What is your least favorite organ system or modality in pathology?

[jupiterianvibe]

I don't like breast.

---

Members don't see this ad.

 

[PrettyLadyDoc24]

I've tried to like Pulmonary but it's hard!

 

[Ishie1013]

Inflammatory derm

 

[yaah]

Breast. Too much gray area and nitpicking. Lots of controversy. Lots of shifting guidelines and expectations. And no one knows what the hell ADH is or what a positive margin really is.

I don't like inflammatory derm either but if you see a lot of that it's less of a problem. Breast remains a problem until you're a widely acknowledged expert for whom no one can legitimately question your dx.

 

[jupiterianvibe]

Breast. Too much gray area and nitpicking. Lots of controversy. Lots of shifting guidelines and expectations. And no one knows what the hell ADH is or what a positive margin really is.

I don't like inflammatory derm either but if you see a lot of that it's less of a problem. Breast remains a problem until you're a widely acknowledged expert for whom no one can legitimately question your dx.

I agree with you about breast. It is the most time consuming, banal organ system, and also the one that is the biggest ticking time bomb for lawsuits. Its about as fun or interesting as doing a jigsaw puzzle, or rearranging a deck of playing cards after they've been blown about by a gust of wind.

Don't forget to add FEA to that list along with ADH. Sometimes I wonder if these criteria serve more to enrich the curricula vitae of banal breast pathology academic drones.

Inflammatory derm is something I actually enjoy because of the discussions that I have with the referring docs about the patient's presentation. The diagnoses change depending on the clinical picture. I feel I am a consultant in those situations, rather than a technician whose job is to produce data, as it is with breast.

 

[Alteran]

Derm, because I never really cared for it personally.

But in terms of annoyance, breast by far. The needle cores aren't that bad if you have IHC to bail you out of the challenging cases...and I have no shame about using it to clarify things. What annoys me about breast beyond all measure are the margins. Good God in heaven, it's such a meaningless time sink. Especially when the expectation of my surgeons is reporting the distance of tumor and DCIS to all margins. It's especially fun if they cauterize the ever loving snot of of the margins too.

 

[longlakeboy]

Derm, because I never really cared for it personally.

But in terms of annoyance, breast by far. The needle cores aren't that bad if you have IHC to bail you out of the challenging cases...and I have no shame about using it to clarify things. What annoys me about breast beyond all measure are the margins. Good God in heaven, it's such a meaningless time sink. Especially when the expectation of my surgeons is reporting the distance of tumor and DCIS to all margins. It's especially fun if they cauterize the ever loving snot of of the margins too.

I especially like when breast surgeons take six extended margins on a lumpectomy, then want precise distances of the tumor from the margins.

 

[Path or bust]

Soft tissue.

 

[gbwillner]

Tie:
Medical renal
Non-neoplastic brain

 

[Ishie1013]

So much breast-hate. I like it; my only problem with it is the lawsuit potential.

Add medical liver and nonneoplastic brain to my list as well.

 

[deleted314957]

The situation with breast is a perfect example of why surgeons should have to do a few/several months of surg path as was the case a few decades ago. But it will now never happen.
Except during training I think most paths are pretty shielded from medical kidney/muscle/nerve. I think in most cases they just get turfed out (?)
Inflam derm I would pigeon hole it with a prelim (eg. intraepidermal vesicular dermatitis with ddx) then send it to one of our derms. Long ago endometrium was quite simple but seemed to start getting unnecessarily complicated a few years ago before I retired.
Non neoplastic brain would be vanishingly rare in surg path (yes/no?). I can think of the rare brain bx for viral dz for someone on drug tx protocol. I would think most cases would be autopsy.

 

[Ishie1013]

You can occasionally get nonneoplastic for seizures. Seeing the disarray was like hearing heart murmurs; just nod until they stop asking.

 

[musom]

My fellowship is in breast and gyn, so I am particularly excited to see those come across my desk. I hate melanocytic and inflammatory derm. I also dislike non-gyn cytology with a passion. I don't see much renal, neuro, liver or bone marrows....thankfully.

 

[musom]

oh....and I rarely use the dx of FEA, even though it was stuffed in my cranium during fellowship, the term only causes confusion and disgust to the local clinicians I work with, so I avoid the dx when possible.

 

[yaah]

At USCAP, Dr Schnitt's lecture discussed the history of breast pathology. When he started, they didn't report margin status. That must have been wonderful.

 

[coroner]

No one mentioned anything macroscopically, so I'll chime in.
1) Bone: The oscillating handsaws can be a real pain and gives my non-cutting hand parasthesias when trying to hold the specimen still. We had a band bonesaw in residency which was great to have.
2) Colon: For obvious reasons...