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Ditzels (view source)

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[[Image:Tonsillectomy tonsils.JPEG|thumb|right|220px|Tonsils (at [[cut-up]]) are a common ditzel. ([[WC]]/Katotomichelakis ''et al.'')]]
This article collects '''ditzels''', which are, in the context of [[pathology]], little specimens that are typically one or two slides and usually of little interest.<ref>{{Ref TPoSP|37}}</ref>
This article collects '''ditzels''', which are, in the context of [[pathology]], little specimens that are typically one or two slides and usually of little interest.<ref>{{Ref TPoSP|37}}</ref>


The challenge in ditzels is not falling asleep... so one misses the unexpected (subtle) tumour.
The challenge in ditzels is not falling asleep... so one misses the unexpected (subtle) tumour.  


=The big table of ditzels=
=The big table of ditzels=
{| class="wikitable sortable"  
{| class="wikitable sortable"  
! Specimen  
! Specimen  
! Typical context (diagnosis)
! System
! System
! Comment
|-
|-
| [[Hernia sac]]
| [[Hernia sac]]
| hernia
| [[Gastrointestinal pathology]]
| [[Gastrointestinal pathology]]
| hernia
|-
|-
| [[Stoma]]
| [[Stoma]] (reversal)
| bowel obstruction, perforated viscus ([[peritonitis]])
| [[Gastrointestinal pathology]]
| [[Gastrointestinal pathology]]
| stoma reversal
|-
|-
| [[Sleeve gastrectomy]]  
| [[Sleeve gastrectomy]]  
| [[obesity]]
| [[Gastrointestinal pathology]]
| [[Gastrointestinal pathology]]
| obesity
|-
|-
| [[Vertebral disc]]
| [[Vertebral disc]]
| herniated disc
| [[Neuropathology]]
| [[Neuropathology]]
| herniated disc
|-
|-
| [[Bands of Ladd]]
| [[Bands of Ladd]]
| [[bands of Ladd]]
| [[Paediatric pathology]]
| [[Paediatric pathology]]
|
|-
|-
| [[Cholesteatoma]]
| [[Cholesteatoma]]
| [[cholesteatoma]]
| [[Paediatric pathology]]
| [[Paediatric pathology]]
|-
|-
| [[Femoral head]]
| [[Femoral head]]
| [[hip fracture]], hip [[osteoarthritis|OA]]
| Orthopaedic
| Orthopaedic
| [[hip fracture]], hip [[osteoarthritis|OA]]
|-
|-
| [[Bone reamings]]
| [[Bone reamings]]
| [[hip fracture]]
| Orthopaedic
| Orthopaedic
|
|-
|-
| [[Tonsil]]
| [[Tonsil]]
| [[tonsillitis]]
| [[Head and neck pathology]]
| [[Head and neck pathology]]
| tonsilitis
|-
|-
| [[Leg amputation]]
| [[Leg amputation]]
| [[atherosclerotic peripheral vascular disease]], trauma
| [[Cardiovascular pathology]]
| [[Cardiovascular pathology]]
| [[atherosclerosis]]
|-
|-
| [[Lipoma]]
| [[Lipoma]]
| lipoma
| [[Soft tissue pathology]]
| [[Soft tissue pathology]]
|
|-  
|-  
| [[Heterotopic ossification]]
| [[Heterotopic ossification]]
| contractures
| [[Soft tissue pathology]]
| [[Soft tissue pathology]]
| contractures
|-
|-
| [[Tubal ligation]]
| Uterine tubes ([[tubal ligation]])
| completed family
| [[Gynecologic pathology]]
| [[Gynecologic pathology]]
| completed family
|-
|-
| [[Pressure ulcer]] ([[AKA]] decubitus ulcer)
| [[Pressure ulcer]] ([[AKA]] decubitus ulcer)
| [[ulcer]], immobility
| [[Dermatopathology]]
| [[Dermatopathology]]
|
|-
|-
| [[Vasectomy]]
| Vas deferens ([[vasectomy]])
| completed family
| [[Genitourinary pathology]]
| [[Genitourinary pathology]]
| completed family
|-
|-
| [[Uvula]]
| [[Uvula]]
| [[obstructive sleep apnea]]
| [[Head and neck pathology]]
|-
| [[Stapes]]
| [[otosclerosis]]
| [[Head and neck pathology]]
| [[Head and neck pathology]]
| obstructive sleep apnea
|-
| [[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 -->
|}
|}


=Gastrointestinal pathology=
=Gastrointestinal pathology=
==Hernia sac==
==Hernia sac==
:''Inguinal hernia'' redirects here.
===General===
===General===
*Hernia repair.
*Hernia repair (herniorrhaphy).
*Pathologic findings are very unusual 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>
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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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   INFLAMMATION AND REACTIVE CHANGES -- CONSISTENT WITH HERNIA SAC.
   INFLAMMATION AND REACTIVE CHANGES -- CONSISTENT WITH HERNIA SAC.
- NEGATIVE FOR MALIGNANCY.
- 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>
</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 done for a number of reasons:
Stomas are created for a number of reasons:
*Perforated viscous/peritonitis.
*Perforated viscous/peritonitis.
**Trauma.
**Trauma.
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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:
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===Sign out===
===Sign out===
====Colostomy====
<pre>
<pre>
COLOSTOMY, COLOSTOMY REVERSAL:
COLOSTOMY, COLOSTOMY REVERSAL:
- LARGE BOWEL WALL WITH SUBMUCOSAL FIBROSIS -- OTHERWISE WITHIN NORMAL LIMITS.
- 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.
- SKIN WITHOUT SIGNIFICANT PATHOLOGY.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
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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.
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>
</pre>


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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=
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*[[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===
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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.


=Head and neck pathology=
==Labia==
==Tonsillitis==
:''Tonsil'' redirects here.
===General===
===General===
*Commonly removed (tonsillectomy) when enlarged.
*Operation ''labioplasty''.
*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===
===Microscopic===
Features:
Features:
*Follicular hyperplasia - see ''[[lymph node pathology]]''.
*Squamous epithelium with compact keratin.
*+/-Colonies (clusters) of [[actinomycetes]] in the tonsillar crypts.
*Fibrous stroma.
 
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>


===Sign out===
===Sign out===
<pre>
<pre>
A. TONSIL, LEFT, TONSILLECTOMY:
LABIA MINORA, RIGHT, LABIOPLASTY:
- REACTIVE FOLLICULAR HYPERPLASIA.
- BENIGN SKIN WITH A THIN LAYER OF COMPACT KERATIN FIBROTIC STROMA -- CONSISTENT
- REACTIVE SQUAMOUS MUCOSA.
  WITH LABIA MINORA.
 
B. TONSIL, RIGHT, TONSILLECTOMY:
- REACTIVE FOLLICULAR HYPERPLASIA.
- REACTIVE SQUAMOUS MUCOSA.
</pre>
</pre>


====Without squamous mucosa====
=Head and neck pathology=
<pre>
==Tonsillitis==
A. TONSIL, LEFT, TONSILLECTOMY:
{{Main|Tonsillitis}}
- REACTIVE FOLLICULAR HYPERPLASIA.
{{Main|Tonsil}}
 
B. TONSIL, RIGHT, TONSILLECTOMY:
- REACTIVE FOLLICULAR HYPERPLASIA.
</pre>


==Obstructive sleep apnea==
==Obstructive sleep apnea==
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*Clinical diagnosis.
*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>
*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===
===Microscopic===
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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]]''.
===General - overview===
Features:
*Like leg ampuations.
*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.
*Thromboembolus.
*Fat embolism.
*Amniotic fluid embolus.
*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===
===Sign out===
<pre>
:See ''[[Ditzels#Atherosclerotic peripheral vascular disease]]''.
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==
===Overview===
Comes in two basic flavours:
*Above the knee ampuation (AKA).
*Below the knee ampuation (BKA).


Etiology:
==Finger amputation==
*[[Diabetes mellitus]] - most common - see ''[[atherosclerotic peripheral vascular disease]]''.
===General - overview===
*Trauma.
*Similar to [[toe amputation]]s.
*Infection - see ''[[chronic osteomyelitis]]''.
*Drug use, e.g. [[cocaine]].<ref name=pmid17059855/>


==Toe amputation==
May be done due to:
*Like leg ampuations.
*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===
<pre>
:See ''[[Ditzels#Atherosclerotic peripheral vascular disease]]''.
TOE, RIGHT THIRD, AMPUTATION:
- SKIN WITH MARKED DERMAL FIBROSIS.
- MILD ATHEROSCLEROSIS.
</pre>


==Atherosclerotic peripheral vascular disease==
==Atherosclerotic peripheral vascular disease==
:''Diabetic foot'' redirects here.
*[[AKA]] ''peripheral vascular disease''.
{{Main|Atherosclerosis}}
{{Main|Atherosclerosis}}
===General===
===General===
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===Gross===
===Gross===
*+/-Ulceration.
*+/-Ulceration.
*+/-Gangrene - black skin - subclassified:
*+/-[[Gangrene]] - black skin - subclassified:
**"Wet" = moist/oozing fluid.  
**"Wet" = moist/oozing fluid.  
**"Dry" = shriveled, no moisture apparent.
**"Dry" = shriveled, no moisture apparent.
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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===
====Forefoot amputation====
<pre>
RIGHT FOREFOOT, AMPUTATION:
- ULCERATED SKIN.
- MODERATE-TO-SEVERE ATHEROSCLEROSIS.
- BLOOD VESSEL WITH RECANALIZATION.
- NEGATIVE FOR MALIGNANCY.
</pre>
====Leg amputation====
<pre>
<pre>
LEFT LEG, BELOW KNEE AMPUTATION:
LEFT LEG, BELOW KNEE AMPUTATION:
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- MARROW CAVITY FIBROSIS WITH SIDEROPHAGES.
- MARROW CAVITY FIBROSIS WITH SIDEROPHAGES.
- RESECTION MARGIN WITH VIABLE TISSUE.
- 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>


<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>
<pre>
SECOND TOE, LEFT, AMPUTATION:
SECOND TOE, LEFT, AMPUTATION:
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- SKIN WITH FIBROUS DERMIS AND A NON-SPECIFIC DERMAL PERIVASCULAR LYMPHOPLASMACYTIC  
- SKIN WITH FIBROUS DERMIS AND A NON-SPECIFIC DERMAL PERIVASCULAR LYMPHOPLASMACYTIC  
INFILTRATE.
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>
</pre>


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==Heterotopic ossification==
==Heterotopic ossification==
*Abbreviated ''HO''.
*Abbreviated ''HO''.
{{Main|Heterotopic ossification}}
==Lumbar bone==
===General===
===General===
*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 }}
*May be seen in the context of laminectomies to treat cauda equina syndrome.
</ref>
 
*Injury at site.
===Microscopic===
*May be seen in the context of tetraplegia.
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===
*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>


Clinical:<ref name=pmid21611960/>
Note:
*+/-Joint stiffness.  
*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>
*+/-Swelling.
*+/-Pain.


===Microscopic===
===Microscopic===
Features:
Features:
*[[Lamellar bone]] - has layering/lines (best seen with polarized light).
*Dense connective tissue.
*+/-Skeletal muscle (within the marrow space).
*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]].


DDx:
===Microscopic===
*[[Myositis ossificans]] - inflammation, cellular.
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>
*[[Osteosarcoma]], extraskeletal.
*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===
===Sign out===
<pre>
<pre>
LESION ("HETEROTOPIC OSSIFICATION"), RIGHT FEMUR, EXCISION:
RIGHT SHOULDER ACROMIOM AND BURSAE, EXCISION:
- BONE -- CONSISTENT WITH MUSCLE HETEROTOPIC OSSIFICATION.
- 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.
- NEGATIVE FOR MALIGNANCY.
</pre>
</pre>


====Micro====
<pre>
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.
"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=
=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>


Line 528: Line 732:


===Sign out===
===Sign out===
====Not apparent====
<pre>
<pre>
FIRST EXTENSOR COMPARTMENT, RIGHT HAND, BIOPSY:
FIRST EXTENSOR COMPARTMENT, RIGHT HAND, BIOPSY:
Line 535: Line 740:


==Tenosynovitis==
==Tenosynovitis==
{{Main|Tenosynovitis}}
==Otosclerosis==
:''Stapes'' redirects here.
===General===
===General===
*Uncommon pathology specimen.
*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===
===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>
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>
*Dense connective tissue (tendon).
*Classically divided into four phases:
*Histocytes.
*#Osteoclastic phase:
*+/-[[Psammoma bodies]].
*#*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:
DDx:
*Calcific tendinitis.
*[[Avascular necrosis]] ~ 25% of cases diagnosed as ''otosclerosis''.<ref name=pmid620199/>
*[[Giant cell tumour of the tendon sheath]].
**May be due to [[fat embolism]].
*[[Palmar fibromatosis]].
 
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>


===IHC===
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:
Features:
*CD68 +ve.
*Neutrophils (pus) - '''key feature'''.
*Beta-catenin -ve.
*Lymphocytes.
*Plasma cells.
*Reactive fibroblasts.
*Reactive mesothelial cells - not common.


Note:
DDx:
*Immunostains are usually not required for the diagnosis.
*[[Malignant mesothelioma]] - should have infiltrative growth.
*[[Fibrosing pleuritis]].


===Sign out===
===Sign out===
<pre>
<pre>
TENOSYNOVIUM, LEFT MIDDLE FINGER, EXCISION:
A. Right Pleural, Pleural Peel:
- DENSE CONNECTIVE TISSUE (CONSISTENT WITH TENDON) WITH LYMPHOHISTOCYTIC INFILTRATE.
    - Proliferative fibroblasts with marked reactive changes.
- NEGATIVE FOR GIANT CELLS.  
    - 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.
- NEGATIVE FOR MALIGNANCY.
</pre>
</pre>


====Micro====
====Not labelled as a peel====
The sections show dense connective tissue (tendon) containing a cluster of cells with
<pre>
indistinct cellular borders, abundant foamy grey cytoplasm, and round/oval
Left Lung, Biopsy:
pale-staining nuclei with small nucleoli (histiocytes). The cell cluster has a small
- Fibrin, neutrophils, necrotic tissue and a fibroblastic
number of interspersed lymphocytes, and the centre of the cell cluster has acellular
  response, compatible with empyema peel.
hyaline material (degenerative tendon).
- 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>


No calcification is identified. No giant cells are seen.
===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>


No nuclear atypia is apparent and no mitotic activity is appreciated.
==Palmar fascia==
{{Main|Palmar fascia}}


=See also=
=See also=
Line 584: Line 953:


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