{{Cite journal  | last1 = Canoso | first1 = JJ. | last2 = Sheckman | first2 = PR. | title = Septic subcutaneous bursitis. Report of sixteen cases. | journal = J Rheumatol | volume = 6 | issue = 1 | pages = 96-102 | month =  | year =  | doi =  | PMID = 439118 }}</ref>
 
Indication:
*Bursitis - may be treated with bursectomy.<ref>{{Cite journal  | last1 = Dillon | first1 = JP. | last2 = Freedman | first2 = I. | last3 = Tan | first3 = JS. | last4 = Mitchell | first4 = D. | last5 = English | first5 = S. | title = Endoscopic bursectomy for the treatment of septic pre-patellar bursitis: a case series. | journal = Arch Orthop Trauma Surg | volume = 132 | issue = 7 | pages = 921-5 | month = Jul | year = 2012 | doi = 10.1007/s00402-012-1494-7 | PMID = 22426936 }}</ref>
 
Note:
*Most bursitis is managed conservatively.<ref name=pmid21814140>{{Cite journal  | last1 = Lustenberger | first1 = DP. | last2 = Ng | first2 = VY. | last3 = Best | first3 = TM. | last4 = Ellis | first4 = TJ. | title = Efficacy of treatment of trochanteric bursitis: a systematic review. | journal = Clin J Sport Med | volume = 21 | issue = 5 | pages = 447-53 | month = Sep | year = 2011 | doi = 10.1097/JSM.0b013e318221299c | PMID = 21814140 }}</ref>


===Microscopic===
===Microscopic===
Features:
Features:
*Follicular hyperplasia.
*Dense connective tissue.
*Fibroadipose tissue.
 
===Sign out===
====No apparent inflammation====
<pre>
BURSA, RIGHT HIP, BURSECTOMY:
- BENIGN DENSE CONNECTIVE TISSUE WITH CALCIFICATIONS, AND FIBROADIPOSE TISSUE.
- NO SIGNIFICANT INFLAMMATION.
- NEGATIVE FOR MALIGNANCY.
</pre>
 
<pre>
BURSA, LEFT TROCHANTERIC, BURSECTOMY:
- BENIGN DENSE CONNECTIVE TISSUE AND BENIGN FIBROADIPOSE TISSUE.
- NO SIGNIFICANT INFLAMMATION.
- NEGATIVE FOR MALIGNANCY.
</pre>
 
==Rotator cuff tear==
===General===
*Surgically repaired.
*[[Clinical diagnosis]].
 
===Microscopic===
Features:<ref>{{Cite journal  | last1 = Longo | first1 = UG. | last2 = Berton | first2 = A. | last3 = Khan | first3 = WS. | last4 = Maffulli | first4 = N. | last5 = Denaro | first5 = V. | title = Histopathology of rotator cuff tears. | journal = Sports Med Arthrosc | volume = 19 | issue = 3 | pages = 227-36 | month = Sep | year = 2011 | doi = 10.1097/JSA.0b013e318213bccb | PMID = 21822106 }}</ref>
*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.<ref name=pmid24084435>{{Cite journal  | last1 = Kuzel | first1 = BR. | last2 = Grindel | first2 = S. | last3 = Papandrea | first3 = R. | last4 = Ziegler | first4 = D. | title = Fatty infiltration and rotator cuff atrophy. | journal = J Am Acad Orthop Surg | volume = 21 | issue = 10 | pages = 613-23 | month = Oct | year = 2013 | doi = 10.5435/JAAOS-21-10-613 | PMID = 24084435 }}</ref>
 
===Sign out===
<pre>
RIGHT SHOULDER ACROMIOM AND BURSAE, EXCISION:
- UNREMARKABLE BONE (GROSS ONLY).
- BENIGN SOFT TISSUE.
</pre>
 
<pre>
"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.
</pre>
 
<pre>
"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.
</pre>
 
=Other=
==Breast prosthesis==
*[[AKA]] ''breast implants''.
{{Main|Breast prostheses}}
 
==De Quervain syndrome==
:Should ''not'' be confused with ''[[De Quervain's thyroiditis]]'' (subacute granulomatous thryoiditis).
*[[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===
*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:
*Pain.
 
Treatment:<ref name=pmid18063716/>
*Steroid.
*Surgery.
 
===Microscopic===
Features:
*Dense connective tissue consistent with tendon.
 
===Sign out===
====Not apparent====
<pre>
FIRST EXTENSOR COMPARTMENT, RIGHT HAND, BIOPSY:
- DENSE CONNECTIVE TISSUE CONSISTENT WITH TENDON.
- FIBROUS TISSUE.
</pre>
 
==Tenosynovitis==
{{Main|Tenosynovitis}}
 
==Otosclerosis==
:''Stapes'' redirects here.
===General===
*Clinical diagnosis.
*Causes conductive hearing loss.<ref name=pmid17245017>{{Cite journal  | last1 = Declau | first1 = F. | last2 = van Spaendonck | first2 = M. | last3 = Timmermans | first3 = JP. | last4 = Michaels | first4 = L. | last5 = Liang | first5 = J. | last6 = Qiu | first6 = JP. | last7 = van de Heyning | first7 = P. | title = Prevalence of histologic otosclerosis: an unbiased temporal bone study in Caucasians. | journal = Adv Otorhinolaryngol | volume = 65 | issue =  | pages = 6-16 | month =  | year = 2007 | doi = 10.1159/000098663 | PMID = 17245017 }}</ref>
*Etiology - genetic.
**Over half a dozen genes have been identified.<ref name=omim166800>{{OMIM|166800}}</ref><ref name=omim605727>{{OMIM|605727}}</ref>
**Classically described as ''autosomal dominant''.
 
Treatment:
*Stapedectomy (removal of the stapes).<ref name=pmid22771999>{{Cite journal  | last1 = Redfors | first1 = YD. | last2 = Gröndahl | first2 = HG. | last3 = Hellgren | first3 = J. | last4 = Lindfors | first4 = N. | last5 = Nilsson | first5 = I. | last6 = Möller | first6 = C. | title = Otosclerosis: anatomy and pathology in the temporal bone assessed by multi-slice and cone-beam CT. | journal = Otol Neurotol | volume = 33 | issue = 6 | pages = 922-7 | month = Aug | year = 2012 | doi = 10.1097/MAO.0b013e318259b38c | PMID = 22771999 }}</ref>
 
===Microscopic===
Features (temporal bone):<ref name=pmid620199>{{Cite journal  | title = Otosclerosis. | journal = Br Med J | volume = 1 | issue = 6105 | pages = 63-4 | month = Jan | year = 1978 | doi =  | PMID = 620199 | PMC = 1602666 | URL = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1602666/?page=1 }}</ref>
*Classically divided into four phases:
*#Osteoclastic phase:
*#*Large spaces form in bone marrow.
*#Replacement phase:
*#*Bone replaced by basophilic web-like tissue.
*#Fibril phase:
*#*Fibrils deposited.
*#Lamellar phase:
*#*[[Lamellar bone]] forms around the blood vessels.
 
Features - (stapes):
*Unremarkable bone.{{fact}}
 
DDx:
*[[Avascular necrosis]] ~ 25% of cases diagnosed as ''otosclerosis''.<ref name=pmid620199/>
**May be due to [[fat embolism]].


Note:
Note:
*Signed-out as ''reactive lymphoid hyperplasia''.
*Avascular necrosis of the stapes crura and otosclerosis together is considered rare.<ref>{{Cite journal  | last1 = Erdoglija | first1 = M. | last2 = Sotirovic | first2 = J. | last3 = Jacimovic | first3 = V. | last4 = Vukomanovic | first4 = B. | title = Avascular necrosis of stapes crura in one case of operated otosclerosis. | journal = Acta Medica (Hradec Kralove) | volume = 55 | issue = 4 | pages = 193-7 | month =  | year = 2012 | doi =  | PMID = 23631292 | URL = ftp://orbis.lfhk.cuni.cz/Acta_Medica/2012/2012_193.pdf}}</ref>
 
Images:
*[http://commons.wikimedia.org/wiki/File:Gray918.png Stapes - sketch (WC)].
 
===Sign out===
<pre>
STAPES, RIGHT, STAPEDECTOMY:
- BENIGN BONE CONSISTENT WITH STAPES.
</pre>
 
<pre>
STAPES, RIGHT, STAPEDECTOMY:
- UNREMARKABLE BONE CONSISTENT WITH STAPES.
</pre>
 
====Missed stapes====
<pre>
STAPES, RIGHT, STAPEDECTOMY:
- BENIGN FIBROFATTY TISSUE.
- NO BONE IDENTIFIED.
</pre>
 
===External links===
*[http://otopathologynetwork.org/tbimages/chapter15/?page=3 Otosclerosis (otopathologynetwork.org)].
 
==Abdominal pannus==
*[[AKA]] ''pannus'', ''panniculus'' and ''pannona''.
{{Main|Abdominal pannus}}
 
==Empyema==
:''Empyema peel'' and ''pleural peel'' redirect here.
===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>
 
*Classically, divided into three stages.<ref name=pmid20628845>{{Cite journal  | last1 = Shiraishi | first1 = Y. | title = Surgical treatment of chronic empyema. | journal = Gen Thorac Cardiovasc Surg | volume = 58 | issue = 7 | pages = 311-6 | month = Jul | year = 2010 | doi = 10.1007/s11748-010-0599-6 | PMID = 20628845 }}</ref><ref>{{Cite journal  | last1 = Hamm | first1 = H. | last2 = Light | first2 = RW. | title = Parapneumonic effusion and empyema. | journal = Eur Respir J | volume = 10 | issue = 5 | pages = 1150-6 | month = May | year = 1997 | doi =  | PMID = 9163661 | url = http://erj.ersjournals.com/content/10/5/1150.long }}</ref>
**I - ''exudative stage'' (acute).
**II - ''fibropurulent stage'' (acute).
**III - ''organizational stage'' (chronic).
 
Etiologies - common:
*[[Pneumonia]] - most common.
*Iatrogenic.
*Trauma.
 
===Microscopic===
Features:
*Neutrophils (pus) - '''key feature'''.
*Lymphocytes.
*Plasma cells.
*Reactive fibroblasts.
*Reactive mesothelial cells - not common.
 
DDx:
*[[Malignant mesothelioma]] - should have infiltrative growth.
*[[Fibrosing pleuritis]].
 
===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>
PLEURA, LEFT, DECORTICATION:
- MIXED INFLAMMATORY INFILTRATE WITH ABUNDANT NEUTROPHILS.
- REACTIVE FIBROBLASTS AND FIBRIN.
- NO MICROORGANISMS APPARENT WITH H&E STAINING.
- 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>
 
==Toenail==
===General===
*Relatively common.
 
Indications for removal:
*Ingrown<ref name=pmid23227941>{{Cite journal  | last1 = Küçüktaş | first1 = M. | last2 = Kutlubay | first2 = Z. | last3 = Yardimci | first3 = G. | last4 = Khatib | first4 = R. | last5 = Tüzün | first5 = Y. | title = Comparison of effectiveness of electrocautery and cryotherapy in partial matrixectomy after partial nail extraction in the treatment of ingrown nails. | journal = Dermatol Surg | volume = 39 | issue = 2 | pages = 274-80 | month = Feb | year = 2013 | doi = 10.1111/dsu.12068 | PMID = 23227941 }}</ref> - typically great toe.<ref name=pmid24063180>{{Cite journal  | last1 = Jia | first1 = C. | last2 = Li | first2 = P. | last3 = Wu | first3 = Y. | last4 = Qiu | first4 = Y. | last5 = Cao | first5 = L. | last6 = Chang | first6 = C. | last7 = Zhang | first7 = Y. | title = [Modified surgical repair of severe ingrown toenail]. | journal = Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi | volume = 27 | issue = 7 | pages = 869-71 | month = Jul | year = 2013 | doi =  | PMID = 24063180 }}</ref>
*Onychomycosis - [[fungus|fungal]] infection.<ref name=pmid12752134>{{Cite journal  | last1 = Reisberger | first1 = EM. | last2 = Abels | first2 = C. | last3 = Landthaler | first3 = M. | last4 = Szeimies | first4 = RM. | title = Histopathological diagnosis of onychomycosis by periodic acid-Schiff-stained nail clippings. | journal = Br J Dermatol | volume = 148 | issue = 4 | pages = 749-54 | month = Apr | year = 2003 | doi =  | PMID = 12752134 }}</ref>
*Pigmented lesion.
**Exclude melanoma.<ref name=pmid23153047>{{Cite journal  | last1 = Fanti | first1 = PA. | last2 = Dika | first2 = E. | last3 = Misciali | first3 = C. | last4 = Vaccari | first4 = S. | last5 = Barisani | first5 = A. | last6 = Piraccini | first6 = BM. | last7 = Cavrin | first7 = G. | last8 = Maibach | first8 = HI. | last9 = Patrizi | first9 = A. | title = Nail apparatus melanoma: is trauma a coincidence? Is this peculiar tumor a real acral melanoma? | journal = Cutan Ocul Toxicol | volume = 32 | issue = 2 | pages = 150-3 | month = Jun | year = 2013 | doi = 10.3109/15569527.2012.740118 | PMID = 23153047 }}</ref>
 
===Microscopic===
Features:
*Nail plate - paucicellular, dense connective tissue.
*Keratinized squamous epithelium.
*+/-Cocci organisms.
 
DDx:
*[[Malignant melanoma]].
*Trauma.
*[[Fungus|Fungal infection]] ([[candidiasis]]).
*Bacteria infection, e.g. [[Pseudomonas]] (causes green nails).
 
===Stains===
For pigmented lesion:
*[[Prussian blue stain]] - trauma +ve, melanocytic lesion -ve.
*[[Fontana-Masson stain]] - trauma -ve, melanocytic lesion usu. +ve.
 
Query fungal infection:
*[[PAS]] +ve for fungal organisms.<ref name=pmid12752134>{{Cite journal  | last1 = Reisberger | first1 = EM. | last2 = Abels | first2 = C. | last3 = Landthaler | first3 = M. | last4 = Szeimies | first4 = RM. | title = Histopathological diagnosis of onychomycosis by periodic acid-Schiff-stained nail clippings. | journal = Br J Dermatol | volume = 148 | issue = 4 | pages = 749-54 | month = Apr | year = 2003 | doi =  | PMID = 12752134 }}</ref>
 
===Sign out===
====Pigmented nail====
<pre>
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.
</pre>
 
=====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====
<pre>
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.
</pre>
 
====Fungal organisms present====
<pre>
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.
</pre>
 
==Canal of Nuck cyst==
===General===
*Canal of Nuck is the female equivalent of the male ''processus vaginalis''.<ref name=pmid36295514/>
*Women/girls only pathology - can be thought of as inguinal hernia in women.
*Very rare pathology.<ref name=pmid36295514>{{cite journal |authors=Kohlhauser M, Pirsch JV, Maier T, Viertler C, Fegerl R |title=The Cyst of the Canal of Nuck: Anatomy, Diagnostic and Treatment of a Very Rare Diagnosis-A Case Report of an Adult Woman and Narrative Review of the Literature |journal=Medicina (Kaunas) |volume=58 |issue=10 |pages= |date=September 2022 |pmid=36295514 |pmc=9609622 |doi=10.3390/medicina58101353 |url=}}</ref>
 
===Sign out===
<pre>
A. Submitted as "Canal of Nuck Cyst", Excision::
- Benign fibroadipose tissue partially covered by mesothelium with inflammation,
  compatible with clinical impression of canal of Nuck cyst.
- NEGATIVE for malignancy.
</pre>
 
==Palmar fascia==
{{Main|Palmar fascia}}


=See also=
=See also=
Line 136: Line 953:


[[Category:Basics]]
[[Category:Basics]]
[[Category:Ditzels]]
Michael
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