Latest revision as of 17:02, 2 July 2024

Tonsils (at cut-up) are a common ditzel. (WC/Katotomichelakis et al.)

This article collects ditzels, which are, in the context of pathology, little specimens that are typically one or two slides and usually of little interest.^[1]

The challenge in ditzels is not falling asleep... so one misses the unexpected (subtle) tumour.

The big table of ditzels

Specimen	Typical context (diagnosis)	System
Hernia sac	hernia	Gastrointestinal pathology
Stoma (reversal)	bowel obstruction, perforated viscus (peritonitis)	Gastrointestinal pathology
Sleeve gastrectomy	obesity	Gastrointestinal pathology
Vertebral disc	herniated disc	Neuropathology
Bands of Ladd	bands of Ladd	Paediatric pathology
Cholesteatoma	cholesteatoma	Paediatric pathology
Femoral head	hip fracture, hip OA	Orthopaedic
Bone reamings	hip fracture	Orthopaedic
Tonsil	tonsillitis	Head and neck pathology
Leg amputation	atherosclerotic peripheral vascular disease, trauma	Cardiovascular pathology
Lipoma	lipoma	Soft tissue pathology
Heterotopic ossification	contractures	Soft tissue pathology
Uterine tubes (tubal ligation)	completed family	Gynecologic pathology
Pressure ulcer (AKA decubitus ulcer)	ulcer, immobility	Dermatopathology
Vas deferens (vasectomy)	completed family	Genitourinary pathology
Uvula	obstructive sleep apnea	Head and neck pathology
Stapes	otosclerosis	Head and neck pathology
Abdominal pannus	obesity	Dermatopathology (?)
Abdominal fat	query amyloidosis	Haematopathology (?)
Breast prosthesis	breast cancer/cosmesis	Breast pathology
Empyema peel	decortication for pneumonia	Pulmonary pathology
Bursa	bursitis	Orthopaedic
Gastric band	obesity	Gastrointestinal pathology
Small bowel excised during Roux-en-Y gastric bypass	obesity	Gastrointestinal pathology
Uterine isthmocele/cesarean scar defect	post-cesarean section	Gynecologic pathology
Distal interosseous nerve (posterior interosseous nerve of wrist and anterior interosseous nerve of wrist)	chronic hand pain, as may be seen in rheumatoid arthritis	Neuropathology
Palmar fascia	palmar fibromatosis (Dupuytren's contracture)	Plastic surgery
Soft tissue of hand or wrist	Ganglion cyst	Plastic surgery

Gastrointestinal pathology

Hernia sac

Inguinal hernia redirects here.

General

Hernia repair (herniorrhaphy).
Pathologic findings are very unusual and if present known to the surgeon.
- Thus, it has been advocated that one ought not examine 'em.^[2]^[3]

Microscopic

Features:

Fibrous tissue.
+/-Adipose tissue.
+/-Mesothelial cells.

Notes:

One should not see vas deferens.
Things worthy of some comment: granulation tissue, inflammation.

Sign out

Incarcerated without mesothelium

SOFT TISSUE ("HERNIA SAC"), RESECTION/HERNIA REPAIR: 
- FIBROADIPOSE TISSUE WITH FAT NECROSIS -- CONSISTENT WITH HERNIA SAC. 
- NEGATIVE FOR MALIGNANCY.

Micro

The sections show fibrofatty tissue with hemosiderin-laden macrophages, plump activated fibroblasts with pale staining nuclei, histiocytes with small nuclei and abundant grey vacuolated cytoplasm, fat necrosis and focal necrosis of the fibrous tissue.

Mesothelial lining present

Submitted as "Hernia Sac", Excision:
- Benign fibroadipose tissue partially covered by mesothelium, consistent 
  with hernia sac.
- NEGATIVE for malignancy.

Block letters

SOFT TISSUE ("HERNIA SAC"), RESECTION/HERNIA REPAIR: 
- FIBROADIPOSE TISSUE PARTIALLY COVERED BY MESOTHELIUM -- CONSISTENT WITH HERNIA SAC. 
- NEGATIVE FOR MALIGNANCY.

Inflamed

SOFT TISSUE ("HERNIA SAC"), LEFT, RESECTION/HERNIA REPAIR:
- FIBROADIPOSE TISSUE PARTIALLY COVERED BY MESOTHELIUM WITH FOCAL CHRONIC
  INFLAMMATION AND REACTIVE CHANGES -- CONSISTENT WITH HERNIA SAC.
- NEGATIVE FOR MALIGNANCY.

Gross only

SOFT TISSUE, RIGHT INGUINAL, HERNIA REPAIR:
- HERNIA SAC (GROSS ONLY).

SOFT TISSUE, LEFT INGUINAL, HERNIA REPAIR:
- HERNIA SAC (GROSS ONLY).

Stoma

Ostomy, ileostomy and colostomy redirect here.

General

See: Colon and Small intestine.

Reversal of ileostomy or colostomy.
- The (generic) encompassing term for ileostomy and colostomy is ostomy.^[4]

Stomas are created for a number of reasons:

Perforated viscous/peritonitis.
- Trauma.
- Colorectal adenocarcinoma.
Diverticulosis.

Microscopic

Features:

Colonic-type or small intestinal-type bowel wall.
- Lymphoid hyperplasia (abundant lymphocytes) - very common.
- +/-Fibromuscular hyperplasia of the lamina propria and submucosa.
Skin.
- Typically has findings of mild irritation:
  - Mild dermal inflammation (usu. lymphocyte predominant).
  - Acanthosis (thickened stratum spinosum).
  - Hypergranulosis (thickened stratum granulosum).
  - Hyperkeratosis (thickened stratum corneum).

Notes:

One is looking for malignancy (e.g. colorectal carcinoma), especially if that is in the history.

DDx:

Sign out

Colostomy

COLOSTOMY, COLOSTOMY REVERSAL:
- LARGE BOWEL WALL WITH SUBMUCOSAL FIBROSIS -- OTHERWISE WITHIN NORMAL LIMITS.
- SKIN WITHOUT SIGNIFICANT PATHOLOGY.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

Ileostomy

Submitted as "Ileostomy", Excision:
- Small bowel with submucosal fibrosis, otherwise within normal limits.
- Skin without significant pathology.
- NEGATIVE for dysplasia and NEGATIVE for malignancy.

Alternate

Submitted As "Ileostomy", Excision:
     - Consistent with ileostomy (small bowel, skin) without significant pathology.
     - NEGATIVE for dysplasia and NEGATIVE for malignancy.

Block letters

ILEOSTOMY, ILEOSTOMY REVERSAL:
- SMALL BOWEL WALL WITH SUBMUCOSAL FIBROSIS -- OTHERWISE WITHIN NORMAL LIMITS.
- SKIN WITHOUT SIGNIFICANT PATHOLOGY.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

Vagus nerve

General

Seen from vagotomy.

Typical indication:

Gastric outlet obstruction.^[5]

Notes:

Left vagus nerve -> anterior vagal trunk.
Right vagus nerve -> posterior vagal trunk.

Microscopic

Features:

Peripheral nerve.

DDx:

Smooth muscle.

IHC

S-100 +ve.
Desmin -ve.

Sign out

A. VAGUS NERVE, POSTERIOR, VAGOTOMY:
- PERIPHERAL NERVE WITHIN NORMAL LIMITS.

B. VAGUS NERVE, ANTERIOR, VAGOTOMY:
- SMOOTH MUSCLE WITHIN NORMAL LIMITS.
- PERIPHERAL NERVE NOT IDENTIFIED, SEE COMMENT.

COMMENT:
The tissue was stained with desmin and S-100; it is positive for desmin. S-100 marks only 
small nerves fibres that innervate the muscle.

Pediatric

Bands of Ladd

General

Associated with intestinal malrotation.
Removed by Ladd's procedure.
Usually associated with duodenal and (other) small bowel obstructions.^[6]

Microscopic

Features:

Benign fibrous tissue.

Sign out

Adhesive band, Ladd's procedure:
- Vascular fibrous tissue consistent with bands of Ladd.

Cholesteatoma

Main article: Cholesteatoma

Genitourinary pathology

Foreskin

Main article: Penis

General

Indications:

Phimosis.

Main considerations:

Squamous cell carcinoma.
Lichen sclerosus, AKA balanitis xerotica obliterans.
Lichen planus.
Infection, e.g. syphilis, candidiasis.
Zoon balanitis - abundant plasma cells.

Microscopic

Features:

Usu. fibrotic dermis.
+/-Inflammation.

DDx:

See Penis.

Sign out

Foreskin, Circumcision: 
- Benign squamous mucosa within normal limits, consistent with foreskin.

A. Foreskin, Circumcision: 
- Benign squamous mucosa without significant histopathology, consistent with foreskin.

Foreskin, Circumcision: 
- Benign squamous mucosa with mild patchy chronic inflammation at the epidermal-dermal interface.
- NEGATIVE for dysplasia and NEGATIVE for malignancy.

Foreskin, Circumcision: 
- Squamous mucosa with mild-to-moderate acute and chronic 
  (lymphocytic) lichenoid inflammation. 
- NEGATIVE for evidence of lichen sclerosus. 
- NEGATIVE for dysplasia and NEGATIVE for malignancy. 

Comment: 
A PASD stain is NEGATIVE for micro-organisms.

Micro

The section shows squamous mucosa with mild basal pigmentation and subepithelial fibrous tissue. The epithelium matures to the surface. Significant inflammation is ABSENT. Atypia is ABSENT.

Paraurethral cyst

Main article: Paraurethral cyst

Labia

General

Operation labioplasty.

Microscopic

Features:

Squamous epithelium with compact keratin.
Fibrous stroma.

Sign out

LABIA MINORA, RIGHT, LABIOPLASTY:
- BENIGN SKIN WITH A THIN LAYER OF COMPACT KERATIN FIBROTIC STROMA -- CONSISTENT
  WITH LABIA MINORA.

Head and neck pathology

Tonsillitis

Main article: Tonsillitis

Main article: Tonsil

Obstructive sleep apnea

Uvula redirects here.

Abbreviated OSA.

General

Clinical diagnosis.
May be treated with a resection of the uvula.^[7]
Associated with obesity.^[8]

Microscopic

Features:

Benign oropharyneal mucosa (stratified squamous epithelium).
+/-Skeletal muscle.
+/-Salivary glands (minor) - mucinous.

Sign out

UVULA, RESECTION:
- OROPHARYNGEAL MUCOSA, CONSISTENT WITH UVULA.

Cardiovascular pathology

Main article: Cardiovascular pathology

Vascular thrombus

Main article: Vascular thrombus

Leg amputation

Main article: Leg amputation

Toe amputation

General - overview

Like leg ampuations.

Sign out

See Ditzels#Atherosclerotic peripheral vascular disease.

Finger amputation

General - overview

Similar to toe amputations.

May be done due to:

Contractures leading to ulcerations.
Scleroderma - leading to ischemia.^[9]

Sign out

See Ditzels#Atherosclerotic peripheral vascular disease.

Atherosclerotic peripheral vascular disease

Diabetic foot redirects here.

AKA peripheral vascular disease.

Main article: Atherosclerosis

General

Very strong association with diabetes mellitus.

Gross

+/-Ulceration.
+/-Gangrene - black skin - subclassified:
- "Wet" = moist/oozing fluid.
- "Dry" = shriveled, no moisture apparent.
+/-Loss of hair.

DDx - gross:

Malignant melanoma.

Image:

Gangrenous foot (WC).

Sections - grossing:

Resection margin (check for viability).
Gangrenous area.
Blood vessels.
Bone (check for osteomyelitis).

Microscopic

Features:

Atherosclerosis.
Coagulative necrosis (gangrene).
Inflammation (wet gangrene).
- Neutrophils.
- Lymphocytes.
- Plasma cells.
+/-Thrombosis.
+/-Chronic osteomyelitis.
+/-Reactive fibroblasts.

Note:

Ischemia may be associated with marked nuclear changes. Uninitiated eyes may think they are seeing a sarcoma.

DDx:

Vasculitis associated with a connective tissue disorder.
Drug use, e.g. cocaine.^[10]
Chronic osteomyelitis.
Cholesterol embolism.

Sign out

Forefoot amputation

RIGHT FOREFOOT, AMPUTATION:
- ULCERATED SKIN. 
- MODERATE-TO-SEVERE ATHEROSCLEROSIS.
- BLOOD VESSEL WITH RECANALIZATION.
- NEGATIVE FOR MALIGNANCY.

Leg amputation

LEFT LEG, BELOW KNEE AMPUTATION:
- MODERATE-TO-SEVERE ATHEROSCLEROSIS.
- COAGULATIVE NECROSIS OF SOFT TISSUE.
- NECROTIC BONE.
- MARROW CAVITY FIBROSIS WITH SIDEROPHAGES.
- RESECTION MARGIN WITH VIABLE TISSUE.

Revision

SKIN AND SOFT TISSUE, RIGHT UPPER LEG, REVISION OF AMPUTATION:
- ULCERATED SKIN WITH NECROTIC SOFT TISSUE WITH IMPETIGINIZATION, AND MICROABSCESS
  FORMATION.
- SEVERE ATHEROSCLEROSIS.
- NEGATIVE FOR MALIGNANCY.

Leg amputation - gross only

LOWER EXTREMITY, LEFT, BELOW THE KNEE AMPUTATION:
- ULCERS AND ISCHEMIC CHANGES WITH FOCAL COMPLETE ARTERIAL OCCLUSION (GROSS ONLY).

LEG, RIGHT, ABOVE THE KNEE AMPUTATION:
- ULCERS AND ISCHEMIC CHANGES WITH EXTENSIVE ARTERIAL DISEASE (GROSS ONLY).

LEG, RIGHT, ABOVE THE KNEE AMPUTATION:
- EXTENSIVE ISCHEMIC CHANGES WITH SEVERE ARTERIAL DISEASE (GROSS ONLY).

Toe amputation

Mild

THIRD TOE, RIGHT, AMPUTATION:
- SKIN WITH MARKED DERMAL FIBROSIS.
- MILD ATHEROSCLEROSIS.
- NEGATIVE FOR MALIGNANCY.

SECOND TOE, RIGHT, AMPUTATION:
- SKIN WITH MARKED DERMAL FIBROSIS AND ULCERATION WITH IMPETIGINIZATION.
- MILD ATHEROSCLEROSIS.
- NEGATIVE FOR MALIGNANCY.

Moderate

SECOND TOE, LEFT, AMPUTATION:
- MODERATE ATHEROSCLEROSIS.
- BONE WITH A FATTY BONE MARROW CAVITY WITH FOCAL FAT NECROSIS AND RARE PLASMA CELLS.
- SKIN WITH FIBROUS DERMIS AND A NON-SPECIFIC DERMAL PERIVASCULAR LYMPHOPLASMACYTIC 
INFILTRATE.

SECOND TOE, LEFT, AMPUTATION:
- MODERATE ATHEROSCLEROSIS.
- BONE WITH A FATTY BONE MARROW CAVITY WITH FOCAL FAT NECROSIS AND RARE PLASMA CELLS.
- SKIN WITH FIBROUS DERMIS AND NON-SPECIFIC PERIVASCULAR LYMPHOPLASMACYTIC DERMAL INFILTRATE.

Severe

SECOND AND THIRD TOE, LEFT, AMPUTATION:
- SEVERE ATHEROSCLEROSIS.
- ACUTE AND CHRONIC OSTEOMYELITIS.
- GANGRENE.

GREAT TOE, LEFT, AMPUTATION:
- GANGRENE.
- SEVERE ATHEROSCLEROSIS.
- ULCERATED SKIN AND CHRONIC ISCHEMIC CHANGES.
- BONE WITH NO SIGNIFICANT PATHOLOGY.
- NEGATIVE FOR MALIGNANCY.

GREAT TOE, RIGHT, AMPUTATION:
- GANGRENE.
- ATHEROSCLEROSIS.
- NECROTIC BONE WITH ABUNDANT COCCI ORGANISMS AND NEUTROPHILS 
  WITHIN THE MARROW CAVITY.
- NEGATIVE FOR MALIGNANCY.

Orthopaedic

Femoral head

Main article: Femoral head

Bone reamings

General

Taken during the surgical repair of a fracture, e.g. intramedullary nail placement.
Done to rule-out a pathologic fracture; considered reliable for detecting malignancy.^[11]
- Hassan et al.^[12] advocate against their use, suggesting the yield is low and a biopsy should be preferred.

Microscopic

Features:^[13]

Fragments of bone (scattered trabeculae).
- Necrotic bone = bone with empty lacunae, i.e. lacunae missing osteocytes.
Bone marrow.
- Megakaryocytes - large cells, multinucleated, eosinophilic cytoplasm.
- Nucleated RBCs - perfectly round, dense nucleus, bright red cytoplasm.
- Myeloid cells and precursors.
- Adipocytes.

DDx:

Metastatic carcinoma.

Sign out

BONE, LEFT FEMUR, REAMINGS:
- FEATURES CONSISTENT WITH A RECENT FRACTURE.
- NEGATIVE FOR MALIGNANCY.

Heterotopic ossification

Abbreviated HO.

Main article: Heterotopic ossification

Lumbar bone

General

May be seen in the context of laminectomies to treat cauda equina syndrome.

Microscopic

Features:

Degenerative fibrocartilage:
- Multiple chondrocytes in one pocket (lacuna) - regenerative change.
- Degenerative cartilage.
Non-vital bone:
- Empty lacuna.

DDx:

Occult malignancy.

Sign out

LUMBAR BONE, DECOMPRESSION:
- BONE AND VERTEBRAL DISC FRAGMENTS WITH DEGENERATIVE CHANGES.
- UNREMARKABLE BONE MARROW.
- NEGATIVE FOR MALIGNANCY.

Bursa

Bursitis redirects here.

General

Uncommon specimen.
Septic bursitis is usually due to S. aureus.^[14]
- Usually associated with trauma to the overlying skin.^[15]

Indication:

Bursitis - may be treated with bursectomy.^[16]

Note:

Most bursitis is managed conservatively.^[17]

Microscopic

Features:

Dense connective tissue.
Fibroadipose tissue.

Sign out

No apparent inflammation

BURSA, RIGHT HIP, BURSECTOMY:
- BENIGN DENSE CONNECTIVE TISSUE WITH CALCIFICATIONS, AND FIBROADIPOSE TISSUE.
- NO SIGNIFICANT INFLAMMATION.
- NEGATIVE FOR MALIGNANCY.

BURSA, LEFT TROCHANTERIC, BURSECTOMY:
- BENIGN DENSE CONNECTIVE TISSUE AND BENIGN FIBROADIPOSE TISSUE.
- NO SIGNIFICANT INFLAMMATION.
- NEGATIVE FOR MALIGNANCY.

Rotator cuff tear

General

Surgically repaired.
Clinical diagnosis.

Microscopic

Features:^[18]

Collagen degeneration.
Disordered arrangement of collagen fibres.
- Wavy fibres.
- Separation of the ﬁbres.
+/-Inflammation - associated with smaller tears.
+/-Decreased cellularity - associated with larger tears.
+/-Fatty replacement.^[19]

Sign out

RIGHT SHOULDER ACROMIOM AND BURSAE, EXCISION:
- UNREMARKABLE BONE (GROSS ONLY).
- BENIGN SOFT TISSUE.

"BURSA AND ACROMION", LEFT SHOULDER, ROTATOR CUFF REPAIR:
- BENIGN DENSE CONNECTIVE TISSUE AND BENIGN FIBROADIPOSE TISSUE.
- NO SIGNIFICANT INFLAMMATION.
- NO BONE IDENTIFIED.
- NEGATIVE FOR MALIGNANCY.

"BURSA AND ACROMION", LEFT SHOULDER, ROTATOR CUFF REPAIR:
- BENIGN DENSE WAVY CONNECTIVE TISSUE WITH FIBRE SEPARATION.
- BENIGN FIBROADIPOSE TISSUE.
- NO SIGNIFICANT INFLAMMATION.
- NO BONE IDENTIFIED.
- NEGATIVE FOR MALIGNANCY.

Other

Breast prosthesis

AKA breast implants.

Main article: Breast prostheses

De Quervain syndrome

Should not be confused with De Quervain's thyroiditis (subacute granulomatous thryoiditis).

AKA de Quervain tenosynovitis,^[20] and de Quervain disease.

General

Benign.
Tenosynovitis of the thumb.
Clinical diagnosis.^[21]

Clinical:

Pain.

Treatment:^[21]

Steroid.
Surgery.

Microscopic

Features:

Dense connective tissue consistent with tendon.

Sign out

Not apparent

FIRST EXTENSOR COMPARTMENT, RIGHT HAND, BIOPSY:
- DENSE CONNECTIVE TISSUE CONSISTENT WITH TENDON.
- FIBROUS TISSUE.

Tenosynovitis

Main article: Tenosynovitis

Otosclerosis

Stapes redirects here.

General

Clinical diagnosis.
Causes conductive hearing loss.^[22]
Etiology - genetic.
- Over half a dozen genes have been identified.^[23]^[24]
- Classically described as autosomal dominant.

Treatment:

Stapedectomy (removal of the stapes).^[25]

Microscopic

Features (temporal bone):^[26]

Classically divided into four phases:
1. Osteoclastic phase:
  - Large spaces form in bone marrow.
2. Replacement phase:
  - Bone replaced by basophilic web-like tissue.
3. Fibril phase:
  - Fibrils deposited.
4. Lamellar phase:
  - Lamellar bone forms around the blood vessels.

Features - (stapes):

Unremarkable bone.^{[citation needed]}

DDx:

Avascular necrosis ~ 25% of cases diagnosed as otosclerosis.^[26]
- May be due to fat embolism.

Note:

Avascular necrosis of the stapes crura and otosclerosis together is considered rare.^[27]

Images:

Stapes - sketch (WC).

Sign out

STAPES, RIGHT, STAPEDECTOMY:
- BENIGN BONE CONSISTENT WITH STAPES.

STAPES, RIGHT, STAPEDECTOMY:
- UNREMARKABLE BONE CONSISTENT WITH STAPES.

Missed stapes

STAPES, RIGHT, STAPEDECTOMY:
- BENIGN FIBROFATTY TISSUE.
- NO BONE IDENTIFIED.

External links

Otosclerosis (otopathologynetwork.org).

Abdominal pannus

AKA pannus, panniculus and pannona.

Main article: Abdominal pannus

Empyema

Empyema peel and pleural peel redirect here.

General

Empyemas are often managed surgically.^[28]

Classically, divided into three stages.^[29]^[30]
- I - exudative stage (acute).
- II - fibropurulent stage (acute).
- III - organizational stage (chronic).

Etiologies - common:

Pneumonia - most common.
Iatrogenic.
Trauma.

Microscopic

Features:

Neutrophils (pus) - key feature.
Lymphocytes.
Plasma cells.
Reactive fibroblasts.
Reactive mesothelial cells - not common.

DDx:

Malignant mesothelioma - should have infiltrative growth.
Fibrosing pleuritis.

Sign out

A. Right Pleural, Pleural Peel:
     - Proliferative fibroblasts with marked reactive changes.
     - Necro-inflammatory debris.
     - NEGATIVE for evidence of malignancy.

B. Right Lung, Biopsy:
     - Necro-inflammatory debris and reactive pleural changes.
     - Infarcted lung parenchyma.
     - NEGATIVE for evidence of malignancy.

Block letters

PLEURA, LEFT, DECORTICATION:
- MIXED INFLAMMATORY INFILTRATE WITH ABUNDANT NEUTROPHILS.
- REACTIVE FIBROBLASTS AND FIBRIN.
- NO MICROORGANISMS APPARENT WITH H&E STAINING.
- NEGATIVE FOR MALIGNANCY.

Not labelled as a peel

Left Lung, Biopsy:
- Fibrin, neutrophils, necrotic tissue and a fibroblastic 
  response, compatible with empyema peel.
- NO viable lung parenchyma identified.
- NEGATIVE for evidence of malignancy.

Toenail

General

Relatively common.

Indications for removal:

Ingrown^[31] - typically great toe.^[32]
Onychomycosis - fungal infection.^[33]
Pigmented lesion.
- Exclude melanoma.^[34]

Microscopic

Features:

Nail plate - paucicellular, dense connective tissue.
Keratinized squamous epithelium.
+/-Cocci organisms.

DDx:

Malignant melanoma.
Trauma.
Fungal infection (candidiasis).
Bacteria infection, e.g. Pseudomonas (causes green nails).

Stains

For pigmented lesion:

Prussian blue stain - trauma +ve, melanocytic lesion -ve.
Fontana-Masson stain - trauma -ve, melanocytic lesion usu. +ve.

Query fungal infection:

PAS +ve for fungal organisms.^[33]

Sign out

Pigmented nail

PARTIAL NAIL PLATE, RIGHT THIRD TOE, SCISSOR EXCISION:
- NAIL PLATE AND THIN LAYER OF KERATINIZED SQUAMOUS EPITHELIUM WITH
  PARAKERATOSIS AND FIBRIN.
- NO APPARENT PIGMENT.
- NO EVIDENCE OF MALIGNANCY.

Micro

The sections show a paucicellular nail plate, and a thin layer of squamous epithelium with keratinization and partial retention of the nuclei (parakeratosis). There is also a small amount of fibrin. No pigmentation is apparent with Prussian blue and Fontana-Masson staining. No melanocytes are apparent. No nuclear atypia is apparent. No mitotic activity is identified. No microorganisms are apparent. No significant inflammation is apparent.

Query infection

GREAT TOENAIL, RIGHT, EXCISION:
- NAIL PLATE AND THIN LAYER OF KERATINIZED SQUAMOUS EPITHELIUM.
- SMALL CLUSTERS OF COCCI, FOCAL.
- NO APPARENT FUNGAL ORGANISMS WITH PASF STAIN.
- NO EVIDENCE OF MALIGNANCY.

Fungal organisms present

GREAT TOE NAIL, RIGHT, REMOVAL:
- NAIL PLATE AND THIN LAYER OF KERATINIZED SQUAMOUS EPITHELIUM WITH
  PARAKERATOSIS AND SCANT SUBEPITHELIAL TISSUE.
- FUNGAL ORGANISMS CONSISTENT WITH CANDIDA, DEMONSTRATED WITH PASF STAIN.
- SMALL CLUSTERS OF COCCI, FOCAL.
- NO EVIDENCE OF MALIGNANCY.

Canal of Nuck cyst

General

Canal of Nuck is the female equivalent of the male processus vaginalis.^[35]
Women/girls only pathology - can be thought of as inguinal hernia in women.
Very rare pathology.^[35]

Sign out

A. Submitted as "Canal of Nuck Cyst", Excision::
- Benign fibroadipose tissue partially covered by mesothelium with inflammation, 
  compatible with clinical impression of canal of Nuck cyst.
- NEGATIVE for malignancy.

Palmar fascia

Main article: Palmar fascia

References

↑ Weedman Molavi, Diana (2008). The Practice of Surgical Pathology: A Beginner's Guide to the Diagnostic Process (1st ed.). Springer. pp. 37. ISBN 978-0387744858.
↑ Siddiqui K, Nazir Z, Ali SS, Pervaiz S (February 2004). "Is routine histological evaluation of pediatric hernial sac necessary?". Pediatr. Surg. Int. 20 (2): 133–5. doi:10.1007/s00383-003-1106-2. PMID 14986035.
↑ Partrick DA, Bensard DD, Karrer FM, Ruyle SZ (July 1998). "Is routine pathological evaluation of pediatric hernia sacs justified?". J. Pediatr. Surg. 33 (7): 1090–2; discussion 1093–4. PMID 9694100.
↑ URL: http://www.nlm.nih.gov/medlineplus/ostomy.html. Accessed on: 27 January 2013.
↑ Okawada, M.; Okazaki, T.; Takahashi, T.; Lane, GJ.; Yamataka, A. (2009). "Gastric outlet obstruction possibly secondary to ulceration in a 2-year-old girl: a case report.". Cases J 2 (1): 8. doi:10.1186/1757-1626-2-8. PMID 19123936.
↑ Raphaeli, T.; Parimi, C.; Mattix, K.; Javid, PJ. (Mar 2010). "Acute colonic obstruction from Ladd bands: a unique complication from intestinal malrotation.". J Pediatr Surg 45 (3): 630-1. doi:10.1016/j.jpedsurg.2009.12.026. PMID 20223332.
↑ Shin, SH.; Ye, MK.; Kim, CG. (Jun 2009). "Modified uvulopalatopharyngoplasty for the treatment of obstructive sleep apnea-hypopnea syndrome: resection of the musculus uvulae.". Otolaryngol Head Neck Surg 140 (6): 924-9. doi:10.1016/j.otohns.2009.01.020. PMID 19467416.
↑ Sarkhosh, K.; Switzer, NJ.; El-Hadi, M.; Birch, DW.; Shi, X.; Karmali, S. (Jan 2013). "The Impact of Bariatric Surgery on Obstructive Sleep Apnea: A Systematic Review.". Obes Surg. doi:10.1007/s11695-012-0862-2. PMID 23299507.
↑ Jones, NF.; Imbriglia, JE.; Steen, VD.; Medsger, TA. (May 1987). "Surgery for scleroderma of the hand.". J Hand Surg Am 12 (3): 391-400. PMID 3584887.
↑ Dhawan, SS.; Wang, BW. (Feb 2007). "Four-extremity gangrene associated with crack cocaine abuse.". Ann Emerg Med 49 (2): 186-9. doi:10.1016/j.annemergmed.2006.08.001. PMID 17059855.
↑ Clarke, AM.; Rogers, S.; Douglas, DL. (Dec 1993). "Closed intramedullary biopsy for metastatic disease.". J R Coll Surg Edinb 38 (6): 368-9. PMID 7509409.
↑ Hassan, K.; Kalra, S.; Moran, C. (Aug 2007). "Intramedullary reamings for the histological diagnosis of suspected pathological fractures.". Surgeon 5 (4): 202-4. PMID 17849954.
↑ Tydings, JD.; Martino, LJ.; Kircher, M.; Alfred, RH.; Lozman, J. (Mar 1987). "Viability of intramedullary canal bone reamings for continued calcification.". Am J Surg 153 (3): 306-9. PMID 3548454.
↑ Hanrahan, JA. (Oct 2013). "Recent developments in septic bursitis.". Curr Infect Dis Rep 15 (5): 421-5. doi:10.1007/s11908-013-0353-1. PMID 23933823.
↑ Canoso, JJ.; Sheckman, PR.. "Septic subcutaneous bursitis. Report of sixteen cases.". J Rheumatol 6 (1): 96-102. PMID 439118.
↑ Dillon, JP.; Freedman, I.; Tan, JS.; Mitchell, D.; English, S. (Jul 2012). "Endoscopic bursectomy for the treatment of septic pre-patellar bursitis: a case series.". Arch Orthop Trauma Surg 132 (7): 921-5. doi:10.1007/s00402-012-1494-7. PMID 22426936.
↑ Lustenberger, DP.; Ng, VY.; Best, TM.; Ellis, TJ. (Sep 2011). "Efficacy of treatment of trochanteric bursitis: a systematic review.". Clin J Sport Med 21 (5): 447-53. doi:10.1097/JSM.0b013e318221299c. PMID 21814140.
↑ Longo, UG.; Berton, A.; Khan, WS.; Maffulli, N.; Denaro, V. (Sep 2011). "Histopathology of rotator cuff tears.". Sports Med Arthrosc 19 (3): 227-36. doi:10.1097/JSA.0b013e318213bccb. PMID 21822106.
↑ Kuzel, BR.; Grindel, S.; Papandrea, R.; Ziegler, D. (Oct 2013). "Fatty infiltration and rotator cuff atrophy.". J Am Acad Orthop Surg 21 (10): 613-23. doi:10.5435/JAAOS-21-10-613. PMID 24084435.
↑ Gigante, MR.; Martinotti, I.; Cirla, PE.. "[Computer work and De Quervain's tenosynovitis: an evidence based approach].". G Ital Med Lav Ergon 34 (3 Suppl): 116-8. PMID 23405595.
↑ ^21.0 ^21.1 Ilyas, AM.; Ilyas, A.; Ast, M.; Schaffer, AA.; Thoder, J. (Dec 2007). "De quervain tenosynovitis of the wrist.". J Am Acad Orthop Surg 15 (12): 757-64. PMID 18063716.
↑ Declau, F.; van Spaendonck, M.; Timmermans, JP.; Michaels, L.; Liang, J.; Qiu, JP.; van de Heyning, P. (2007). "Prevalence of histologic otosclerosis: an unbiased temporal bone study in Caucasians.". Adv Otorhinolaryngol 65: 6-16. doi:10.1159/000098663. PMID 17245017.
↑ Online 'Mendelian Inheritance in Man' (OMIM) 166800
↑ Online 'Mendelian Inheritance in Man' (OMIM) 605727
↑ Redfors, YD.; Gröndahl, HG.; Hellgren, J.; Lindfors, N.; Nilsson, I.; Möller, C. (Aug 2012). "Otosclerosis: anatomy and pathology in the temporal bone assessed by multi-slice and cone-beam CT.". Otol Neurotol 33 (6): 922-7. doi:10.1097/MAO.0b013e318259b38c. PMID 22771999.
↑ ^26.0 ^26.1 "Otosclerosis.". Br Med J 1 (6105): 63-4. Jan 1978. PMC 1602666. PMID 620199. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1602666/.
↑ Erdoglija, M.; Sotirovic, J.; Jacimovic, V.; Vukomanovic, B. (2012). "Avascular necrosis of stapes crura in one case of operated otosclerosis.". Acta Medica (Hradec Kralove) 55 (4): 193-7. PMID 23631292.
↑ Ferguson, MK. (Mar 1999). "Surgical management of intrapleural infections.". Semin Respir Infect 14 (1): 73-81. PMID 10197399.
↑ Shiraishi, Y. (Jul 2010). "Surgical treatment of chronic empyema.". Gen Thorac Cardiovasc Surg 58 (7): 311-6. doi:10.1007/s11748-010-0599-6. PMID 20628845.
↑ Hamm, H.; Light, RW. (May 1997). "Parapneumonic effusion and empyema.". Eur Respir J 10 (5): 1150-6. PMID 9163661. http://erj.ersjournals.com/content/10/5/1150.long.
↑ Küçüktaş, M.; Kutlubay, Z.; Yardimci, G.; Khatib, R.; Tüzün, Y. (Feb 2013). "Comparison of effectiveness of electrocautery and cryotherapy in partial matrixectomy after partial nail extraction in the treatment of ingrown nails.". Dermatol Surg 39 (2): 274-80. doi:10.1111/dsu.12068. PMID 23227941.
↑ Jia, C.; Li, P.; Wu, Y.; Qiu, Y.; Cao, L.; Chang, C.; Zhang, Y. (Jul 2013). "[Modified surgical repair of severe ingrown toenail].". Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 27 (7): 869-71. PMID 24063180.
↑ ^33.0 ^33.1 Reisberger, EM.; Abels, C.; Landthaler, M.; Szeimies, RM. (Apr 2003). "Histopathological diagnosis of onychomycosis by periodic acid-Schiff-stained nail clippings.". Br J Dermatol 148 (4): 749-54. PMID 12752134.
↑ Fanti, PA.; Dika, E.; Misciali, C.; Vaccari, S.; Barisani, A.; Piraccini, BM.; Cavrin, G.; Maibach, HI. et al. (Jun 2013). "Nail apparatus melanoma: is trauma a coincidence? Is this peculiar tumor a real acral melanoma?". Cutan Ocul Toxicol 32 (2): 150-3. doi:10.3109/15569527.2012.740118. PMID 23153047.
↑ ^35.0 ^35.1 Kohlhauser M, Pirsch JV, Maier T, Viertler C, Fegerl R (September 2022). "The Cyst of the Canal of Nuck: Anatomy, Diagnostic and Treatment of a Very Rare Diagnosis-A Case Report of an Adult Woman and Narrative Review of the Literature". Medicina (Kaunas) 58 (10). doi:10.3390/medicina58101353. PMC 9609622. PMID 36295514. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9609622/.

[1] Weedman Molavi, Diana (2008). The Practice of Surgical Pathology: A Beginner's Guide to the Diagnostic Process (1st ed.). Springer. pp. 37. ISBN 978-0387744858.

[pmid14986035-2] Siddiqui K, Nazir Z, Ali SS, Pervaiz S (February 2004). "Is routine histological evaluation of pediatric hernial sac necessary?". Pediatr. Surg. Int. 20 (2): 133–5. doi:10.1007/s00383-003-1106-2. PMID 14986035.

[pmid9694100-3] Partrick DA, Bensard DD, Karrer FM, Ruyle SZ (July 1998). "Is routine pathological evaluation of pediatric hernia sacs justified?". J. Pediatr. Surg. 33 (7): 1090–2; discussion 1093–4. PMID 9694100.

[4] URL: http://www.nlm.nih.gov/medlineplus/ostomy.html. Accessed on: 27 January 2013.

[5] Okawada, M.; Okazaki, T.; Takahashi, T.; Lane, GJ.; Yamataka, A. (2009). "Gastric outlet obstruction possibly secondary to ulceration in a 2-year-old girl: a case report.". Cases J 2 (1): 8. doi:10.1186/1757-1626-2-8. PMID 19123936.

[pmid20223332-6] Raphaeli, T.; Parimi, C.; Mattix, K.; Javid, PJ. (Mar 2010). "Acute colonic obstruction from Ladd bands: a unique complication from intestinal malrotation.". J Pediatr Surg 45 (3): 630-1. doi:10.1016/j.jpedsurg.2009.12.026. PMID 20223332.

[pmid19467416-7] Shin, SH.; Ye, MK.; Kim, CG. (Jun 2009). "Modified uvulopalatopharyngoplasty for the treatment of obstructive sleep apnea-hypopnea syndrome: resection of the musculus uvulae.". Otolaryngol Head Neck Surg 140 (6): 924-9. doi:10.1016/j.otohns.2009.01.020. PMID 19467416.

[pmid23299507-8] Sarkhosh, K.; Switzer, NJ.; El-Hadi, M.; Birch, DW.; Shi, X.; Karmali, S. (Jan 2013). "The Impact of Bariatric Surgery on Obstructive Sleep Apnea: A Systematic Review.". Obes Surg. doi:10.1007/s11695-012-0862-2. PMID 23299507.

[pmid3584887-9] Jones, NF.; Imbriglia, JE.; Steen, VD.; Medsger, TA. (May 1987). "Surgery for scleroderma of the hand.". J Hand Surg Am 12 (3): 391-400. PMID 3584887.

[pmid17059855-10] Dhawan, SS.; Wang, BW. (Feb 2007). "Four-extremity gangrene associated with crack cocaine abuse.". Ann Emerg Med 49 (2): 186-9. doi:10.1016/j.annemergmed.2006.08.001. PMID 17059855.

[pmid7509409-11] Clarke, AM.; Rogers, S.; Douglas, DL. (Dec 1993). "Closed intramedullary biopsy for metastatic disease.". J R Coll Surg Edinb 38 (6): 368-9. PMID 7509409.

[pmid17849954-12] Hassan, K.; Kalra, S.; Moran, C. (Aug 2007). "Intramedullary reamings for the histological diagnosis of suspected pathological fractures.". Surgeon 5 (4): 202-4. PMID 17849954.

[pmid3548454-13] Tydings, JD.; Martino, LJ.; Kircher, M.; Alfred, RH.; Lozman, J. (Mar 1987). "Viability of intramedullary canal bone reamings for continued calcification.". Am J Surg 153 (3): 306-9. PMID 3548454.

[pmid23933823-14] Hanrahan, JA. (Oct 2013). "Recent developments in septic bursitis.". Curr Infect Dis Rep 15 (5): 421-5. doi:10.1007/s11908-013-0353-1. PMID 23933823.

[pmid439118-15] Canoso, JJ.; Sheckman, PR.. "Septic subcutaneous bursitis. Report of sixteen cases.". J Rheumatol 6 (1): 96-102. PMID 439118.

[16] Dillon, JP.; Freedman, I.; Tan, JS.; Mitchell, D.; English, S. (Jul 2012). "Endoscopic bursectomy for the treatment of septic pre-patellar bursitis: a case series.". Arch Orthop Trauma Surg 132 (7): 921-5. doi:10.1007/s00402-012-1494-7. PMID 22426936.

[pmid21814140-17] Lustenberger, DP.; Ng, VY.; Best, TM.; Ellis, TJ. (Sep 2011). "Efficacy of treatment of trochanteric bursitis: a systematic review.". Clin J Sport Med 21 (5): 447-53. doi:10.1097/JSM.0b013e318221299c. PMID 21814140.

[18] Longo, UG.; Berton, A.; Khan, WS.; Maffulli, N.; Denaro, V. (Sep 2011). "Histopathology of rotator cuff tears.". Sports Med Arthrosc 19 (3): 227-36. doi:10.1097/JSA.0b013e318213bccb. PMID 21822106.

[pmid24084435-19] Kuzel, BR.; Grindel, S.; Papandrea, R.; Ziegler, D. (Oct 2013). "Fatty infiltration and rotator cuff atrophy.". J Am Acad Orthop Surg 21 (10): 613-23. doi:10.5435/JAAOS-21-10-613. PMID 24084435.

[pmid23405595-20] Gigante, MR.; Martinotti, I.; Cirla, PE.. "[Computer work and De Quervain's tenosynovitis: an evidence based approach].". G Ital Med Lav Ergon 34 (3 Suppl): 116-8. PMID 23405595.

[pmid18063716-21] 21.0 ^21.1 Ilyas, AM.; Ilyas, A.; Ast, M.; Schaffer, AA.; Thoder, J. (Dec 2007). "De quervain tenosynovitis of the wrist.". J Am Acad Orthop Surg 15 (12): 757-64. PMID 18063716.

[pmid17245017-22] Declau, F.; van Spaendonck, M.; Timmermans, JP.; Michaels, L.; Liang, J.; Qiu, JP.; van de Heyning, P. (2007). "Prevalence of histologic otosclerosis: an unbiased temporal bone study in Caucasians.". Adv Otorhinolaryngol 65: 6-16. doi:10.1159/000098663. PMID 17245017.

[omim166800-23] Online 'Mendelian Inheritance in Man' (OMIM) 166800

[omim605727-24] Online 'Mendelian Inheritance in Man' (OMIM) 605727

[pmid22771999-25] Redfors, YD.; Gröndahl, HG.; Hellgren, J.; Lindfors, N.; Nilsson, I.; Möller, C. (Aug 2012). "Otosclerosis: anatomy and pathology in the temporal bone assessed by multi-slice and cone-beam CT.". Otol Neurotol 33 (6): 922-7. doi:10.1097/MAO.0b013e318259b38c. PMID 22771999.

[pmid620199-26] 26.0 ^26.1 "Otosclerosis.". Br Med J 1 (6105): 63-4. Jan 1978. PMC 1602666. PMID 620199. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1602666/.

[27] Erdoglija, M.; Sotirovic, J.; Jacimovic, V.; Vukomanovic, B. (2012). "Avascular necrosis of stapes crura in one case of operated otosclerosis.". Acta Medica (Hradec Kralove) 55 (4): 193-7. PMID 23631292.

[pmid10197399-28] Ferguson, MK. (Mar 1999). "Surgical management of intrapleural infections.". Semin Respir Infect 14 (1): 73-81. PMID 10197399.

[pmid20628845-29] Shiraishi, Y. (Jul 2010). "Surgical treatment of chronic empyema.". Gen Thorac Cardiovasc Surg 58 (7): 311-6. doi:10.1007/s11748-010-0599-6. PMID 20628845.

[30] Hamm, H.; Light, RW. (May 1997). "Parapneumonic effusion and empyema.". Eur Respir J 10 (5): 1150-6. PMID 9163661. http://erj.ersjournals.com/content/10/5/1150.long.

[pmid23227941-31] Küçüktaş, M.; Kutlubay, Z.; Yardimci, G.; Khatib, R.; Tüzün, Y. (Feb 2013). "Comparison of effectiveness of electrocautery and cryotherapy in partial matrixectomy after partial nail extraction in the treatment of ingrown nails.". Dermatol Surg 39 (2): 274-80. doi:10.1111/dsu.12068. PMID 23227941.

[pmid24063180-32] Jia, C.; Li, P.; Wu, Y.; Qiu, Y.; Cao, L.; Chang, C.; Zhang, Y. (Jul 2013). "[Modified surgical repair of severe ingrown toenail].". Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 27 (7): 869-71. PMID 24063180.

[pmid12752134-33] 33.0 ^33.1 Reisberger, EM.; Abels, C.; Landthaler, M.; Szeimies, RM. (Apr 2003). "Histopathological diagnosis of onychomycosis by periodic acid-Schiff-stained nail clippings.". Br J Dermatol 148 (4): 749-54. PMID 12752134.

[pmid23153047-34] Fanti, PA.; Dika, E.; Misciali, C.; Vaccari, S.; Barisani, A.; Piraccini, BM.; Cavrin, G.; Maibach, HI. et al. (Jun 2013). "Nail apparatus melanoma: is trauma a coincidence? Is this peculiar tumor a real acral melanoma?". Cutan Ocul Toxicol 32 (2): 150-3. doi:10.3109/15569527.2012.740118. PMID 23153047.

[pmid36295514-35] 35.0 ^35.1 Kohlhauser M, Pirsch JV, Maier T, Viertler C, Fegerl R (September 2022). "The Cyst of the Canal of Nuck: Anatomy, Diagnostic and Treatment of a Very Rare Diagnosis-A Case Report of an Adult Woman and Narrative Review of the Literature". Medicina (Kaunas) 58 (10). doi:10.3390/medicina58101353. PMC 9609622. PMID 36295514. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9609622/.

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

[9]

[10]

[11]

[12]

[13]

[14]

[15]

[16]

[17]

[18]

[19]

[20]

[21]

[22]

[23]

[24]

[25]

[26]

[27]

[28]

[29]

[30]

[31]

[32]

[33]

[34]

[35]

@@ Line 1: / Line 1: @@
+[[Image:Tonsillectomy tonsils.JPEG|thumb|right|220px|Tonsils (at [[cut-up]]) are a common ditzel. ([[WC]]/Katotomichelakis ''et al.'')]]
 This article collects '''ditzels''', which are, in the context of [[pathology]], little specimens that are typically one or two slides and usually of little interest.<ref>{{Ref TPoSP|37}}</ref>
 The challenge in ditzels is not falling asleep... so one misses the unexpected (subtle) tumour.
 =The big table of ditzels=
@@ Line 57: / Line 58: @@
 | [[Soft tissue pathology]]
 |-
-| [[Tubal ligation]]
+| Uterine tubes ([[tubal ligation]])
 | completed family
 | [[Gynecologic pathology]]
@@ Line 65: / Line 66: @@
 | [[Dermatopathology]]
 |-
-| [[Vasectomy]]
+| Vas deferens ([[vasectomy]])
 | completed family
 | [[Genitourinary pathology]]
@@ Line 92: / Line 93: @@
 | decortication for [[pneumonia]]
 | [[Pulmonary pathology]]
+|-
+| [[Bursa]]
+| [[bursitis]]
+| Orthopaedic
+|-
+| [[Gastric band]]
+| [[obesity]]
+| [[Gastrointestinal pathology]]
+|-
+| Small bowel excised during [[Roux-en-Y gastric bypass]]
+| [[obesity]]
+| [[Gastrointestinal pathology]]
+|-
+| [[Uterine isthmocele]]/cesarean scar defect
+| post-cesarean section
+| [[Gynecologic pathology]]
+|-
+| [[Distal interosseous nerve]] (''[[posterior interosseous nerve]] of wrist'' and ''[[anterior interosseous nerve]] of wrist'')
+| chronic hand pain, as may be seen in [[rheumatoid arthritis]]
+| [[Neuropathology]]
+|-
+| [[Palmar fascia]]
+| [[palmar fibromatosis]] (Dupuytren's contracture)
+| Plastic surgery
+|-
+| Soft tissue of hand or wrist
+| [[Ganglion cyst]]
+| Plastic surgery
+|- <!--
+| Specimen
+| Typical context (diagnosis)
+| System -->
 |}
 =Gastrointestinal pathology=
 ==Hernia sac==
+:''Inguinal hernia'' redirects here.
 ===General===
 *Hernia repair (herniorrhaphy).
@@ Line 123: / Line 157: @@
 ====Mesothelial lining present====
+<pre>
+Submitted as "Hernia Sac", Excision:
+- Benign fibroadipose tissue partially covered by mesothelium, consistent
+  with hernia sac.
+- NEGATIVE for malignancy.
+</pre>
+======Block letters======
 <pre>
 SOFT TISSUE ("HERNIA SAC"), RESECTION/HERNIA REPAIR:
@@ Line 139: / Line 181: @@
 =====Gross only=====
 <pre>
-SOFT TISSUE, RIGHT INGUINAL, HERNIORRHAPHY:
+SOFT TISSUE, RIGHT INGUINAL, HERNIA REPAIR:
 - HERNIA SAC (GROSS ONLY).
 </pre>
 <pre>
-SOFT TISSUE, LEFT INGUINAL, HERNIORRHAPHY:
+SOFT TISSUE, LEFT INGUINAL, HERNIA REPAIR:
 - HERNIA SAC (GROSS ONLY).
 </pre>
@@ Line 190: / Line 232: @@
 ====Ileostomy====
+<pre>
+Submitted as "Ileostomy", Excision:
+- Small bowel with submucosal fibrosis, otherwise within normal limits.
+- Skin without significant pathology.
+- NEGATIVE for dysplasia and NEGATIVE for malignancy.
+</pre>
+=====Alternate=====
+<pre>
+Submitted As "Ileostomy", Excision:
+     - Consistent with ileostomy (small bowel, skin) without significant pathology.
+     - NEGATIVE for dysplasia and NEGATIVE for malignancy.
+</pre>
+=====Block letters=====
 <pre>
 ILEOSTOMY, ILEOSTOMY REVERSAL:
@@ Line 252: / Line 309: @@
 ==Cholesteatoma==
-===General===
+{{Main|Cholesteatoma}}
-*Squamous epithelium in the middle ear - leading to accumulation of keratinaceous debris.<ref>URL: [http://www.harrisonspractice.com/practice/ub/view/Harrisons%20Practice/141015/all/otitis_media_and_mastoiditis http://www.harrisonspractice.com/practice/ub/view/Harrisons%20Practice/141015/all/otitis_media_and_mastoiditis]. Accessed on: 16 March 2011.</ref>
-**''Keratosis obturans'' - accumulation in the external ear canal - is considered to be a different process;<ref>{{cite journal |author=Piepergerdes MC, Kramer BM, Behnke EE |title=Keratosis obturans and external auditory canal cholesteatoma |journal=Laryngoscope |volume=90 |issue=3 |pages=383–91 |year=1980 |month=March |pmid=7359960 |doi= |url=}}</ref> though some consider it a synonym.<ref>{{cite journal |author=Shire JR, Donegan JO |title=Cholesteatoma of the external auditory canal and keratosis obturans |journal=Am J Otol |volume=7 |issue=5 |pages=361–4 |year=1986 |month=September |pmid=3538893 |doi= |url=}}</ref>
-*The etiology is ''not'' well understood.<ref name=pmid20860924>{{Cite journal  | last1 = Nevoux | first1 = J. | last2 = Lenoir | first2 = M. | last3 = Roger | first3 = G. | last4 = Denoyelle | first4 = F. | last5 = Ducou Le Pointe | first5 = H. | last6 = Garabédian | first6 = EN. | title = Childhood cholesteatoma. | journal = Eur Ann Otorhinolaryngol Head Neck Dis | volume = 127 | issue = 4 | pages = 143-50 | month = Sep | year = 2010 | doi = 10.1016/j.anorl.2010.07.001 | PMID = 20860924 }}</ref><ref name=pmid20156369>{{Cite journal  | last1 = Louw | first1 = L. | title = Acquired cholesteatoma pathogenesis: stepwise explanations. | journal = J Laryngol Otol | volume = 124 | issue = 6 | pages = 587-93 | month = Jun | year = 2010 | doi = 10.1017/S0022215109992763 | PMID = 20156369 }}</ref>
-**Theories include migration/hyperplasia, and metaplasia.<ref name=pmid20156369/>
-May be subdivided into:<ref name=pmid20860924/>
-*Acquired - due to trauma, surgery or infection.
-*Congenital.
-===Gross===
-*Whitish mass in the middle ear.<ref name=pmid23217274>{{Cite journal  | last1 = Al Balushi | first1 = T. | last2 = Naik | first2 = JZ. | last3 = Al Khabori | first3 = M. | title = Congenital cholesteatoma in identical twins. | journal = J Laryngol Otol | volume = 127 | issue = 1 | pages = 67-9 | month = Jan | year = 2013 | doi = 10.1017/S0022215112002757 | PMID = 23217274 }}</ref>
-Image:
-<gallery>
-Image:Cholesteatom_kuppelraum_1a.jpg | Cholesteatoma. (WC)
-</gallery>
-===Microscopic===
-Features:<ref name=pmid1694387>{{cite journal |author=Iino Y, Toriyama M, Ohmi S, Kanegasaki S |title=Activation of peritoneal macrophages with human cholesteatoma debris and alpha-keratin |journal=Acta Otolaryngol. |volume=109 |issue=5-6 |pages=444–9 |year=1990 |pmid=1694387 |doi= |url=}}</ref>
-*Keratinaceous debris - '''key feature'''.
-*Squamous epithelium.
-*Macrophages +/- giant cell (containing keratinceous debris).
-*Chronic inflammation (lymphocytes).
-DDx:
-*Cholesterol granuloma.<ref>URL: [http://path.upmc.edu/cases/case273/dx.html http://path.upmc.edu/cases/case273/dx.html]. Accessed on: 14 January 2012.</ref>
-===Sign out===
-<pre>
-SOFT TISSUE (CHOLESTEATOMA), SITE NOT FURTHER SPECIFIED, REMOVAL:
-- KERATINACEOUS DEBRIS, COMPATIBLE WITH CHOLESTEATOMA.
-</pre>
-<pre>
-Soft tissue, left ear ("left ear keratosis"), excision:
-- Keratinaceous debris, squamous epithelium and bone (consistent with cholesteatoma).
-</pre>
 =Genitourinary pathology=
@@ Line 303: / Line 323: @@
 *[[Lichen planus]].
 *Infection, e.g. [[syphilis]], [[candidiasis]].
-*[[Zoon balantitis]] - abundant plasma cells.
+*[[Zoon balanitis]] - abundant [[plasma cell]]s.
 ===Microscopic===
@@ Line 313: / Line 333: @@
 *See ''[[Penis]].
-==Paraurethral cyst==
+===Sign out===
-===General===
+<pre>
-*Rare.
+Foreskin, Circumcision:
-*Benign.
+- Benign squamous mucosa within normal limits, consistent with foreskin.
+</pre>
+<pre>
+A. Foreskin, Circumcision:
+- Benign squamous mucosa without significant histopathology, consistent with foreskin.
+</pre>
+<pre>
+Foreskin, Circumcision:
+- Benign squamous mucosa with mild patchy chronic inflammation at the epidermal-dermal interface.
+- NEGATIVE for dysplasia and NEGATIVE for malignancy.
+</pre>
-Clinical:<ref>{{Cite journal  | last1 = Isen | first1 = K. | last2 = Utku | first2 = V. | last3 = Atilgan | first3 = I. | last4 = Kutun | first4 = Y. | title = Experience with the diagnosis and management of paraurethral cysts in adult women. | journal = Can J Urol | volume = 15 | issue = 4 | pages = 4169-73 | month = Aug | year = 2008 | doi =  | PMID = 18706145 }}</ref>
+<pre>
-*Presentation: mass lesion, dyspareunia or dysuria.
+Foreskin, Circumcision:
-*Multipareous.
+- Squamous mucosa with mild-to-moderate acute and chronic
+  (lymphocytic) lichenoid inflammation.
+- NEGATIVE for evidence of lichen sclerosus.
+- NEGATIVE for dysplasia and NEGATIVE for malignancy.
-===Microscopic===
+Comment:
-Features:
+A PASD stain is NEGATIVE for micro-organisms.
-*Cystic space with epithelial lining - diagnosis based on epithelial lining.
+</pre>
-Subclassification:<ref>{{Cite journal  | last1 = Satani | first1 = H. | last2 = Yoshimura | first2 = N. | last3 = Hayashi | first3 = N. | last4 = Arima | first4 = K. | last5 = Yanagawa | first5 = M. | last6 = Kawamura | first6 = J. | title = [A case of female paraurethral cyst diagnosed as epithelial inclusion cyst]. | journal = Hinyokika Kiyo | volume = 46 | issue = 3 | pages = 205-7 | month = Mar | year = 2000 | doi =  | PMID = 10806582 }}</ref><ref name=pmid7195943>{{Cite journal  | last1 = Das | first1 = SP. | title = Paraurethral cysts in women. | journal = J Urol | volume = 126 | issue = 1 | pages = 41-3 | month = Jul | year = 1981 | doi =  | PMID = 7195943 }}</ref>
+====Micro====
-*[[Epithelial inclusion cyst]].
+The section shows squamous mucosa with mild basal pigmentation and subepithelial fibrous tissue. The epithelium matures to the surface. Significant inflammation is ABSENT. Atypia is ABSENT.
-*Müllerian cyst.
-*[[Gartner duct cyst]] ([[AKA]] [[mesonephric duct cyst]] [[AKA]] Wolffian duct cyst).<ref>URL: [http://webpathology.com/image.asp?n=3&Case=540 http://webpathology.com/image.asp?n=3&Case=540]. Accessed on: 5 February 2012.</ref>
+==Paraurethral cyst==
-*Skene duct cyst.
+{{Main|Paraurethral cyst}}
 ==Labia==
@@ Line 350: / Line 385: @@
 =Head and neck pathology=
 ==Tonsillitis==
-:''Tonsil'' redirects here.
+{{Main|Tonsillitis}}
-===General===
+{{Main|Tonsil}}
-*Commonly removed (tonsillectomy) when enlarged.
-*Very low probability of malignancy (<0.2%) in tonsilectomies in individuals <19 years old if no clinical suspicion.<ref name=pmid15963574>{{Cite journal  | last1 = Erdag | first1 = TK. | last2 = Ecevit | first2 = MC. | last3 = Guneri | first3 = EA. | last4 = Dogan | first4 = E. | last5 = Ikiz | first5 = AO. | last6 = Sutay | first6 = S. | title = Pathologic evaluation of routine tonsillectomy and adenoidectomy specimens in the pediatric population: is it really necessary? | journal = Int J Pediatr Otorhinolaryngol | volume = 69 | issue = 10 | pages = 1321-5 | month = Oct | year = 2005 | doi = 10.1016/j.ijporl.2005.05.005 | PMID = 15963574 }}</ref>
-===Gross===
-*Symmetrical and equal size.
-Note:
-*Gross exam is considered sufficient if there is no asymmetry.<ref name=pmid14608541>{{Cite journal  | last1 = Williams | first1 = MD. | last2 = Brown | first2 = HM. | title = The adequacy of gross pathological examination of routine tonsils and adenoids in patients 21 years old and younger. | journal = Hum Pathol | volume = 34 | issue = 10 | pages = 1053-7 | month = Oct | year = 2003 | doi =  | PMID = 14608541 }}</ref>
-===Microscopic===
-Features:
-*Follicular hyperplasia - see ''[[lymph node pathology]]''.
-*+/-Colonies (clusters) of [[actinomycetes]] in the tonsillar crypts.
-DDx:
-*Non-Hodgkin [[lymphoma]].<ref name=pmid20426908>{{Cite journal  | last1 = Wang | first1 = XY. | last2 = Wu | first2 = N. | last3 = Zhu | first3 = Z. | last4 = Zhao | first4 = YF. | title = Computed tomography features of enlarged tonsils as a first symptom of non-Hodgkin's lymphoma. | journal = Chin J Cancer | volume = 29 | issue = 5 | pages = 556-60 | month = May | year = 2010 | doi =  | PMID = 20426908 }}</ref>
-===IHC===
-If there is a clinical suspicion - a panel to exclude (small cell) non-Hodgkin lymphomas:
-*CD3.
-*CD20.
-*CD5.
-*CD10.
-*CD23.
-*Cyclin D1.
-===Sign out===
-<pre>
-A. TONSIL, LEFT, TONSILLECTOMY:
-- REACTIVE FOLLICULAR HYPERPLASIA.
-- REACTIVE SQUAMOUS MUCOSA.
-B. TONSIL, RIGHT, TONSILLECTOMY:
-- REACTIVE FOLLICULAR HYPERPLASIA.
-- REACTIVE SQUAMOUS MUCOSA.
-</pre>
-====Without squamous mucosa====
-<pre>
-A. TONSIL, LEFT, TONSILLECTOMY:
-- REACTIVE FOLLICULAR HYPERPLASIA.
-B. TONSIL, RIGHT, TONSILLECTOMY:
-- REACTIVE FOLLICULAR HYPERPLASIA.
-</pre>
 ==Obstructive sleep apnea==
@@ Line 421: / Line 411: @@
 {{Main|Cardiovascular pathology}}
 ==Vascular thrombus==
-:''Venous thrombus'' and ''arterial thrombus'' redirect here.
+{{Main|Vascular thrombus}}
-===General===
-*Uncommonly comes to pathology.
-Risk factors - think [[Virchow's triad]]:
+==Leg amputation==
-*Stasis, e.g. atrial fibrillation.
+{{Main|Leg amputation}}
-*Hypercoagulable states, e.g. cancer - see ''[[risks factors venous thromboembolism]]''.
-*Endothelial injury.
-===Gross===
+==Toe amputation==
-: See ''[[pulmonary embolism]]''.
-Features:
-*Dull appearance.
-*Laminations.
-===Microscopic===
-Features:
-*Layers consisting of platelets and fibrin.
-**Classically alternating with layers of RBCs - known as ''Lines of Zahn''.<ref name=Ref_PBoD8_124>{{Ref PBoD8|124}}</ref>
-Note:
-*Multiple laminations (layers), in general, suggest that clot was formed in a dynamic environment, i.e. in the context of blood flow.
-DDx:
-*Tumour embolus - malignant cells.
-*Thromboembolus - may require [[clinical history]].
-*[[Fat embolism]].
-*Amniotic fluid embolus - in the context of pregnancy/postpartum.
-*Foreign body.
-Images:
-*www:
-**[http://library.med.utah.edu/WebPath/ATHHTML/ATH031.html Lines of Zahn (utah.edu)].
-**[http://pathhsw5m54.ucsf.edu/case9/image94.html Lines of Zahn (ucsf.edu)].
-*[[WC]]:
-**[http://commons.wikimedia.org/wiki/File:Laminations_in_a_thrombus_-_low_mag.jpg Laminated thrombus - low mag. (WC)].
-**[http://commons.wikimedia.org/wiki/File:Laminations_in_a_thrombus_-_high_mag.jpg Laminated thrombus - high mag. (WC)].
-===Sign out===
-<pre>
-BLOOD CLOT, LEFT ILIAC ARTERY, THROMBECTOMY:
-- THROMBUS.
-- NEGATIVE FOR MALIGNANCY.
-</pre>
-====Micro====
-The sections show layers of red blood cells alternating with fibrin and white blood cells (Lines of Zahn).
-==Leg amputation==
 ===General - overview===
-Comes in two basic flavours:
+*Like leg ampuations.
-*Above the knee ampuation (AKA).
-*Below the knee ampuation (BKA).
-Etiology:
-*[[Diabetes mellitus]] - most common - see ''[[atherosclerotic peripheral vascular disease]]''.
-*Trauma.
-*Infection - see ''[[chronic osteomyelitis]]''.
-*Drug use, e.g. [[cocaine]].<ref name=pmid17059855/>
 ===Sign out===
 :See ''[[Ditzels#Atherosclerotic peripheral vascular disease]]''.
-==Toe amputation==
+==Finger amputation==
 ===General - overview===
-*Like leg ampuations.
+*Similar to [[toe amputation]]s.
+May be done due to:
+*Contractures leading to ulcerations.
+*[[Scleroderma]] - leading to ischemia.<ref name=pmid3584887>{{Cite journal  | last1 = Jones | first1 = NF. | last2 = Imbriglia | first2 = JE. | last3 = Steen | first3 = VD. | last4 = Medsger | first4 = TA. | title = Surgery for scleroderma of the hand. | journal = J Hand Surg Am | volume = 12 | issue = 3 | pages = 391-400 | month = May | year = 1987 | doi =  | PMID = 3584887 }}</ref>
 ===Sign out===
@@ Line 536: / Line 479: @@
 *Drug use, e.g. [[cocaine]].<ref name=pmid17059855>{{Cite journal  | last1 = Dhawan | first1 = SS. | last2 = Wang | first2 = BW. | title = Four-extremity gangrene associated with crack cocaine abuse. | journal = Ann Emerg Med | volume = 49 | issue = 2 | pages = 186-9 | month = Feb | year = 2007 | doi = 10.1016/j.annemergmed.2006.08.001 | PMID = 17059855 }}</ref>
 *[[Chronic osteomyelitis]].
+*[[Cholesterol embolism]].
 ===Sign out===
+====Forefoot amputation====
+<pre>
+RIGHT FOREFOOT, AMPUTATION:
+- ULCERATED SKIN.
+- MODERATE-TO-SEVERE ATHEROSCLEROSIS.
+- BLOOD VESSEL WITH RECANALIZATION.
+- NEGATIVE FOR MALIGNANCY.
+</pre>
 ====Leg amputation====
 <pre>
@@ Line 555: / Line 509: @@
 - SEVERE ATHEROSCLEROSIS.
 - NEGATIVE FOR MALIGNANCY.
+</pre>
+=====Leg amputation - gross only=====
+<pre>
+LOWER EXTREMITY, LEFT, BELOW THE KNEE AMPUTATION:
+- ULCERS AND ISCHEMIC CHANGES WITH FOCAL COMPLETE ARTERIAL OCCLUSION (GROSS ONLY).
+</pre>
+<pre>
+LEG, RIGHT, ABOVE THE KNEE AMPUTATION:
+- ULCERS AND ISCHEMIC CHANGES WITH EXTENSIVE ARTERIAL DISEASE (GROSS ONLY).
+</pre>
+<pre>
+LEG, RIGHT, ABOVE THE KNEE AMPUTATION:
+- EXTENSIVE ISCHEMIC CHANGES WITH SEVERE ARTERIAL DISEASE (GROSS ONLY).
 </pre>
@@ Line 603: / Line 573: @@
 - ULCERATED SKIN AND CHRONIC ISCHEMIC CHANGES.
 - BONE WITH NO SIGNIFICANT PATHOLOGY.
+- NEGATIVE FOR MALIGNANCY.
+</pre>
+<pre>
+GREAT TOE, RIGHT, AMPUTATION:
+- GANGRENE.
+- ATHEROSCLEROSIS.
+- NECROTIC BONE WITH ABUNDANT COCCI ORGANISMS AND NEUTROPHILS
+  WITHIN THE MARROW CAVITY.
 - NEGATIVE FOR MALIGNANCY.
 </pre>
@@ Line 638: / Line 617: @@
 ==Heterotopic ossification==
 *Abbreviated ''HO''.
+{{Main|Heterotopic ossification}}
+==Lumbar bone==
 ===General===
-*Definition of ''heterotopic ossification'': bone formation in soft tissue.<ref name=pmid21611960>{{Cite journal  | last1 = Leblanc | first1 = E. | last2 = Trensz | first2 = F. | last3 = Haroun | first3 = S. | last4 = Drouin | first4 = G. | last5 = Bergeron | first5 = E. | last6 = Penton | first6 = CM. | last7 = Montanaro | first7 = F. | last8 = Roux | first8 = S. | last9 = Faucheux | first9 = N. | title = BMP-9-induced muscle heterotopic ossification requires changes to the skeletal muscle microenvironment. | journal = J Bone Miner Res | volume = 26 | issue = 6 | pages = 1166-77 | month = Jun | year = 2011 | doi = 10.1002/jbmr.311 | PMID = 21611960 }}
+*May be seen in the context of laminectomies to treat cauda equina syndrome.
-</ref>
-*Injury at site.
-*May be seen in the context of tetraplegia.
-Clinical:<ref name=pmid21611960/>
-*+/-Joint stiffness.
-*+/-Swelling.
-*+/-Pain.
 ===Microscopic===
 Features:
-*[[Lamellar bone]] - has layering/lines (best seen with polarized light).
+*Degenerative fibrocartilage:
-*+/-Skeletal muscle (within the marrow space).
+**Multiple chondrocytes in one pocket (lacuna) - regenerative change.
+**Degenerative cartilage.
+*Non-vital bone:
+**Empty lacuna.
 DDx:
-*[[Myositis ossificans]] - inflammation, cellular.
+*Occult malignancy.
-*[[Osteosarcoma]], extraskeletal.
+===Sign out===
+<pre>
+LUMBAR BONE, DECOMPRESSION:
+- BONE AND VERTEBRAL DISC FRAGMENTS WITH DEGENERATIVE CHANGES.
+- UNREMARKABLE BONE MARROW.
+- NEGATIVE FOR MALIGNANCY.
+</pre>
+==Bursa==
+:''Bursitis'' redirects here.
+===General===
+*Uncommon specimen.
+*Septic bursitis is usually due to ''S. aureus''.<ref name=pmid23933823>{{Cite journal  | last1 = Hanrahan | first1 = JA. | title = Recent developments in septic bursitis. | journal = Curr Infect Dis Rep | volume = 15 | issue = 5 | pages = 421-5 | month = Oct | year = 2013 | doi = 10.1007/s11908-013-0353-1 | PMID = 23933823 }}</ref>
+**Usually associated with trauma to the overlying skin.<ref name=pmid439118>{{Cite journal  | last1 = Canoso | first1 = JJ. | last2 = Sheckman | first2 = PR. | title = Septic subcutaneous bursitis. Report of sixteen cases. | journal = J Rheumatol | volume = 6 | issue = 1 | pages = 96-102 | month =  | year =  | doi =  | PMID = 439118 }}</ref>
+Indication:
+*Bursitis - may be treated with bursectomy.<ref>{{Cite journal  | last1 = Dillon | first1 = JP. | last2 = Freedman | first2 = I. | last3 = Tan | first3 = JS. | last4 = Mitchell | first4 = D. | last5 = English | first5 = S. | title = Endoscopic bursectomy for the treatment of septic pre-patellar bursitis: a case series. | journal = Arch Orthop Trauma Surg | volume = 132 | issue = 7 | pages = 921-5 | month = Jul | year = 2012 | doi = 10.1007/s00402-012-1494-7 | PMID = 22426936 }}</ref>
+Note:
+*Most bursitis is managed conservatively.<ref name=pmid21814140>{{Cite journal  | last1 = Lustenberger | first1 = DP. | last2 = Ng | first2 = VY. | last3 = Best | first3 = TM. | last4 = Ellis | first4 = TJ. | title = Efficacy of treatment of trochanteric bursitis: a systematic review. | journal = Clin J Sport Med | volume = 21 | issue = 5 | pages = 447-53 | month = Sep | year = 2011 | doi = 10.1097/JSM.0b013e318221299c | PMID = 21814140 }}</ref>
+===Microscopic===
+Features:
+*Dense connective tissue.
+*Fibroadipose tissue.
 ===Sign out===
+====No apparent inflammation====
 <pre>
-LESION ("HETEROTOPIC OSSIFICATION"), RIGHT FEMUR, EXCISION:
+BURSA, RIGHT HIP, BURSECTOMY:
-- BONE -- CONSISTENT WITH MUSCLE HETEROTOPIC OSSIFICATION.
+- BENIGN DENSE CONNECTIVE TISSUE WITH CALCIFICATIONS, AND FIBROADIPOSE TISSUE.
+- NO SIGNIFICANT INFLAMMATION.
 - NEGATIVE FOR MALIGNANCY.
 </pre>
-====Micro====
+<pre>
-The sections show laminar bone with a marrow space containing adipose tissue and benign skeletal muscle. The osteocytes show no nuclear atypia. No mitotic activity is appreciated.
+BURSA, LEFT TROCHANTERIC, BURSECTOMY:
+- BENIGN DENSE CONNECTIVE TISSUE AND BENIGN FIBROADIPOSE TISSUE.
+- NO SIGNIFICANT INFLAMMATION.
+- NEGATIVE FOR MALIGNANCY.
+</pre>
-=Other=
+==Rotator cuff tear==
-==Breast prosthesis==
-:''Breast expander'' redirects here.
 ===General===
-*Commonly used for cosmesis in the context of [[breast cancer]].
+*Surgically repaired.
+*[[Clinical diagnosis]].
-===Gross===
+===Microscopic===
-''Specimen received in formalin labelled "right breast prosthesis" consists of a breast prosthesis measuring 13.5 x 12.5 x 4.5 cm. Seen on one side the number 356 is seen. The prosthesis is intact. No tissue is identified. No sections are submitted.''
+Features:<ref>{{Cite journal  | last1 = Longo | first1 = UG. | last2 = Berton | first2 = A. | last3 = Khan | first3 = WS. | last4 = Maffulli | first4 = N. | last5 = Denaro | first5 = V. | title = Histopathology of rotator cuff tears. | journal = Sports Med Arthrosc | volume = 19 | issue = 3 | pages = 227-36 | month = Sep | year = 2011 | doi = 10.1097/JSA.0b013e318213bccb | PMID = 21822106 }}</ref>
+*Collagen degeneration.
+*Disordered arrangement of collagen fibres.
+**Wavy fibres.
+**Separation of the ﬁbres.
+*+/-Inflammation - associated with smaller tears.
+*+/-Decreased cellularity - associated with larger tears.
+*+/-Fatty replacement.<ref name=pmid24084435>{{Cite journal  | last1 = Kuzel | first1 = BR. | last2 = Grindel | first2 = S. | last3 = Papandrea | first3 = R. | last4 = Ziegler | first4 = D. | title = Fatty infiltration and rotator cuff atrophy. | journal = J Am Acad Orthop Surg | volume = 21 | issue = 10 | pages = 613-23 | month = Oct | year = 2013 | doi = 10.5435/JAAOS-21-10-613 | PMID = 24084435 }}</ref>
-====Images====
+===Sign out===
-<gallery>
+<pre>
-Image:Saline-filled_breast_implants.jpeg | Breast implants. (WC)
+RIGHT SHOULDER ACROMIOM AND BURSAE, EXCISION:
-</gallery>
+- UNREMARKABLE BONE (GROSS ONLY).
-WP:
+- BENIGN SOFT TISSUE.
-*[http://en.wikipedia.org/wiki/File:Ruptured_implant.JPG Ruptured breast implant (WP)].
+</pre>
-===Sign out===
 <pre>
-BREAST PROSTHESIS, RIGHT, REMOVAL:
+"BURSA AND ACROMION", LEFT SHOULDER, ROTATOR CUFF REPAIR:
-- INTACT BREAST PROSTHESIS (GROSS ONLY).
+- BENIGN DENSE CONNECTIVE TISSUE AND BENIGN FIBROADIPOSE TISSUE.
+- NO SIGNIFICANT INFLAMMATION.
+- NO BONE IDENTIFIED.
+- NEGATIVE FOR MALIGNANCY.
 </pre>
-====Not intact====
 <pre>
-BREAST PROSTHESIS, LEFT, REMOVAL:
+"BURSA AND ACROMION", LEFT SHOULDER, ROTATOR CUFF REPAIR:
-- BREAST PROSTHESIS WITH EVIDENCE OF PERFORATION AND LEAKAGE (GROSS ONLY).
+- BENIGN DENSE WAVY CONNECTIVE TISSUE WITH FIBRE SEPARATION.
+- BENIGN FIBROADIPOSE TISSUE.
+- NO SIGNIFICANT INFLAMMATION.
+- NO BONE IDENTIFIED.
+- NEGATIVE FOR MALIGNANCY.
 </pre>
+=Other=
+==Breast prosthesis==
+*[[AKA]] ''breast implants''.
+{{Main|Breast prostheses}}
 ==De Quervain syndrome==
 :Should ''not'' be confused with ''[[De Quervain's thyroiditis]]'' (subacute granulomatous thryoiditis).
-*[[AKA]] ''de Quervain disease''.
+*[[AKA]] ''de Quervain tenosynovitis'',<ref name=pmid23405595>{{Cite journal  | last1 = Gigante | first1 = MR. | last2 = Martinotti | first2 = I. | last3 = Cirla | first3 = PE. | title = [Computer work and De Quervain's tenosynovitis: an evidence based approach]. | journal = G Ital Med Lav Ergon | volume = 34 | issue = 3 Suppl | pages = 116-8 | month =  | year =  | doi =  | PMID = 23405595 }}</ref> and ''de Quervain disease''.
 ===General===
 *Benign.
+*[[Tenosynovitis]] of the thumb.
 *Clinical diagnosis.<ref name=pmid18063716>{{Cite journal  | last1 = Ilyas | first1 = AM. | last2 = Ilyas | first2 = A. | last3 = Ast | first3 = M. | last4 = Schaffer | first4 = AA. | last5 = Thoder | first5 = J. | title = De quervain tenosynovitis of the wrist. | journal = J Am Acad Orthop Surg | volume = 15 | issue = 12 | pages = 757-64 | month = Dec | year = 2007 | doi =  | PMID = 18063716 }}</ref>
@@ Line 715: / Line 740: @@
 ===Sign out===
+====Not apparent====
 <pre>
 FIRST EXTENSOR COMPARTMENT, RIGHT HAND, BIOPSY:
@@ Line 722: / Line 748: @@
 ==Tenosynovitis==
-===General===
+{{Main|Tenosynovitis}}
-*Uncommon pathology specimen.
-===Microscopic===
-Features:<ref name=pmid20442645>{{Cite journal  | last1 = Shon | first1 = W. | last2 = Folpe | first2 = AL. | title = Tenosynovitis with psammomatous calcification: a poorly recognized pseudotumor related to repetitive tendinous injury. | journal = Am J Surg Pathol | volume = 34 | issue = 6 | pages = 892-5 | month = Jun | year = 2010 | doi = 10.1097/PAS.0b013e3181d95a36 | PMID = 20442645 }}</ref>
-*Dense connective tissue (tendon).
-*Histocytes.
-*+/-[[Psammoma bodies]].
-DDx:
-*Calcific tendinitis.
-*[[Giant cell tumour of the tendon sheath]].
-*[[Palmar fibromatosis]].
-===IHC===
-Features:
-*CD68 +ve.
-*Beta-catenin -ve.
-Note:
-*Immunostains are usually not required for the diagnosis.
-===Sign out===
-<pre>
-TENOSYNOVIUM, LEFT MIDDLE FINGER, EXCISION:
-- DENSE CONNECTIVE TISSUE (CONSISTENT WITH TENDON) WITH LYMPHOHISTOCYTIC INFILTRATE.
-- NEGATIVE FOR GIANT CELLS.
-- NEGATIVE FOR MALIGNANCY.
-</pre>
-====Micro====
-The sections show dense connective tissue (tendon) containing a cluster of cells with
-indistinct cellular borders, abundant foamy grey cytoplasm, and round/oval
-pale-staining nuclei with small nucleoli (histiocytes).  The cell cluster has a small
-number of interspersed lymphocytes, and the centre of the cell cluster has acellular
-hyaline material (degenerative tendon).
-No calcification is identified. No giant cells are seen.
-No nuclear atypia is apparent and no mitotic activity is appreciated.
 ==Otosclerosis==
@@ Line 792: / Line 779: @@
 DDx:
 *[[Avascular necrosis]] ~ 25% of cases diagnosed as ''otosclerosis''.<ref name=pmid620199/>
 **May be due to [[fat embolism]].
+Note:
+*Avascular necrosis of the stapes crura and otosclerosis together is considered rare.<ref>{{Cite journal  | last1 = Erdoglija | first1 = M. | last2 = Sotirovic | first2 = J. | last3 = Jacimovic | first3 = V. | last4 = Vukomanovic | first4 = B. | title = Avascular necrosis of stapes crura in one case of operated otosclerosis. | journal = Acta Medica (Hradec Kralove) | volume = 55 | issue = 4 | pages = 193-7 | month =  | year = 2012 | doi =  | PMID = 23631292 | URL = ftp://orbis.lfhk.cuni.cz/Acta_Medica/2012/2012_193.pdf}}</ref>
 Images:
@@ Line 798: / Line 788: @@
 ===Sign out===
+<pre>
+STAPES, RIGHT, STAPEDECTOMY:
+- BENIGN BONE CONSISTENT WITH STAPES.
+</pre>
 <pre>
 STAPES, RIGHT, STAPEDECTOMY:
@@ Line 809: / Line 804: @@
 - NO BONE IDENTIFIED.
 </pre>
+===External links===
+*[http://otopathologynetwork.org/tbimages/chapter15/?page=3 Otosclerosis (otopathologynetwork.org)].
 ==Abdominal pannus==
-{{Main|Obesity}}
+*[[AKA]] ''pannus'', ''panniculus'' and ''pannona''.
-===General===
+{{Main|Abdominal pannus}}
-*An apron-like excess of skin - following weight loss.<ref>URL: [http://plasticsurgery.about.com/od/glossary/g/panniculectomy.htm http://plasticsurgery.about.com/od/glossary/g/panniculectomy.htm]. Accessed on: 18 July 2012.</ref>
-*Seen in [[obesity]].
-===Microscopic===
-Features:
-*Adipose tissue.
-DDx:
-*[[Lipoma]].
-*[[Liposarcoma]].
-===Sign out===
-<pre>
-ABDOMINAL PANNUS, EXCISION:
-- BENIGN SKIN AND ADIPOSE TISSUE.
-</pre>
-<pre>
-ABDOMINAL PANNUS, EXCISION:
-- BENIGN SKIN AND ADIPOSE TISSUE (GROSS ONLY).
-</pre>
 ==Empyema==
-:''Empyema peel'' redirects here.
+:''Empyema peel'' and ''pleural peel'' redirect here.
 ===General===
 *Empyemas are often managed surgically.<ref name=pmid10197399>{{Cite journal  | last1 = Ferguson | first1 = MK. | title = Surgical management of intrapleural infections. | journal = Semin Respir Infect | volume = 14 | issue = 1 | pages = 73-81 | month = Mar | year = 1999 | doi =  | PMID = 10197399 }}</ref>
@@ Line 857: / Line 834: @@
 *Reactive fibroblasts.
 *Reactive mesothelial cells - not common.
+DDx:
+*[[Malignant mesothelioma]] - should have infiltrative growth.
+*[[Fibrosing pleuritis]].
 ===Sign out===
+<pre>
+A. Right Pleural, Pleural Peel:
+     - Proliferative fibroblasts with marked reactive changes.
+     - Necro-inflammatory debris.
+     - NEGATIVE for evidence of malignancy.
+B. Right Lung, Biopsy:
+     - Necro-inflammatory debris and reactive pleural changes.
+     - Infarcted lung parenchyma.
+     - NEGATIVE for evidence of malignancy.
+</pre>
+====Block letters====
 <pre>
 PLEURA, LEFT, DECORTICATION:
-- MIXED INFLAMMATORY WITH ABUNDANT NEUTROPHILS.
+- MIXED INFLAMMATORY INFILTRATE WITH ABUNDANT NEUTROPHILS.
-- REACTIVE FIBROBLASTS.
+- REACTIVE FIBROBLASTS AND FIBRIN.
+- NO MICROORGANISMS APPARENT WITH H&E STAINING.
 - NEGATIVE FOR MALIGNANCY.
 </pre>
+====Not labelled as a peel====
+<pre>
+Left Lung, Biopsy:
+- Fibrin, neutrophils, necrotic tissue and a fibroblastic
+  response, compatible with empyema peel.
+- NO viable lung parenchyma identified.
+- NEGATIVE for evidence of malignancy.
+</pre>
+==Toenail==
+===General===
+*Relatively common.
+Indications for removal:
+*Ingrown<ref name=pmid23227941>{{Cite journal  | last1 = Küçüktaş | first1 = M. | last2 = Kutlubay | first2 = Z. | last3 = Yardimci | first3 = G. | last4 = Khatib | first4 = R. | last5 = Tüzün | first5 = Y. | title = Comparison of effectiveness of electrocautery and cryotherapy in partial matrixectomy after partial nail extraction in the treatment of ingrown nails. | journal = Dermatol Surg | volume = 39 | issue = 2 | pages = 274-80 | month = Feb | year = 2013 | doi = 10.1111/dsu.12068 | PMID = 23227941 }}</ref> - typically great toe.<ref name=pmid24063180>{{Cite journal  | last1 = Jia | first1 = C. | last2 = Li | first2 = P. | last3 = Wu | first3 = Y. | last4 = Qiu | first4 = Y. | last5 = Cao | first5 = L. | last6 = Chang | first6 = C. | last7 = Zhang | first7 = Y. | title = [Modified surgical repair of severe ingrown toenail]. | journal = Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi | volume = 27 | issue = 7 | pages = 869-71 | month = Jul | year = 2013 | doi =  | PMID = 24063180 }}</ref>
+*Onychomycosis - [[fungus|fungal]] infection.<ref name=pmid12752134>{{Cite journal  | last1 = Reisberger | first1 = EM. | last2 = Abels | first2 = C. | last3 = Landthaler | first3 = M. | last4 = Szeimies | first4 = RM. | title = Histopathological diagnosis of onychomycosis by periodic acid-Schiff-stained nail clippings. | journal = Br J Dermatol | volume = 148 | issue = 4 | pages = 749-54 | month = Apr | year = 2003 | doi =  | PMID = 12752134 }}</ref>
+*Pigmented lesion.
+**Exclude melanoma.<ref name=pmid23153047>{{Cite journal  | last1 = Fanti | first1 = PA. | last2 = Dika | first2 = E. | last3 = Misciali | first3 = C. | last4 = Vaccari | first4 = S. | last5 = Barisani | first5 = A. | last6 = Piraccini | first6 = BM. | last7 = Cavrin | first7 = G. | last8 = Maibach | first8 = HI. | last9 = Patrizi | first9 = A. | title = Nail apparatus melanoma: is trauma a coincidence? Is this peculiar tumor a real acral melanoma? | journal = Cutan Ocul Toxicol | volume = 32 | issue = 2 | pages = 150-3 | month = Jun | year = 2013 | doi = 10.3109/15569527.2012.740118 | PMID = 23153047 }}</ref>
+===Microscopic===
+Features:
+*Nail plate - paucicellular, dense connective tissue.
+*Keratinized squamous epithelium.
+*+/-Cocci organisms.
+DDx:
+*[[Malignant melanoma]].
+*Trauma.
+*[[Fungus|Fungal infection]] ([[candidiasis]]).
+*Bacteria infection, e.g. [[Pseudomonas]] (causes green nails).
+===Stains===
+For pigmented lesion:
+*[[Prussian blue stain]] - trauma +ve, melanocytic lesion -ve.
+*[[Fontana-Masson stain]] - trauma -ve, melanocytic lesion usu. +ve.
+Query fungal infection:
+*[[PAS]] +ve for fungal organisms.<ref name=pmid12752134>{{Cite journal  | last1 = Reisberger | first1 = EM. | last2 = Abels | first2 = C. | last3 = Landthaler | first3 = M. | last4 = Szeimies | first4 = RM. | title = Histopathological diagnosis of onychomycosis by periodic acid-Schiff-stained nail clippings. | journal = Br J Dermatol | volume = 148 | issue = 4 | pages = 749-54 | month = Apr | year = 2003 | doi =  | PMID = 12752134 }}</ref>
+===Sign out===
+====Pigmented nail====
+<pre>
+PARTIAL NAIL PLATE, RIGHT THIRD TOE, SCISSOR EXCISION:
+- NAIL PLATE AND THIN LAYER OF KERATINIZED SQUAMOUS EPITHELIUM WITH
+  PARAKERATOSIS AND FIBRIN.
+- NO APPARENT PIGMENT.
+- NO EVIDENCE OF MALIGNANCY.
+</pre>
+=====Micro=====
+The sections show a paucicellular nail plate, and a thin layer of squamous epithelium with
+keratinization and partial retention of the nuclei (parakeratosis). There is also a small
+amount of fibrin. No pigmentation is apparent with Prussian blue and Fontana-Masson
+staining. No melanocytes are apparent. No nuclear atypia is apparent. No mitotic activity
+is identified. No microorganisms are apparent. No significant inflammation is apparent.
+====Query infection====
+<pre>
+GREAT TOENAIL, RIGHT, EXCISION:
+- NAIL PLATE AND THIN LAYER OF KERATINIZED SQUAMOUS EPITHELIUM.
+- SMALL CLUSTERS OF COCCI, FOCAL.
+- NO APPARENT FUNGAL ORGANISMS WITH PASF STAIN.
+- NO EVIDENCE OF MALIGNANCY.
+</pre>
+====Fungal organisms present====
+<pre>
+GREAT TOE NAIL, RIGHT, REMOVAL:
+- NAIL PLATE AND THIN LAYER OF KERATINIZED SQUAMOUS EPITHELIUM WITH
+  PARAKERATOSIS AND SCANT SUBEPITHELIAL TISSUE.
+- FUNGAL ORGANISMS CONSISTENT WITH CANDIDA, DEMONSTRATED WITH PASF STAIN.
+- SMALL CLUSTERS OF COCCI, FOCAL.
+- NO EVIDENCE OF MALIGNANCY.
+</pre>
+==Canal of Nuck cyst==
+===General===
+*Canal of Nuck is the female equivalent of the male ''processus vaginalis''.<ref name=pmid36295514/>
+*Women/girls only pathology - can be thought of as inguinal hernia in women.
+*Very rare pathology.<ref name=pmid36295514>{{cite journal |authors=Kohlhauser M, Pirsch JV, Maier T, Viertler C, Fegerl R |title=The Cyst of the Canal of Nuck: Anatomy, Diagnostic and Treatment of a Very Rare Diagnosis-A Case Report of an Adult Woman and Narrative Review of the Literature |journal=Medicina (Kaunas) |volume=58 |issue=10 |pages= |date=September 2022 |pmid=36295514 |pmc=9609622 |doi=10.3390/medicina58101353 |url=}}</ref>
+===Sign out===
+<pre>
+A. Submitted as "Canal of Nuck Cyst", Excision::
+- Benign fibroadipose tissue partially covered by mesothelium with inflammation,
+  compatible with clinical impression of canal of Nuck cyst.
+- NEGATIVE for malignancy.
+</pre>
+==Palmar fascia==
+{{Main|Palmar fascia}}
 =See also=
@@ Line 874: / Line 961: @@
 [[Category:Basics]]
+[[Category:Ditzels]]

Difference between revisions of "Ditzels"

Latest revision as of 17:02, 2 July 2024

The big table of ditzels

Gastrointestinal pathology

Hernia sac

General

Microscopic

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Incarcerated without mesothelium

Micro

Mesothelial lining present

Block letters

Inflamed

Gross only

Stoma

General

Microscopic

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Colostomy

Ileostomy

Alternate

Block letters

Vagus nerve

General

Microscopic

IHC

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Pediatric

Bands of Ladd

General

Microscopic

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Cholesteatoma

Genitourinary pathology

Foreskin

General

Microscopic

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Micro

Paraurethral cyst

Labia

General

Microscopic

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Head and neck pathology

Tonsillitis

Obstructive sleep apnea

General

Microscopic

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Cardiovascular pathology

Vascular thrombus

Leg amputation

Toe amputation

General - overview

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Finger amputation

General - overview

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Atherosclerotic peripheral vascular disease

General

Gross

Microscopic

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Forefoot amputation

Leg amputation

Revision

Leg amputation - gross only

Toe amputation

Mild

Moderate

Severe

Orthopaedic

Femoral head

Bone reamings

General

Microscopic

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Heterotopic ossification

Lumbar bone