Barrett's Esophagus

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LADoc00

LADoc00

Gen X, the last great generation
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For intestinal metaplasia are people still using Alcian Blues at 2.5pH or is that crap gone by the wayside?
 
I haven't seen it used here at all, but then again they avoid stains like that here for the most part. Isn't there a histochemical stain for the appropriate mucin now?

Some people I guess are looking at CDX2 stains to ID it.
 
yaah said:
I haven't seen it used here at all, but then again they avoid stains like that here for the most part. Isn't there a histochemical stain for the appropriate mucin now?

Some people I guess are looking at CDX2 stains to ID it.
Click to expand...

Ever since that crazed resident assassinated Haggitt, the GI path field has been all downhill....
 
LADoc00 said:
For intestinal metaplasia are people still using Alcian Blues at 2.5pH or is that crap gone by the wayside?
Click to expand...


stanford isn't promoting alcian blue use for it...mainly led by Dr. Longacre's claim to rid the stain in intestinal metaplasia dx based on the pitfall that esophageal submucosal glands are alcian blue +
 
LADoc00 said:
Ever since that crazed resident assassinated Haggitt, the GI path field has been all downhill....
Click to expand...

Wow!

I just read about that after you mentioned it.

How common is it for residents to be asked to leave at the end of the year? I thought in path everyone stayed, while surg had lots of attrition.
 
fedor said:
Wow!

I just read about that after you mentioned it.

How common is it for residents to be asked to leave at the end of the year? I thought in path everyone stayed, while surg had lots of attrition.
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"asked to leave"? Never heard of that. Few people in pathology do leave after their first year though, I imagine.
 
AndyMilonakis said:
"asked to leave"? Never heard of that. Few people in pathology do leave after their first year though, I imagine.
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People are asked to leave all the time, from almost all programs. Someone may vanish and the reason may not be clear to everyone, but it is a regular occurrence.

Actually, firing of staff pathologists is also very common so dont think everything is all good once you are boarded and out in the real world. I think the number is like 10-15% of groups that reported firing a staff last year.
 
Having encountered some strange residents over the years during med school, I can see why many people would get fired. Way too much incompetence in the world.
 
yaah said:
Having encountered some strange residents over the years during med school, I can see why many people would get fired. Way too much incompetence in the world.
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It is unbelievable sometimes how some of these incompetent people have gotten as far as they did.
 
beary said:
It is unbelievable sometimes how some of these incompetent people have gotten as far as they did.
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Yeah, every day I thank the heavens about how lucky I have been!
 
I was introduced to the Peters Principle on my psychiatry rotation.

The principle states: "In an organization, each person rises to the level of his own incompetence."

Then again, I also like the other quote that goes: One tries to be extraordinary - but more often one tries simply to survive.
 
LADoc00 said:
For intestinal metaplasia are people still using Alcian Blues at 2.5pH or is that crap gone by the wayside?
Click to expand...

I order an Alcian Blue only rarely, maybe 2-3 times/yr. It really should confirm what you already suspect.
 
LADoc00 said:
Ever since that crazed resident assassinated Haggitt, the GI path field has been all downhill....
Click to expand...

Word. That was a sick, sick act. I think of him whenever I give a Haggitt's Level for an intramucosal adenoca in a polyp.

I remember the day that happened, btw. There were more than a few nervous attendings in my dept. who had been particularly cruel to residents prior to that tragedy. They were holded up in their offices nervous that a copycat resident would come after them or something.
 
pathdawg said:
Word. That was a sick, sick act. I think of him whenever I give a Haggitt's Level for an intramucosal adenoca in a polyp.

I remember the day that happened, btw. There were more than a few nervous attendings in my dept. who had been particularly cruel to residents prior to that tragedy. They were holded up in their offices nervous that a copycat resident would come after them or something.
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HUH? You were there?

Okay, spill the beans....what happened?


..Unrelated GI ?: Okay, intestinal metaplasia in the stomach is meaningless right?? Does any mention it in the Dx line? crap its been years since I signed out GI.
 
LADoc00 said:
HUH? You were there?

Okay, spill the beans....what happened?


..Unrelated GI ?: Okay, intestinal metaplasia in the stomach is meaningless right?? Does any mention it in the Dx line? crap its been years since I signed out GI.
Click to expand...

I was a fellow at the time, not at UWash, but at an east coast medical center. Word of the shooting spread very quickly that day and there were nervous attendings nationwide.

I don't think intestinal metaplasia of the stomach is meaningless, since they are more prone to dysplasia. I always mention the presence of intesinal metaplasia and they comment on the presence or absence of dysplasia.
Thats how I roll.
 
pathdawg said:
I was a fellow at the time, not at UWash, but at an east coast medical center. Word of the shooting spread very quickly that day and there were nervous attendings nationwide.

I don't think intestinal metaplasia of the stomach is meaningless, since they are more prone to dysplasia. I always mention the presence of intesinal metaplasia and they comment on the presence or absence of dysplasia.
Thats how I roll.
Click to expand...

Dude, Im gonna have to roll with you on that point then. Sounds good.
 
Intestinal metaplasia in the stomach, you have to look at whether it is associated with atrophy and neuroendocrine cell hyperplasia, thus MAG or AAG. But I think yeah you can have random areas of intestinal metaplasia without any huge significance, and whether there is dysplasia usually isn't commented on, unless there is. It isn't like Barrett's where they do surveillance for it.
 
Bile reflux would probably cause intestinal metaplasia in addition to reactive gastropathy.
 
Mrbojangles said:
Bile reflux would probably cause intestinal metaplasia in addition to reactive gastropathy.
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Actually, no. Intestinal metaplasia is not a feature of reactive gastropathy. In fact, if I see a "chemical"-type pattern but then notice intestinal metaplasia, I think twice before calling it a chemical gastritis.
 
FFS....

I got someone in my group who is going on record as to disagreeing with me on a hysterectomy case, another partner called it well differentiated endometrial adenoCA on frozen and I agreed on my resection specimen...but, the third reviewer claims that you need to have distinct nucleoli in the absence of a high mit count, mets or angiolymph invasion....this thing grossly was a papillary mass invasive to outer 1/2 myomet about 2-3 cm in GD, FIGO grade 1...could it be all just complex hyperplasia with adenomyosis? I find it absurd nucleoli in endometrial lesions are all powerful...

My super powers are eluding me this morning, too much sangria yesterday....
 
At my early stage I tend to wonder about any diagnosis which relies on the presence or absence of nucleoli, something which seems to vary depending on the histo processor and staining method. At the VA, we never see nucleoli in the prostate cores. Here at the U, we see them in benign glands all the time.

That case sounds like CA to me (seems awfully deep invasion for just adenomyosis), but I am starting to realize that the masters and mistresses of vag path keep creating more subcategories and new definitions to justify their specialty. Seriously, WTF is a borderline tumor anyway? Is it cancer or not? Make up your ****ing minds! Any specialty that names an entity "Benign metastasizing leiomyoma" needs a reality check.
 
yaah said:
At my early stage I tend to wonder about any diagnosis which relies on the presence or absence of nucleoli, something which seems to vary depending on the histo processor and staining method. At the VA, we never see nucleoli in the prostate cores. Here at the U, we see them in benign glands all the time.

That case sounds like CA to me (seems awfully deep invasion for just adenomyosis), but I am starting to realize that the masters and mistresses of vag path keep creating more subcategories and new definitions to justify their specialty. Seriously, WTF is a borderline tumor anyway? Is it cancer or not? Make up your ****ing minds! Any specialty that names an entity "Benign metastasizing leiomyoma" needs a reality check.
Click to expand...

Vaginas and their contents have always been a great enigma to me.
 
LADoc00 said:
FFS....

I got someone in my group who is going on record as to disagreeing with me on a hysterectomy case, another partner called it well differentiated endometrial adenoCA on frozen and I agreed on my resection specimen...but, the third reviewer claims that you need to have distinct nucleoli in the absence of a high mit count, mets or angiolymph invasion....this thing grossly was a papillary mass invasive to outer 1/2 myomet about 2-3 cm in GD, FIGO grade 1...could it be all just complex hyperplasia with adenomyosis? I find it absurd nucleoli in endometrial lesions are all powerful...

My super powers are eluding me this morning, too much sangria yesterday....
Click to expand...

LA,

A good rule of thumb is that if you have a significant disagrement within your department on a case, that case should be sent out for consultation to an "expert".

However...the presesence of nucleoli is meaningless. Look for actual stromal invasion into the myometrium with an accompanying "stromal reaction" to the tumor. It can indeed be tough to differentiate this from complex hyperplasia involving adenomyosis, but I rely heavily on stromal reaction.

Again, so as to not have professional or political fallout, send the case out to Scully or some endometrium guru at some impressive-sounding place.
 
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