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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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| decortication for [[pneumonia]]
| decortication for [[pneumonia]]
| [[Pulmonary pathology]]
| [[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 -->
|}
|}


=Gastrointestinal pathology=
=Gastrointestinal pathology=
==Hernia sac==
==Hernia sac==
:''Inguinal hernia'' redirects here.
===General===
===General===
*Hernia repair (herniorrhaphy).
*Hernia repair (herniorrhaphy).
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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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=====Gross only=====
=====Gross only=====
<pre>
<pre>
SOFT TISSUE, RIGHT INGUINAL, HERNIORRHAPHY:
SOFT TISSUE, RIGHT INGUINAL, HERNIA REPAIR:
- HERNIA SAC (GROSS ONLY).
- HERNIA SAC (GROSS ONLY).
</pre>
</pre>


<pre>
<pre>
SOFT TISSUE, LEFT INGUINAL, HERNIORRHAPHY:
SOFT TISSUE, LEFT INGUINAL, HERNIA REPAIR:
- HERNIA SAC (GROSS ONLY).
- HERNIA SAC (GROSS ONLY).
</pre>
</pre>
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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:
Line 252: Line 309:


==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>
 
<pre>
Foreskin, Circumcision:
- Benign squamous mucosa with mild patchy chronic inflammation at the epidermal-dermal interface.
- NEGATIVE for dysplasia and NEGATIVE for malignancy.
</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]]:
==Leg amputation==
*Stasis, e.g. atrial fibrillation.
{{Main|Leg amputation}}
*Hypercoagulable states, e.g. cancer - see ''[[risks factors venous thromboembolism]]''.
*Endothelial injury.


===Gross===
==Toe amputation==
: 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==
===General - overview===
===General - overview===
Comes in two basic flavours:
*Like leg ampuations.
*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===
===Sign out===
:See ''[[Ditzels#Atherosclerotic peripheral vascular disease]]''.
:See ''[[Ditzels#Atherosclerotic peripheral vascular disease]]''.


==Toe amputation==
==Finger amputation==
===General - overview===
===General - overview===
*Like leg ampuations.
*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===
===Sign out===
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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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- SEVERE ATHEROSCLEROSIS.
- SEVERE ATHEROSCLEROSIS.
- NEGATIVE FOR MALIGNANCY.
- 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>
</pre>


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- ULCERATED SKIN AND CHRONIC ISCHEMIC CHANGES.
- ULCERATED SKIN AND CHRONIC ISCHEMIC CHANGES.
- BONE WITH NO SIGNIFICANT PATHOLOGY.
- 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.
- NEGATIVE FOR MALIGNANCY.
</pre>
</pre>
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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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:''Bursitis'' redirects here.
:''Bursitis'' redirects here.
===General===
===General===
*Uncommon.
*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:
Indication:
*Bursitis - 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>
*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===
Line 718: Line 653:


===Sign out===
===Sign out===
====No apparent inflammation====
<pre>
<pre>
BURSA, RIGHT HIP, BURSECTOMY:
BURSA, RIGHT HIP, BURSECTOMY:
- DENSE CONNECTIVE TISSUE.
- BENIGN DENSE CONNECTIVE TISSUE WITH CALCIFICATIONS, AND FIBROADIPOSE TISSUE.
- FIBROADIPOSE TISSUE.
- NO SIGNIFICANT INFLAMMATION.
- NO SIGNIFICANT INFLAMMATION.
- NEGATIVE FOR MALIGNANCY.
- NEGATIVE FOR MALIGNANCY.
</pre>
</pre>


=Other=
<pre>
==Breast prosthesis==
BURSA, LEFT TROCHANTERIC, BURSECTOMY:
:''Breast expander'' redirects here.
- BENIGN DENSE CONNECTIVE TISSUE AND BENIGN FIBROADIPOSE TISSUE.
- NO SIGNIFICANT INFLAMMATION.
- NEGATIVE FOR MALIGNANCY.
</pre>
 
==Rotator cuff tear==
===General===
===General===
*Commonly used for cosmesis in the context of [[breast cancer]].
*Surgically repaired.
*[[Clinical diagnosis]].


===Gross===
===Microscopic===
''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.''
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>


====Images====
===Sign out===
<gallery>
<pre>
Image:Saline-filled_breast_implants.jpeg | Breast implants. (WC)
RIGHT SHOULDER ACROMIOM AND BURSAE, EXCISION:
</gallery>
- UNREMARKABLE BONE (GROSS ONLY).
WP:
- BENIGN SOFT TISSUE.
*[http://en.wikipedia.org/wiki/File:Ruptured_implant.JPG Ruptured breast implant (WP)].
</pre>


===Sign out===
<pre>
<pre>
BREAST PROSTHESIS, RIGHT, REMOVAL:
"BURSA AND ACROMION", LEFT SHOULDER, ROTATOR CUFF REPAIR:
- INTACT BREAST PROSTHESIS (GROSS ONLY).
- BENIGN DENSE CONNECTIVE TISSUE AND BENIGN FIBROADIPOSE TISSUE.
- NO SIGNIFICANT INFLAMMATION.
- NO BONE IDENTIFIED.
- NEGATIVE FOR MALIGNANCY.
</pre>
</pre>


====Not intact====
<pre>
<pre>
BREAST PROSTHESIS, LEFT, REMOVAL:
"BURSA AND ACROMION", LEFT SHOULDER, ROTATOR CUFF REPAIR:
- BREAST PROSTHESIS WITH EVIDENCE OF PERFORATION AND LEAKAGE (GROSS ONLY).
- BENIGN DENSE WAVY CONNECTIVE TISSUE WITH FIBRE SEPARATION.
- BENIGN FIBROADIPOSE TISSUE.
- NO SIGNIFICANT INFLAMMATION.
- NO BONE IDENTIFIED.
- NEGATIVE FOR MALIGNANCY.
</pre>
</pre>
=Other=
==Breast prosthesis==
*[[AKA]] ''breast implants''.
{{Main|Breast prostheses}}


==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 780: Line 740:


==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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DDx:
DDx:
*[[Avascular necrosis]] ~ 25% of cases diagnosed as ''otosclerosis''.<ref name=pmid620199/>
*[[Avascular necrosis]] ~ 25% of cases diagnosed as ''otosclerosis''.<ref name=pmid620199/>
**May be due to [[fat embolism]].  
**May be due to [[fat embolism]].
 
Note:
*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:
Images:
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===Sign out===
===Sign out===
<pre>
STAPES, RIGHT, STAPEDECTOMY:
- BENIGN BONE CONSISTENT WITH STAPES.
</pre>
<pre>
<pre>
STAPES, RIGHT, STAPEDECTOMY:
STAPES, RIGHT, STAPEDECTOMY:
Line 874: Line 796:
- NO BONE IDENTIFIED.
- NO BONE IDENTIFIED.
</pre>
</pre>
===External links===
*[http://otopathologynetwork.org/tbimages/chapter15/?page=3 Otosclerosis (otopathologynetwork.org)].


==Abdominal pannus==
==Abdominal pannus==
{{Main|Obesity}}
*[[AKA]] ''pannus'', ''panniculus'' and ''pannona''.
===General===
{{Main|Abdominal pannus}}
*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. 
 
===Microscopic===
Features:
*Adipose tissue.
 
DDx:
*[[Lipoma]].
*[[Liposarcoma]].
 
===Sign out===
<pre>
ABDOMINAL PANNUS, EXCISION:
- BENIGN SKIN AND ADIPOSE TISSUE.
</pre>
 
<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:
Line 939: Line 851:
- 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>


Line 961: Line 882:
*Trauma.
*Trauma.
*[[Fungus|Fungal infection]] ([[candidiasis]]).
*[[Fungus|Fungal infection]] ([[candidiasis]]).
*Bacteria infection, e.g. [[Pseudomonas]] (causes green nails).


===Stains===
===Stains===
Line 1,005: Line 927:
- NO EVIDENCE OF MALIGNANCY.
- NO EVIDENCE OF MALIGNANCY.
</pre>
</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 1,014: Line 953:


[[Category:Basics]]
[[Category:Basics]]
[[Category:Ditzels]]
Michael
48,460

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