Path Consult Needed

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Ha! That's a great thread. I have no idea what it is.

I nominate Andy since he has spent so much time on vag path lately.
 
I have no idea what it is...people on that thread are making it seem like it's a foreign object.
 
Members don't see this ad :)
The original post was October 29. If it wasn't plopped in formalin then, I highly doubt path is going to show anything now.

If it is even organic/cellular.
 
The thread has been updated with 2 new pictures.

Maybe we can request the picture taker to cross-section it if it will help.

Normally I read these forums on break while I eat, but that thread has given me second thoughts about that strategy.
 
You can still probably do histology on it and see if there is any real structure or if it's synthetic or plant material or whatever. Decomp bodies sit around for weeks and you can still do histology. Alcohol is something of a fixative anyway.

There's no blood and it's firm. I would presume it's foreign material.
 
fedor said:
The thread has been updated with 2 new pictures.
Click to expand...
Not showing on my screen. Oh well.

fedor said:
Normally I read these forums on break while I eat, but that thread has given me second thoughts about that strategy.
Click to expand...
No worries, by the end of med school you will be seasoned enough to appreciate food no matter what ;)
 
yaah said:
There's no blood and it's firm. I would presume it's foreign material.
Click to expand...
Yeah, certainly on the differential. Perhaps a fragment of the ultra-dildonic 4000...who knows.

I'm curious as to exactly where this came from and how it was extracted and if extraction of the specimen led to bleeding.
 
deschutes said:
But those lumps look completely different from the original blob. I am thinking they belong to other threads?
Click to expand...

The first one is in solution. The next three are not.

I wonder if the poster is trying to pull a fast one on us and it's actually a piece of chicken or something.
 
hello! I'm the one posting in there with the is it a dildo,condom, chocolate cyst and now possibly fetus... the thing is and tell me if I'm wrong, it looks like some kind of rubber I've seen before - NOT A DILDO SO SHAD UP!

I'm wondering if that coudl possibly BE a fetus or what did I jsut read about in OBGYn last week, a kind of growth that eventually extrudes from the uterus - I can't remember is it endometrioma? THe description for it is: On physical exam you can see it hanging out of the cervix, looks like globular tissue - is it like an adenomyosis that can extrude? ARRGHGHGH can't remember.

Well what do you think Fedor?
 
fedor said:
The first one is in solution. The next three are not.

I wonder if the poster is trying to pull a fast one on us and it's actually a piece of chicken or something.
Click to expand...


Fedor, i was going to say and then i deleted above: doesn't it look like rubber glue? you know when you roll it up like that? or some kind of polymer
 
Members don't see this ad :)
It's hard to know exactly what it is simply from the gross photo. We don't know what it feels like. It would be useful to have any histology...especially if this is not foreign body material.

Let's presume for a moment that this is not foreign material (and not having handled this specimen), I may be barking up the wrong tree here.

You say that this growth is hanging out of the cervix. It could be some funky endocervical polyp (not likely from the gross but still somewhere on the differential). It could be some endometrial based mass that is extensive enough to come out of the cervical os. If we go on with this line of reasoning, it doesn't really look like an endometrial polyp either. If this could be cancer, then our differential expands quite a bit...and we would need to see the histology.

You mention adenomyosis. This is not likely since adenomyosis involves the presence of endometrial glands and stroma within the myometrium of the uterus. It would be very very difficult to remove an adenomyoma manually without eliciting pain or bleeding.

Endometriosis...well this is an odd location or presentation but endometriosis can present in funny ways.

Fragment of a fetus...this could be a possibility. Maybe this random chunk of tissue is a fragment of a fetus papyracious. Doesn't look like it though.
 
Leiomyomata and endocervical polyps can both protrude out of the cervix, and fetal parts can be passed as well. However, all of these pass with a lot of blood. I highly doubt it is a fragment of fetus.
 
Hi Andy, well thanks for that reply - I'm not even the one who made the post! I'm just obsessed with what it is LOLOLOL :laugh: So I went on a path site jsut now here: http://www-medlib.med.utah.edu/WebPath/FEMHTML/FEM115.html and its saying endometriosis can show up anywhere (just like you said) even in vagina.

I'm just curious as to 1. how did an MS2 get this specimen to TAKE HOM

2. how can someone NOT WANT THAT SENT TO PATH AFTER IT CAME OUT?

Its a bit fishy to me!

ok i just fnished looking at a bunch of pics and from what i've seen, the only thing that looks remotely rubbery like that in those gross pics are fibromas - so I dont know! I give up :)
 
Poety said:
2. how can someone NOT WANT THAT SENT TO PATH AFTER IT CAME OUT?
Click to expand...
Yeah, well the clinicians have to deal with that part. :laugh: As a pathologist, I love saying that!
 
Poety said:
Hi Andy, well thanks for that reply - I'm not even the one who made the post! I'm just obsessed with what it is LOLOLOL :laugh: So I went on a path site jsut now here: http://www-medlib.med.utah.edu/WebPath/FEMHTML/FEM115.html and its saying endometriosis can show up anywhere (just like you said) even in vagina.

I'm just curious as to 1. how did an MS2 get this specimen to TAKE HOM

2. how can someone NOT WANT THAT SENT TO PATH AFTER IT CAME OUT?

Its a bit fishy to me!

ok i just fnished looking at a bunch of pics and from what i've seen, the only thing that looks remotely rubbery like that in those gross pics are fibromas - so I dont know! I give up :)
Click to expand...


Yeah the small brown black spots are the endometrial implants not the fleshy looking thing. A fibroid would probably be round white and rubbery, the shape of that thing really looks like a maybe a spermicidal sponge? I dont think its biologic? Maybe she put it up there when she was drunk and forgot about it, people do weird things
 
what do you mean endometrial implants? Into the sponge she put in her vagina?
 
Poety said:
what do you mean endometrial implants? Into the sponge she put in her vagina?
Click to expand...


No i was refering to your link as far as endometriosis, but the tissue in question kind of looks like the sponge
 
AndyMilonakis said:
Yeah, certainly on the differential. Perhaps a fragment of the ultra-dildonic 4000...who knows.

I'm curious as to exactly where this came from and how it was extracted and if extraction of the specimen led to bleeding.
Click to expand...

Patient removed it manually in the shower without blood or pain.

After moving from water to alcohol, it got more spheroid (as opposed to flat and fried-egg-ish in shape) and started looking more rubbery. It also got sticky (was not originally sticky). Was originally and still remains stretchy and has elastic properties.

I definitely think it's tissue of some sort, but it's not chicken. :)
 
yaah said:
Leiomyomata and endocervical polyps can both protrude out of the cervix, and fetal parts can be passed as well. However, all of these pass with a lot of blood. I highly doubt it is a fragment of fetus.
Click to expand...

A leiomyoma that out grows its blood supply and breaks off into the vaginal cavity would be very rare and produce an extraordinary amount of pain. I think it may very well be an endocervical polyp the protruded through the cervical os and broke off, but I agree that alot of blood would be present in this scenario. I also can't tell how big it is. Maybe she thought the blood was part of her last menstrual cycle. Its still a stretch because we have no idea how long that thing has been in there. If it happened during around her last menstrual period, being left in the vagina that long would coat it would old clot, mucous, and possibly inflammatory exudate. I can not believe that was not sent to pathology. Talk about a break down in patient care.
 
sinaility said:
A leiomymata that out grows its blood supply and breaks off into the vaginal cavity would be very rare and produce an extraordinary amount of pain. I think it may very well be an endocervical polyp the protruded through the cervical os and broke off, but I agree that alot of blood would be present in this scenario. I also can't tell how big it is. Maybe she thought the blood was part of her last menstrual cycle. Its still a stretch because we have no idea how long that thing has been in there. I can not believe that was not sent to pathology. Talk about a break down in patient care.
Click to expand...

Patient doesn't have menstrual periods because she's on depo. Last spotting was July 4th of this year.

Diameter of currently spheroid object is about that of my pinkynail - maybe 1/4 of an inch by 1/2 an inch by 1/4 inch tall.
 
baya said:
It also got sticky (was not originally sticky). Was originally and still remains stretchy and has elastic properties.

I definitely think it's tissue of some sort, but it's not chicken. :)
Click to expand...
What does it taste like?
 
RyMcQ said:
What does it taste like?
Click to expand...


OMG IM LAFFIN SO HARD :laugh: :laugh: :laugh: YOU ARE SO FUNNY <LAFFIN>

Baya, quit lying and tell us where you got this damn thing - I'm obsessing over it and thats not nice :scared: - I don't think its tissue if she just pulled it out of her vagina. Once on an ER rotation I did have a prostitue come in that had a sponge stuck in her from like 4 mos previous because she used it to stop the bleeding of her period so she could still do tricks- I don't mean birth control sponge, I mean a "natural scrubbing sponge" the ones women use to scrub their face, like from the ocean. It got stuck in the apex and she HAD DYSPARANEURIA so she ended up coming in - perhaps this is the same woman HAHAHAHAHA :laugh: :laugh:


However, if that thing is the size you are saying its either : 1. a condom (which is so absolutely likely, especially with you saying its stretchy, and after being in there for that long, its shape would be all messed up) or its a piece of a dildo as I originally stated - or its a penile ring that she didn't know her partner from 6 mos ago had on....I don't know about this whole "tissue" thing. And please baya, WHY ARE YOU TOUCHING IT - ARE YOU WEARING GLOVES?
 
Poety said:
what did I jsut read about in OBGYn last week, a kind of growth that eventually extrudes from the uterus - I can't remember is it endometrioma? THe description for it is: On physical exam you can see it hanging out of the cervix, looks like globular tissue - is it like an adenomyosis that can extrude? ARRGHGHGH can't remember.

Well QUOTE]

are you thinking of adenosarcoma?
Click to expand...
 
i dunno, but I dont think so! I've changed my mind about the diagnosis again anyway HAHAHA :laugh:
 
Alright people, I know patients lie about what they do sexually, but just for fun, let's review: has anyone come up with anything compatible with the patient's story?

1) No sex in 6+ months.
2) No foreign objects in vagina for even longer (other than speculum during pap)
3) Her daily in-the-shower 1 finger sweep of her vagina one day yielded this piece of tissue, which freaked her out enough to bring it in.
4) Although she has a long history of dysparaneuria, this incident was not associated with any blood or pain.

Does anything anyone has said match this scenario?
 
Decidual cast folks. :laugh: :laugh: :laugh: :laugh:

Noobs. :smuggrin:
 
LADoc00 said:
Decidual cast folks. :laugh: :laugh: :laugh: :laugh:

Noobs. :smuggrin:
Click to expand...


LA IS RIGHT, ABSOLUTELY RIGHT!!! HERE IS TEH LINK THAT GOES ALONG WITH THE HISTORY:::::::

http://www2.uchsc.edu/son/camp/edits/time_to_add_decidual_casts_to_th.htm

I'm so proud that was on my differential ;) WAY TO GO LADOC!

Here is the article if links aren't working:




TIME TO ADD DECIDUAL CASTS TO THE LIST OF RARE DEPO MEDROXYPROGESTERONE ACETATE (DMPA) SIDE EFFECTCTS



CASE REPORTS







Case 1

A sixteen year old female recovering from Anorexia Nervosa presented to clinic for a health maintenance examination. Weight recovery had been noted for six months and she exhibited signs of estrogen stimulation, but was still amenorrheic. For contraception, she had received her first injection of DMPA one month earlier. Although she denied cramping or vaginal bleeding, during her pelvic examination the health care provider removed a large amount of white tissue from her cervical os. Her urine pregnancy test was negative and histology confirmed the diagnosis - decidual cast.





Case 2

A twenty year old female with cerebral palsy and mental ******ation was brought to the clinic by her mother who presented the health care provider with a plastic bag containing a large amount of white tissue which she reported her daughter had passed from her vagina hours earlier. Three weeks earlier, in an effort to minimize hygiene problems related to her erratic pattern of menstrual bleeding - the young woman, who had difficulty swallowing and very sensitive skin, had been given an initial injection of DMPA. Her urine pregnancy test was negative and histology confirmed the diagnosis - decidual cast.





Case 3

An eleven year old Hemophiliac presented to clinic with the complaint of severe menstrual cramps and the sensation of a mass in the vagina. Menarche occurred eight months earlier with an episode of vaginal bleeding that was so heavy that she had to be hospitalized and given a blood transfusion. Since the bleeding was not controlled with oral contraceptives, she was given an injection of DMPA. Her current symptoms resolved after the health care provider removed a large mass of white tissue from her cervical os. Her urine pregnancy test was negative and histology confirmed the diagnosis - decidual cast.





Case 4

An amenorrheic, breastfeeding nineteen year old presented to the clinic 5 months after her third normal, spontaneous vaginal delivery and 2 months after an initial contraceptive injection of DMPA. She complained of vaginal bleeding and abdominal cramping. Speculum examination revealed a large amount of white tissue at the cervical os. When the tissue was removed her symptoms resolved. Her urine pregnancy test was negative and histology confirmed the diagnosis - decidual cast.
 
LADoc00 said:
Decidual cast folks. :laugh: :laugh: :laugh: :laugh:

Noobs. :smuggrin:
Click to expand...

That sounds like a match. Thanks!
 
Poety said:
OMG IM LAFFIN SO HARD :laugh: :laugh: :laugh: YOU ARE SO FUNNY <LAFFIN>

Baya, quit lying and tell us where you got this damn thing - I'm obsessing over it and thats not nice :scared: - I don't think its tissue if she just pulled it out of her vagina. Once on an ER rotation I did have a prostitue come in that had a sponge stuck in her from like 4 mos previous because she used it to stop the bleeding of her period so she could still do tricks- I don't mean birth control sponge, I mean a "natural scrubbing sponge" the ones women use to scrub their face, like from the ocean. It got stuck in the apex and she HAD DYSPARANEURIA so she ended up coming in - perhaps this is the same woman HAHAHAHAHA :laugh: :laugh:


However, if that thing is the size you are saying its either : 1. a condom (which is so absolutely likely, especially with you saying its stretchy, and after being in there for that long, its shape would be all messed up) or its a piece of a dildo as I originally stated - or its a penile ring that she didn't know her partner from 6 mos ago had on....I don't know about this whole "tissue" thing. And please baya, WHY ARE YOU TOUCHING IT - ARE YOU WEARING GLOVES?
Click to expand...

A lot of times people don't know what things are. During my PSF the floor sent down a piece of **** and said it was something that was found in the patient's diaper and they wanted to know what it was.
 
You must log in or register to reply here.
Next unread thread

Similar threads

O
Radiology vs Path
Replies
8
Views
1K
90sportsfan
9
CaptainFire
Derm vs. Path
Replies
12
Views
1K
WEBB PINKERTON
WEBB PINKERTON
mike-sheree
California makes forensic path P.C.
Replies
8
Views
1K
mike-sheree
mike-sheree
initialize
Hours worked as a first year path resident
Replies
22
Views
2K
Guest8
G
PathNeuroIMorFM
  • Question
Is path right for me + next steps?
Replies
9
Views
1K
MetroPath
M
Top