Discover and read the best of Twitter Threads about #pathtweetorial

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A 65 year old male presented with low urine output and bone pain. On further investigation serum creatinine was high and the patient had low hemoglobin. Bone marrow biopsy showed finding in the image. What is your diagnosis? #pathtwitter #pathtweetorial #pathresidents #pathboards
Answer is multiple myeloma.
They are deposits of immunoglobulins. Intracytoplasmic immunoglobulin inclusions are called RUSSEL BODIES.
Seen in multiple myeloma, plasmacytoma, lymphoplasmacytic lymphoma (LPL).
Read 9 tweets
A 48 year old male presented with submandibular swelling for 3 weeks.On examination the swelling was painless, solid, firm and immobile. Excision was performed. Hand E stained section of the tumour is shown below. What is your diagnosis? #pathtweetorial #pathboards #pathresidents Image
Answer is Acinic cell carcinoma -"acinic cells" (abundant finely vacuolated cytoplasm with basophilic granules, small nuclei with stippled chromatin), scattered "intercalcated duct type cells" (eosinophilic cytoplasm with moderate amount of cytoplasm and bland nuclei). Note the vacuolated acinic ...
Read 8 tweets
A 68-year old male presented with arthralgias and skin rashes. A complete blood count performed shows MCV of 80 fl and low platelet count. Peripheral smear and bone marrow images are shown. Which mutation is likely to be identified in this condition? #pathoboards #pathtweetorial
VEXAS Syndrome- mutations identified in UBA1 gene.
Some key features (images)
Read 7 tweets
A 17-year old male presented with a breast lump . Gross and Microscopic images from the excised lump ( shown in the images). Identify the true statement? (Options in the comments) #pathology #PathTwitter #PathTwitterFamily #pathtweetorial #tweetorial #MedTwitter #pathboards ImageImageImage
Diagnosis is juvenile papilomatosis.
Observe "swiss-cheese appearance" in gross and microscopy.
Other conditions with Swiss cheese appearance Image
Read 7 tweets
🩸#HemePath AML subtype #PathTweetorial 🧵

Which cytogenetic/molecular finding is most consistent with this morphology? (Poll⬇️)

#PathTwitter #MolecularPath #MedEd @MayoClinicPath
(P.S. Always learning - I welcome any feedback!) ImageImage
Which cytogenetic/molecular finding is most consistent with this morphology? AML with…
Answer: ✨inversion of chromosome 16 is associated with acute myeloid leukemia with abnormal eosinophils✨

These abnormal eosinophils have mixed eosinophilic and basophilic granules Image
Read 11 tweets
Multiple tweet thread #tweetorial on pathologic abnormalities in the lung caused by cigarette smoking

Smoking causes a wide variety of pathologic changes in the lung, not just lung cancer. Some of these are underrecognized or poorly named

#smokinglungpath #pulmpath
These smoking-related abnormalities include:
💥 Emphysema
💥 Pigmented airspace macrophages
💥 Ropy interstitial fibrosis (SRIF)
💥 Pulmonary Langerhans cell histiocytosis

Overlap is common because these abnormalities commonly occur together.
Every week I will add my thoughts to this #pathtweetorial . I feel strongly about this topic because I see SO much smoking-related lung pathology that is misinterpreted and underrecognized. Not just SRIF (👇🏾) but also pigmented macrophages, commonly dismissed as “anthracotic”
Read 10 tweets
#Pathologists ♥️ eosinophils.

We love scanning for them in a skin rash, admiring them when they infiltrate a tumor, & even counting them in esophageal biopsy. 🔬

But what do you know about eosinophils in the blood? 🤔


#pathbracket #hemepath #pathtweetorial @EmoryPathology
If the answer is "not much 🤷🏼‍♀️", then you're in luck, because the subject of my 2nd #pathtweetorial is:


🩸 Approach to Peripheral Blood Eosinophilia 🩸

Here's a brief outline of what I'll be discussing:


Let's get started with a case!

30 y/o M, presents with 3 months of fatigue, weakness, weight loss & abdominal pain.

Peripheral blood 🩸 & bone marrow 🦴 show the following 👇

Read 15 tweets
1. How do we tell primary lung cancer from metastatic cancers from other sites?

It’s correct to say we should use all available clinical, radiologic and pathologic information, but that’s too vague to be helpful in a practical sense.

Here I offer some tips. #tweetorial
2. This #pathtweetorial is applicable mainly to #pulmpath . The principles in each organ are different. A carcinoma in a lymph node is a metastasis by definition. Not so in lung or colon.

IMHO it’s a mistake to approach a carcinoma in the lung as carcinoma of unknown primary
3. Most metastatic carcinomas to the lung occur after the primary carcinoma has already been diagnosed in another site.

💥Clinicians: give your pathologists this information! If you don’t, this is substandard, dangerous patient care.

Read 42 tweets
Age: 14-year old female
History: Proptosis & pain
Specimen: Exenteration
#pathology #PediPath #BSTPath #orbit

(*Image courtesy: Dr. Sayed Hashim)
3 main questions:
Q1. Is it benign or malignant?
Q2. If malignant - differentials?

DDx of orbital tumors in children:
1. Rhabdomyosarcoma (RMS)
2. Neuroblastoma
3. Synovial sarcoma
4. Chloroma
& so on
Read 28 tweets
History: Female, 50-ish, presented with hematuria.

Cystoscopy: Congested mucosa with bleeding ulcers

Biopsy from urinary bladder lesion

#pathology #GUPath
What should I do?
I should call the surgeon

“Did the patient have urinary bladder cancer before?”

Patient had cervix cancer, a year back
Read 17 tweets
How about a #Tweetorial on immunotherapy in quiz and answer form? Let’s try it! I’ll post a quiz in one tweet and then the answer in the next, and so on. Scroll down to follow the thread!

#pathology #pulmpath #ihcpath #pdl1 #Immunotherapy #pathtweetorial
First question. When PD-1 on T cells binds PD-L1 on tumor cells, what happens to the T cells?
The correct answer is that the binding of PD-1 to PD-L1 INHIBITS T cell killing of tumor cells.

See nice tweet on this by @kis_lorand

Read 35 tweets
A 23-year-old woman w/ a history of SLE was admitted to the hospital w/ abdominal pain & headache. Purpura is seen on her chest & thighs. Hb /Hct= 8.3,28.4, PLT= 7,000, LDH = 952, Hapto = <8, Ind Bili = 1.2, Cr = 1.2 PT/INR = 1.3. 👇🏼Take a look at her peripheral smear.
⁉️Based on the initial lab results and the peripheral smear findings above, what is your differential? #PathTweetorial #Blooducation #ApheresisRounds
The findings above (evidence of hemolysis, drop in platelet count & schistocytes on the peripheral smear) point to a thrombotic microangiopathic hemolytic anemia (TMA). The classic diseases that fall under this category are #TTP & #HUS. Let's review how we manage these patients
Read 10 tweets
24 y/o w/ h/o of Crohn’s Disease presents w/ worsening fatigue, weakness & dizziness. He has mild abdominal pain, but no signs of bleeding. No transfusion history. Infliximab was discontinued for autoimmune hepatitis. Hb/Hct = 4.4/13.5. 👇🏽Check out his peripheral smear below.
🤨Since you are the Heme/Onc Fellow on-call, you are 📟paged to consult on this patient’s anemia. What are the first labs you would order to assess #hemolysis?
#Blooducation #BBRounds #PathTweetorial
🔎When suspecting a hemolytic anemia, 4 hemolytic indexes can help you quickly determine the etiology of the patient's bleeding.
📰🧪Our patient’s lab results: LDH= 408, Hapto<8, IndBili =3.8 %Retic >30% which indicate a hemolytic anemia with adequate bone marrow response.
Read 10 tweets
Thursday #Blooducation schmooze on the topic of anti-G antibodies as they pertain to pregnancy and #HDFN. 👇🏽Follow the thread below to get capture the key points🅰️🅱️🆎🅾️🤰🏽👶🏽 Let's get started. #PathTweetorial ImageImage
🚧The anti-G antibody can cause confusion because it presents on a panel as a combination of anti-D and anti-C, sometimes called "anti-CD", when truly, an anti-D may not be present at all 🤦🏽‍♀️
⁉️What type of patients can form an anti-G?
Anti-G antibodies are formed when an Rh(D) neg person, generally rr (dce/dce ) individuals, are exposed through transfusion/pregnancy, to either C+, D+ or C+D+ blood. That's because the G-Ag is always found on C+ & mostly on the D+ RBCs. This is what the panel would look like👇🏽 Image
Read 9 tweets
These are the lungs of a patient who died while receiving a PLT transfusion. He developed sudden respiratory distress and did not respond to O2 support. Lungs compressed by 3000 mL of transudative pleural fluid. Notice the increased neutrophils #PathTweetorial
The above clinical scenario along with the histologic findings is consistent with which type of transfusion reaction?
#Blooducation #TransfusionReaction
Yes, the histologic findings and clinical history is consistent with Transfusion-Related Acute Lung Injury (TRALI). Second to TACO, it is the most common cause of transfusion-related morbidities and fatalities. What causes it?
Read 11 tweets
How about a #Tweetorial with no ending? A document that can be added to at any time? Can it work? Let’s find out!

This #pathtweetorial will address the entity know as “talc granulomatosis” and review the literature, including old papers!

#pathology #pulmpath #granuloma
I did a quick search to find the first time “talc granulomatosis” was used as a term for lung lesions caused by excipients in pills, and came across this 1970 paper. Were Hopkins and Taylor the first to coin the term? Correct me if I’m wrong @yro854
But first, let me give you a taste of what talc granulomatosis looks like, courtesy of Extra Super Duper Pathologist @DrjohninNE

The main finding is foreign body granulomas surrounding birefringent particulate matter (excipients) in the interstitium

Read 14 tweets
#GUpath puzzler time!
(for those of you familiar with this case, please keep 🤫!)

middle aged M found to have bilateral breast enlargement. Work-up revealed elevated serum PSA. MRI-guided prostate biopsy done of abnormal area seen on imaging.

my DDx:
▶️Gleason 5+5 prostatic adenocarcinoma (for all new bx cases, I always do confirmatory prostate #IHCpath)
▶️plasmacytoid urothelial carcinoma
▶️signet ring GI tract adenocarcinoma
▶️metastatic lobular carcinoma
not shown but negative were:
NKX3.1/PSAP, CK20, uroplakin2
Read 9 tweets
62 y/o man, O positive with de novo AML undergoes workup for Hematopoietic Stem Cell Transplant (HSCT). 😃Good news: Sibling with 8/8 HLA match! 👎🏽Bad news: Sibling is A positive. Can this sibling be a donor?
#Blooducation #PathTweetorial #HSCT
Unlike solid organ transplants, ABO-mismatch HSCT is not a barrier. In fact, 25-50% of all HSCT are ABO-incompatible. The most important factor in transplant survival outcomes is HLA compatibility (Chrom. 6p)
✅Critical to engraftment
✅ Balances potential harm of GVHD vs GVL
ABO carbohydrate glycosyltransferases are genes located on chromosome 9 and inherited completed independent of HLA. ABO Ags are not only on RBC membranes, but are also expressed on PLTs, vascular and organ endothelium as well as present in the plasma.
Read 12 tweets
Necrosis = cell death (unlike apoptosis, it does not occur naturally and is not programmed)

This short #Tweetorial shows you some of the histologic flavors of necrosis. The stain in each of these pics is hematoxylin-eosin (H&E)

#pathology #pulmpath #pathtweetorial
First a question to test your knowledge. Necrosis with large numbers of neutrophils is called:
And now a few examples. Necrosis in colorectal carcinoma is often described as “dirty” because it contains nuclear debris. This makes it look purplish instead of pink.

#gipath #MedEd
Read 14 tweets
This is the beginning of a #tweetorial or #pathtweetorial on a mystery topic. Fear not, it’ll become evident soon what we’re talking about. But first I’ll show you an image. These serpiginous fibroblast plugs are diagnostic if organizing pneumonia (formerly BOOP)
In MOST cases of organizing pneumonia seen on lung biopsy, the etiology is not evident on histology. But sometimes, there is a clue. Examine this pic closely and then see if you can answer the quiz in the next tweet in this thread.
What does the pic in the previous tweet show?
Read 24 tweets
What happens after you inhale Histoplasma into your lungs? Is #histoplasmosis always a deadly disease?

Here’s a #tweetorial or #pathtweetorial

You are at risk if you live in the Ohio or Mississippi River valleys, go spelunking, or work with chicken coops
Many (maybe most) people who inhale Histoplasma remain asymptomatic. Many have symptoms that mimic “the flu” and are treated as such. Only a minority of immunocompetent folks are seriously and acutely ill at first exposure. This is called acute pulmonary histoplasmosis.
What do you think happens next in the vast majority of infected individuals?
Read 31 tweets
It’s time for a #tweetorial on hypersensitivity pneumonitis. It’s a greatly misunderstood entity. Potentially treatable, so can be very good news. OTOH, misdiagnosing UIP as chronic hypersensitivity pneumonitis can be very bad.

Follow this thread for a #pathtweetorial
Let’s start with a poll regarding a common misconception. What is the predominant inflammatory cell in hypersensitivity pneumonitis?
Hypersensitivity pneumonitis is an inflammatory reaction that occurs in individuals (classically never-smokers) who are exquisitely sensitive to an organic antigen.

Obvious exposures (moldy hay=farmer’s lung) can be fairly straightforward to recognize clinically.
Read 20 tweets
Are you new to Twitter? Are you a pathology resident or a pathologist? Are you wondering what to tweet about or where to start? This brief tutorial is for you. Pathology on Twitter is awesome 👍🏾❤️✅

#Tweetorial = Tutorial of tweets

#pathtweetorial = Pathology version
First step, check out this awesome guide to social media for newcomers. SUPER useful.…

It had great tips, like this one: ALWAYS include a picture of yourself on your profile. He’s right: please do it NOW! It’s essential. Just use a selfie 😊
Follow a few pathologists. Use this handy guide created by @RoseannIWu to begin with, and then just follow people whose tweets you like. Following is a friendly gesture on Twitter, and conveys that you are interested that person’s tweets.
Read 27 tweets

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