funny exchange during signout

[Rbrav]

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A few days ago, our dermatology-trained dermatopathologist was signing cases out. A punch bx comes across, sarcoidosis vs. metastatic Crohn's. We (me, him, path resident) look at the slide.

DP: "This is looking more like sarcoidosis to me, but I'm sure you've seen more Crohn's disease than I have. What do you usually see in Crohn's?"
Res: "Um ... colon."

Maybe you had to be there.

 

[Sulfinator]

That's awesome. Good to know even highly-trained folks overlook the obvious now and then.

 

[HRantz]

That's awesome. Good to know even highly-trained folks overlook the obvious now and then.

What's obvious about it? Crohn's disease can have cutaneous manifestations, including the so-called metastatic Crohn's.

 

[mlw03]

someone care to explain "metastatic Crohn's" to those of us not quite there yet?

 

[cjw0918]

One day I had a lot of breast cores which I previewed and passed along to the attending-

Me (resident) shouting across AP sign-out room: "Dr. X, what do you think of my breasts?"

Attending: "I'm still looking at them..."

 

[HRantz]

someone care to explain "metastatic Crohn's" to those of us not quite there yet?

Histologically similar to Crohn's (non-caseating granulomas, negative staining for organisms, acute and chronic inflammation, +/- ulceration) except outside the GI tract. Patient typically has a history of Crohn's hence the clinical suspicion, but it can be the presenting symptom too. I've only seen one or two cases in residency. I believe "metastatic" is a misnomer. The pathogenesis is poorly understood.

 

[mlw03]

Histologically similar to Crohn's (non-caseating granulomas, negative staining for organisms, acute and chronic inflammation, +/- ulceration) except outside the GI tract. Patient typically has a history of Crohn's hence the clinical suspicion, but it can be the presenting symptom too. I've only seen one or two cases in residency. I believe "metastatic" is a misnomer. The pathogenesis is poorly understood.

gratzi

 

[Sulfinator]

What's obvious about it? Crohn's disease can have cutaneous manifestations, including the so-called metastatic Crohn's.

Ah, now I get it. I was supposed to be laughing at the resident, not the DP.😛

 

[gbwillner]

Ah, now I get it. I was supposed to be laughing at the resident, not the DP.😛

????

 

[yaah]

I think you were supposed to be laughing at the patient.

 

[Arctic Char]

I think you were supposed to be laughing at the patient.

 

[djmd]

I think you were supposed to be laughing at the patient.

That is wrong to suggest.. Horrible horrible bad...



Ahem.. er sorry there I channeled someone else...

 

[Rbrav]

Ah, now I get it. I was supposed to be laughing at the resident, not the DP.😛

Nah, they both know what they're doing. It was just a funny little exchange. They spent a while talking about the histology on the slide and whatnot, but I thought the story would be funnier keeping it short and sweet.

 

[Sulfinator]

Nah, they both know what they're doing. It was just a funny little exchange. They spent a while talking about the histology on the slide and whatnot, but I thought the story would be funnier keeping it short and sweet.

Well now I'm totally confused. Maybe I need to wait a few more years before trying to "get" path jokes.

 

[Rbrav]

Well now I'm totally confused. Maybe I need to wait a few more years before trying to "get" path jokes.

Derm-trained dermpath asks what path resident usually sees in Crohn's, resident answers "colon." I guess you did have to be there 🙂

 

[horrendoma]

hehe, loved the part about 'my breasts'.
Those jokes are quite common as we tend to use the possessive article 'my' and drop away the 'case' at the end. 'my breast case' becomes 'my breast' .

Speaking of which, I was signing out a case where the clinician wrote.... Gynaecomastia, breast reduction.
Looking at the slides, all we saw was fat, fat, and more fat, with nary a breast duct or fibrous stroma in sight. So my attending says... 'this isn't gynaecomastia, this guys just a f**king lardass.'

 

[yaah]

Attending: Where is this biopsy from?
Me: It says, "Deep tongue."
Attending: Sounds like a porno.