joint shavings

[trudyfae]

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just curious... how do you guys sign out joint shavings with no particular diagnostic abnormality? i just had 4 in a row (almost fell asleep at the scope) and was wondering. I generally give a description of whatever type of tissue i see. thanks 🙂

 

[LADoc00]

just curious... how do you guys sign out joint shavings with no particular diagnostic abnormality? i just had 4 in a row (almost fell asleep at the scope) and was wondering. I generally give a description of whatever type of tissue i see. thanks 🙂

You sign them out, rule out neoplasm and thank whatever Ortho diety designed to send you such offerings...its free money.

 

[2121115]

You sign them out, rule out neoplasm and thank whatever Ortho diety designed to send you such offerings...its free money.

I would hope to build a practice around that, if I could be so lucky.

 

[Patho2009]

Knee, right, shaving:
- fragments of degenerated cartilage negative for malignancy.

 

[Pingu]

-Fibrocartilage with degenerative change
-No evidence of acute inflammation, crystal deposition, or malignancy

My orthos love to know about the crystals

 

[rirriri]

there is no reason to say 'negative for malignancy'.....joint shavings are routine specimens, they're not looking for malignancy.

other than that, always focus on any degenerative changes, mention that it is composed of fibrocartilage, mention if there are any bone or cartilage pieces present, mention if there are any loose bodies, as well as any positive findings like crystals (primarily CPPD observed in these tissues), etc

 

[pathdoc68]

I don't see this type of specimen in my practice. But I am curious, are they truly fibrocartilage which is more characteristic of say an intervertebral disc or fragments of hyaline cartilage which you are more likely to see from the articular surface?

 

[zao275]

I don't see this type of specimen in my practice. But I am curious, are they truly fibrocartilage which is more characteristic of say an intervertebral disc or fragments of hyaline cartilage which you are more likely to see from the articular surface?

They are hyaline cartilage rather than fibrocartilage. But I agree with the above statements about listing degenerative changes if present. Otherwise, just say fragments of cartilage (and bone if present). No need to comment on malignancy in my opinion.

Jerad

 

[Pingu]

There is no reason to comment on maligancy...unless your orthos ask for it and mine do. They even ask about malignancy on synovial frozens for acute inflammation. One of them had a case of PVNS a few years back and ever since then, he asks and somehow he got the rest of them into it.

 

[deleted314957]

There is no reason to comment on maligancy...unless your orthos ask for it and mine do. They even ask about malignancy on synovial frozens for acute inflammation. One of them had a case of PVNS a few years back and ever since then, he asks and somehow he got the rest of them into it.

Just a habit i've developed over 30 years but my diagnoses almost always have "no atypical features seen" as the last sentence if such is the case.
It seems to be reassuring to a number docs.

 

[gschl1234]

No need to comment on malignancy in my opinion.

Jerad

I agree. They also seem to like to know about presence or absence of acute inflammation. Do you not include that in your Dx?

 

[deleted314957]

I agree. They also seem to like to know about presence or absence of acute inflammation. Do you not include that in your Dx?

in joint stuff i almost always comment on acute inflam and crystals.
in intravertebral discs i will comment on neovasculasr proliferation which is one of the objective findings which has a significant positive correlation with history of herniation.

 

[zao275]

I agree. They also seem to like to know about presence or absence of acute inflammation. Do you not include that in your Dx?

Most joint material I have seen is from knee or hip arthroplasty. My diagnosis for these is typically "Degenerative Joint Disease". If crystals are present, I comment on them but don't normally state they are absent (as the indication for most of these cases is osteoarthritis). I don't usually mention absence of acute inflammation unless it is a revision arthroplasty or removal of hardware, as inflammation is suspected and clinically important in such cases.

Perhaps I should start mentioning absence of crystals. Nice idea.

Regarding mentioning "no cancer" or "no atypical features"....I can't fault anyone for that. As I am only a fellow, I don't have a good feel for what real world clinicians want me to say yet!

Jerad

 

[zao275]

One of them had a case of PVNS a few years back and ever since then, he asks and somehow he got the rest of them into it.

Awesome!

 

[green mantis]

There is no reason to comment on maligancy...unless your orthos ask for it and mine do. They even ask about malignancy on synovial frozens for acute inflammation. One of them had a case of PVNS a few years back and ever since then, he asks and somehow he got the rest of them into it.

Is PVNS considered a malignancy?

I was taught to mention certain negatives in the diagnosis. According to one of my attendings, if you didn't mention it, you didn't look for it. This was also one of the reason why he didn't like templates for grossing & final diagnoses.


----- Antony

 

[KCShaw]

I think if your clientele is stable and trusts you, then there is little need to routinely include lots of negatives, particularly if the specimen isn't being sent solely to rule in/out X (which in that case is negative/absent). I also think there's nothing wrong with routinely including a set of relevant negatives; you never know who's going to look at the report later, nor how the "standard of care" perceptions may change over time, and for some people it's a reminder to look for those extra things (crystals, etc.) in specimens perhaps they don't always see.

 

[zao275]

Is PVNS considered a malignancy?

No, diffuse-type tenosynovial giant cell tumor (aka pigmented villonodular synovitis) is a benign neoplasm that is essentially a clinical variation on the localized type of that same disease (aka giant cell tumor of tendon sheath). Both types of TSGCT look very similar, if not identical, microscopically, and the main differentiation between the two is the clinical presentation/extent of disease. Atypical/malignant/metastasizing examples of these tumors have been reported, but they are quite rare. However, PVNS/Diffuse TSGCT can be locally aggressive/recurrent, involving soft tissue around the joint, and even leading to issues with joint mobility.

Jerad

PS - These tumors are often desmin positive (usually focal), a fact that is not widely known, I think.

 

[Torsed]

Knee, right, shaving:
- fragments of degenerated cartilage negative for malignancy.

There is a god among us. Go team ortho!