Guess the lesion

[yaah]

Sorry the pictures aren't so great...but

1) Easy one: Thigh mass

2) Hard one: Humeral head mass - is this a tumor?

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[b&ierstiefel]

yaarcoma?

 

[yaah]

yaarcoma?

Yaarcomas are more infiltrative.

 

[b&ierstiefel]

Yaarcomas are more infiltrative.

actually they're quite benign and low-grade in nature. they don't really look all that angry at low or high power either.

 

[bananaface]

Hmm. I have to disagree w/ Andy, just to be argumentative. It's not at all pirate-like.

 

[deschutes]

1) Easy one: Thigh mass

You do have a knack of making me feel stupid.

Where's the pink and purple?

 

[yaah]

You do have a knack of making me feel stupid.

Where's the pink and purple?

Gross dx is a key part of pathology!

I do not have the H&Es yet.

 

[Pookies]

OK, I'll step into it.

1) lipomyosarcoma

2) Osteosarcoma (Random Guess) Malignant. A surgeon would never cut off a limb for a benign process

 

[scopemonkey]

They both look delicious

 

[yaah]

OK, I'll step into it.

1) lipomyosarcoma

2) Osteosarcoma (Random Guess) Malignant. A surgeon would never cut off a limb for a benign process

1) Creating tumor names now, are we? I figure you could mean a leiomyosarcoma, a liposarcoma, or a rhabdomyosarcoma. This particular tumor is pretty soft and squishy, hence the gooey red area.

2) Good guess and possibly correct, but the microscopy often does not agree...I will try to take a picture of the histo slide tomorrow and see if you still agree.

 

[b&ierstiefel]

wow that was deep.

 

[yaah]

wow that was deep.

Yes, it is a deep seated lesion!

 

[b&ierstiefel]

Yes, it is a deep seated lesion!

exactly. you understood my logic 100%. good for you. wanna cookie?

 

[Pookies]

Sorry, brain fart (I was thinking lipoma for a bit)

As a med student most of my gross work has been limited to GYN, Skin, Gall bladder, hernia sack, foreign objects, and Colon. I have not seen very many bone and soft tissue tumors. I am mostly guessing.

I cant wait till next year. Autopsies and surgical path. Should be fantastic.

 

[LADoc00]

OK, I'll step into it.

1) lipomyosarcoma

2) Osteosarcoma (Random Guess) Malignant. A surgeon would never cut off a limb for a benign process

hahaha

Reminds me of consult someone sent in, they made up a name that sounded so real, I had to look it up.

Dude whats up with the gross pathology quiz. Gross pathology is WORTHLESS. No one sits around and ponders, is this a ganglioblastoma without putting in micro sections.

But....
#1 10cm soft tissue mass in the thigh, could be a liposarcoma with firm areas being foci of dedifferentiation/high grade stuff. It looks gelatinous, fatty but its fairly symmetrical and well circumscribed.

#2 Dude, what is that green crap on it? Dont tell me you inked that specimen. I need radiologic correlation. Is it primarily a metaphyseal or epiphyseal lesion? Is there cortical involvement?
But since I learned early on to game the system, if it was removed and this isnt an autposy specimen (because autopsy specimens are never inked), it must be malignant, given that it looks myxoid, I would say chondrosarcoma.

 

[b&ierstiefel]

LADoc00 - 2
yaah - 0

PWNT!

 

[bananaface]

hahaha

Reminds me of consult someone sent in, they made up a name that sounded so real, I had to look it up.

Dude whats up with the gross pathology quiz. Gross pathology is WORTHLESS. No one sits around and ponders, is this a ganglioblastoma without putting in micro sections.

But....
#1 10cm soft tissue mass in the thigh, could be a liposarcoma with firm areas being foci of dedifferentiation/high grade stuff. It looks gelatinous, fatty but its fairly symmetrical and well circumscribed.

#2 Dude, what is that green crap on it? Dont tell me you inked that specimen. I need radiologic correlation. Is it primarily a metaphyseal or epiphyseal lesion? Is there cortical involvement?
But since I learned early on to game the system, if it was removed and this isnt an autposy specimen (because autopsy specimens are never inked), it must be malignant, given that it looks myxoid, I would say chondrosarcoma.

When yaah reads , he is going to get turned on.

 

[b&ierstiefel]

yaah, where them H&E's be at?

 

[LADoc00]

yaah, where them H&E's be at?

They are stuck in poo at the moment Andy.

 

[yaah]

yaah, where them H&E's be at?

Yeah, well I am sorry but there is a delay in the H&Es. If you want to know the actual histology though the thigh lesion is a classic low grade myxoid liposarcoma. The bone lesion, however, is just marrow fibrosis. No residual tumor. Interesting, eh?

I will start taking pics of interesting cases soon...however yesterday was a 15 hour day and today was a 14 hour day and I just wasn't interested in taking pictures today!

 

[LADoc00]

Yeah, well I am sorry but there is a delay in the H&Es. If you want to know the actual histology though the thigh lesion is a classic low grade myxoid liposarcoma. The bone lesion, however, is just marrow fibrosis. No residual tumor. Interesting, eh? I will start taking pics of interesting cases soon...however yesterday was a 15 hour day and today was a 14 hour day and I just wasn't interested in taking pictures today!

That makes no sense, they did a resection/amputation for a ??? tumor, with no biopsy confirmation of involvement, then after the leg was out, realized "Ooops there be no tumor in dat bone"? Or is this a post mortem?

Dude, WTF is going on over there.

Diagnostic pandemonium.

 

[stormjen]

I admit, hearing about yaah's long days is getting me a little excited about starting residency. I am planning to go gunner and, crazy enough, I'm a little anxious to get started. If only I had $400 to throw at a Rosai and Ackerman! Maybe if I start saving my pennies...

 

[PathOne]

??? ONLY Rosai???
Haven't you ever heard of differentials?
In addition to Rosai/Ackerman, you'd AT LEAST need Sternberg's pathology and Fletcher's diagnostic histo. to match and compare. They're abt. $369 each, btw.....

If you plan on being a gunner, better add a complete lineup of the AFIP Fascicles+the WHO books.

Hope you haven't made your b-day wish-list yet!

 

[LADoc00]

??? ONLY Rosai???
Haven't you ever heard of differentials?
In addition to Rosai/Ackerman, you'd AT LEAST need Sternberg's pathology and Fletcher's diagnostic histo. to match and compare. They're abt. $369 each, btw.....

If you plan on being a gunner, better add a complete lineup of the AFIP Fascicles+the WHO books.

Hope you haven't made your b-day wish-list yet!

Or you can pay 50 cents in library fines to read em all.

 

[geddy]

??? ONLY Rosai???
Haven't you ever heard of differentials?
In addition to Rosai/Ackerman, you'd AT LEAST need Sternberg's pathology and Fletcher's diagnostic histo. to match and compare. They're abt. $369 each, btw.....

If you plan on being a gunner, better add a complete lineup of the AFIP Fascicles+the WHO books.

Hope you haven't made your b-day wish-list yet!

What about Histology for Pathologists? Useful or not?

 

[stormjen]

Okay, now I'm getting stressed out!

 

[LADoc00]

What the is the second lesion?

There has to be more a story behind this....

 

[b&ierstiefel]

What the is the second lesion?

There has to be more a story behind this....

yeah, isn't this the million dollar question now isn't it?

 

[LADoc00]

yeah, isn't this the million dollar question now isn't it?

usually when people a post case they have a story and answer. I have yet to see someone go a conference, flash a jpeg of a ****** femur specimen and say: Hmmm dont know what the fook it is, what do y'all think

is this a UMich thing?

 

[b&ierstiefel]

usually when people a post case they have a story and answer. I have yet to see someone go a conference, flash a jpeg of a ****** femur specimen and say: Hmmm dont know what the fook it is, what do y'all think

is this a UMich thing?

**** if i know...i ain't doing my residency here...unless my top 7 choices tell me to take a hike!

 

[LADoc00]

**** if i know...i ain't doing my residency here...unless my top 7 choices tell me to take a hike!

Dude, that doesnt speak well of UMich....

 

[deschutes]

Dude, that doesnt speak well of UMich....

I don't think it's a UMich thing, as much as it is a "seven years in Ann Arbor" thing.

Don't get me wrong. I like Ann Arbor. Ann Arbor is cute. Sure beats Detroit!

 

[b&ierstiefel]

I don't think it's a UMich thing, as much as it is a "seven years in Ann Arbor" thing.

Don't get me wrong. I like Ann Arbor. Ann Arbor is cute. Sure beats Detroit!

Thanks deschutes. That was exactly my point. The MSTP folks advise us to diversify our training and get the **** outta here.

 

[yaah]

usually when people a post case they have a story and answer. I have yet to see someone go a conference, flash a jpeg of a ****** femur specimen and say: Hmmm dont know what the fook it is, what do y'all think

is this a UMich thing?

Well, it's a humeral head. And he did have biopsy confirmation of the lesion, but then underwent heavy dose chemo and rads and they resected it. No residual! You can't really biopsy to see if it's still viable because your sample could be unrepresentative. That's how it works sometimes. I don't know if I was a patient if that would cheese me off or make me happy.

 

[LADoc00]

Well, it's a humeral head. And he did have biopsy confirmation of the lesion, but then underwent heavy dose chemo and rads and they resected it. No residual! You can't really biopsy to see if it's still viable because your sample could be unrepresentative. That's how it works sometimes. I don't know if I was a patient if that would cheese me off or make me happy.

Hmm, did I miss what the original tumor was? Dude, if you didnt find residual, put in tons more sections, get on that bandsaw boy and cut in more. Dood, you are lucky Im not your attending. I would be having you cutting that thing in toto until I found residual. Dont make me go all Pepper Dehner on you, its not pretty.

Anyone ever get a prostate resection and not see tumor? What do you do? Put in the whole thing.

 

[Freestyle]

Hmm, did I miss what the original tumor was? Dude, if you didnt find residual, put in tons more sections, get on that bandsaw boy and cut in more. Dood, you are lucky Im not your attending. I would be having you cutting that thing in toto until I found residual. Dont make me go all Pepper Dehner on you, its not pretty.

Anyone ever get a prostate resection and not see tumor? What do you do? Put in the whole thing.

If you were my Attending, I'd be all like "Bring it on, biotch!"

 

[deschutes]

It's called a total body biopsy.

 

[yaah]

Hmm, did I miss what the original tumor was? Dude, if you didnt find residual, put in tons more sections, get on that bandsaw boy and cut in more. Dood, you are lucky Im not your attending. I would be having you cutting that thing in toto until I found residual. Dont make me go all Pepper Dehner on you, its not pretty.

Anyone ever get a prostate resection and not see tumor? What do you do? Put in the whole thing.

Yeah, no kidding. When I got the slides back for previewing I immediately went and got the bone out and put it back in decal so I could take more. But he said he didn't want any more. Everybody's different! This case is a little different though because the humeral lesion was actually a met from a primary somewhere else - the surgeons didn't actually want to operate as it isn't going to change his prognosis much, but they ended up offering it and he jumped at the chance. So they are not incredibly concerned about residual in this case.

Worst case like that I got though (no residual) was the total penectomy for a previously biopsied (and apparently excised) SCC. Had to put through the whole scar (it was a 3cm tumor) and no residual. Isn't that just a kick in the groin.

 

[b&ierstiefel]

Isn't that just a kick in the groin.

That's like gettin' kicked squaw in the nnnnnuts!

 

[beary]

The MSTP folks advise us to diversify our training and get the **** outta here.

That's what they tell us at Iowa too. I like Iowa so much though, it will be hard for me to leave!

 

[b&ierstiefel]

That's what they tell us at Iowa too. I like Iowa so much though, it will be hard for me to leave!

yes, but you should listen to them. it's time to GTF outta dodge.

 

[yaah]

That's what they tell us at Iowa too. I like Iowa so much though, it will be hard for me to leave!

It isn't just MSTP folks who advise that - I got that advice as well from people at my school. There is something to be said for staying at the same place you do school - you're familiar with it and there may be more opportunities. But at the same time, it doesn't take a ton of time to get used to the new place.

 

[beary]

yes, but you should listen to them. it's time to GTF outta dodge.

Yeah, that's what I have been thinking lately. I certainly will go interview at a bunch of places - I actually am interested in many of the same places that you are, which I guess makes sense since we're both into research!

 

[b&ierstiefel]

It isn't just MSTP folks who advise that - I got that advice as well from people at my school. There is something to be said for staying at the same place you do school - you're familiar with it and there may be more opportunities. But at the same time, it doesn't take a ton of time to get used to the new place.

werd!
seriously though, i have nothing against the path program at michigan. i think it is one of the l33t programs in the country.

i mean ****...if you can make it to militiagan, you have the honor and privilege of meeting yaah.

 

[beary]

Do people usually do their fellowship at the same place as they do their residency?

 

[b&ierstiefel]

Do people usually do their fellowship at the same place as they do their residency?

from the little that i know and heard...yes. fellowships take a shorter period of time than residency...and sometimes it isn't worth moving to a different part of the country to do a 1 year fellowship.

but ask yaah, he's the daddy.

 

[beary]

i mean ****...if you can make it to militiagan, you have the honor and privilege of meeting yaah.

I'm there. What more could a woman ask for.

 

[b&ierstiefel]

I'm there. What more could a woman ask for.

yaah's dad.

 

[yaah]

Do people usually do their fellowship at the same place as they do their residency?

It varies. Of the people finishing here this year, a couple are going to other places for fellowships and a few more are staying here. Both hemepath fellows this year are from somewhere else, and one of the cyto fellows is. All the surg path related fields are internal though. But then again there are quite a few fellowships here. I think it all depends on you. A lot of people don't like moving for a year to go to do a fellowship.

 

[b&ierstiefel]

It varies. Of the people finishing here this year, a couple are going to other places for fellowships and a few more are staying here. Both hemepath fellows this year are from somewhere else, and one of the cyto fellows is. All the surg path related fields are internal though. But then again there are quite a few fellowships here. I think it all depends on you. A lot of people don't like moving for a year to go to do a fellowship.

totally. i can't agree more. this was one of the most smartest greatest posts i've read this evening.