Discover and read the best of Twitter Threads about #pulmpath

Most recents (15)

1) Nice illustrative example on a common issue in lung biopsy interpretation. Lung cancers are notorious for presenting with a mixture of patterns as well as invasive and non-invasive components that can make for pitfalls on sampling.

#pathtwitter #pulmpath @smlungpathguy
2) Here is an axial HRCT scan from a lesion - it shows two components - periphery of "ground glass" and a central denser area with a little bit of enhancement.
3) Now imagine two separate biopsies from this tumor; one where the needle is placed in the periphery, and one that snags that central component- likely to turn up pretty different findings.
Read 7 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
Brain tumour, adult

PET positive

#Neuropath #Pathtwitter #Pathresidents
Based on the initial images only, what is your first impression?

Another image
Read 18 tweets
#Pulmpath #Thoracicpath #Pathbugs
Excited to share unusual case ,Male 60s ,3.8 cm lung mass ,Bx sent as suspected malignancy ,look at the first set ,try to make the Dx ,then go to second set ImageImageImageImage
#Pulmpath #Pathbugs @GeronimoJrLapac
This is the most painful tweet I have made ,was not able to upload on my IMac 😏 ImageImageImage
Dear friends my apologies for not being responsive , I will catch up in the next days to read all responses, promise 😊🙏 and indeed this is a textbook example ( my first one) of paracoccidioidomycosis
Read 3 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
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
Opinion appreciated!
▪️52/M, bx labeled “pleural/chest wall” done elsewhere

▪️CT report: consolidation LT upper lobe lung (paramediastinal). Another CT: suprahilar 8cm mass encasing LT upper bronchus.
(Not sure exact location pulm or pleura?)
3pic sets #Pulmpath @AltaherN88
▪️Prominent storiform pattern.
▪️Cells relatively uniform.
▪️No HPC vascular pattern.
▪️Not blue/fascicular enough for synovial sarc.
▪️Current bx does not include border of the lesion, but a previous core showed infiltration into lung parenchyma.

Positive (patchy):
▪️pan CK
▪️TLE1 (focal)


▪️D2-40, CK8/18
Read 4 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
Here are 10 cryptic clues to this diagnosis:
1. Georgina, William and Arthur
2. Chest pain
3. 17p11.2
4. Larger, lower
5. Canada
6. Face
7. No cathepsin
8. It's ok to be a man
9. Nothing in the wall
10. Epidermolysis bullosa, ichthyosis, neurofibromatosis

#pulmpath #dermpath
@kriyer68 and @ariella8 you guys are on top of your game!

Clues explained:
1. Georgina, William and Arthur (first names of Birt, Hogg and Dube)
2. Chest pain (from pneumothorax)
3. 17p11.2 (FLCN gene)
4. Larger, lower (cysts larger than LAM with predisposition for lower lobes..
Clues explained..(contd)

5. Canadian authors
6. Face (where fibrofolliculomas occur)
7. No cathepsin (cathepsin is pos in LAM not BHD)
8. It's ok to be a man (LAM is super rare in men, not BHD)
9. Nothing in the wall (unlike LAM, where cysts contain abnormal smooth ms cells)
Read 4 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
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
Tweetorial on carcinoid tumor of the lung. I’ll add to it little by little every week 😊

#pathology #pulmpath

Carcinoid tumor is the lower grade end of the spectrum of neuroendocrine tumors in the lung.

Caution: lung terminology is different from GI tract terminology
In the lung, the terminology is
✴️ Typical carcinoid tumor
✴️ Atypical carcinoid tumor
✴️ Small cell carcinoma
✴️ Large cell neuroendocrine carcinoma

We don’t terms such as “well differentiated NET” because...this is #pulmpath and we are special 😜
Carcinoid tumors are very similar on H&E to low grade NE tumors in the GI tract or pancreas. Nesting, odd patterns, bland cytology, granular chromatin (“salt and pepper”)

Read 27 tweets

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