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Sanjay Mukhopadhyay @smlungpathguy
, 14 tweets, 6 min read Read on Twitter
1/
 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
2/
 First a question to test your knowledge. Necrosis with large numbers of neutrophils is called:
3/
 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
4/
 Here’s necrosis in a pleomorphic carcinoma of the lung. Necrosis is at the bottom of the pic. You can almost discern elongated dead cells in there. Pleomorphic carcinoma is the WHO term for a type of sarcomatoid lung carcinoma

#pulmpath @JenniferBoland7
5/
 Here’s suppurative necrosis in an empyema. This is what we call “pus” when seen with the naked eye. There are hundreds of neutrophils in this type of necrosis. Bacterial infection is the most common cause. Suppurative granulomas should make you think blastomycosis.
6/
 Necrosis is a poorly differentiated squamous cell carcinoma. Nothing fancy...doesn’t it look a bit “dirty”?
7/
 Necrosis in a lung adenocarcinoma. I guess “dirty necrosis” isn’t all that specific ¯\_(ツ)_/¯
8/
 Necrosis in a mycobacterial granuloma. Is it “caseous”? This term (“caseating”) has to be one of the most meaningless in pathology. It means “cheese-like” (when seen with the naked eye), has no consistent microscopic counterpart and is FAR from specific for TB.
9/
 Can’t get a more classic “caseating granuloma” than this. Looked cheese like grossly too. Any guesses as to what bugs were found in it?

AFB? ❌
Histoplasma ✅

Just call this a necrotizing granuloma. Please. Please?
10/
 There’s nothing specific about pink necrosis either. Here’s necrosis in a melanoma.

#necrosis
11/
 Necrosis is a key feature in small cell lung carcinoma. It often contains nuclear fragments too.
12/
Necrosis in squamous cell carcinoma often contains the ghosts of keratinized malignant cells. Some imagination is required here 😉
13/
 Now let’s see if we improved learning! What do you call necrosis that contains MANY neutrophils?

#pathologypoll #pathpoll #MedEd
14/
 Tweeples, please share your tips re: types of necrosis in different situations. Pics will be greatly appreciated.

Thank you for reading! 🙏🏾🙏🏾

🌹🌹🌹 End of Tweetorial 🌹🌹🌹
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More from @smlungpathguy see all

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Mini #tweetorial for anyone who wants to learn how to do a good PowerPoint presentation:

Tip 1: Look and sound bored. Sigh a lot.
Tip 2:
Look towards your PowerPoint and away from your audience. This way they will appreciate the back of your haircut and everyone can avoid awkward eye contact
Tip 3:
Put lots of fancy graphs and tables loaded with data in there that take 5-10 minutes to understand. Give your audience 15 seconds to admire them and move on to the next slide
Read 12 tweets
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1/
 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)
2/
 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.
3/
What does the pic in the previous tweet show?
Read 24 tweets
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1/
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
2/
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.
3/
What do you think happens next in the vast majority of infected individuals?
Read 31 tweets

Related threads

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I’m glad that this article was written, it makes a LOT of great points about sun exposure and melanoma, but I think a few things need further discussion.

My final #tweetorial of 2018! 👇🏾👇🏾👇🏾
In order to appreciate the complexity of this relationship (i.e. sun exposure and melanoma), one must remember that measuring sun exposure over time is HARD.
The sun is all around us making it difficult to measure exposure levels and thus draw conclusions with absolute certainty.
Read 21 tweets
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Going to slowly tweet out 15 of the most interesting things I read, listened to and saw in 2018. With oncology/ health policy/ evidence themes

Starting with Same Dataset, Different Interpretations by @BrianNosek nature.com/news/crowdsour…
The point in this paper is if you give researchers the (a) exact same data set and ask the (b) exact same question you get a variety of answers.

Some point out that *some* of the point estimates are consistent....
Of course that is true, but other teams are reporting qualitatively different conclusions: some say no evidence of bias, others say bias

And, imagine a second what happens if...
Read 84 tweets
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#Tweetorial on hypoxemic #respiratoryfailure. #FITSurvivalGuide #FOAMed
1️⃣ Shunt
2️⃣ V/Q mismatch
3️⃣ Low FiO2/low O2 tension
4️⃣ Alveolar hypoventilation
5️⃣ Diffusion limitation
6️⃣ Venous admixture
#CriticalCare
1️⃣Shunt - can be intra or extrapulmonary. No V, only Q. Does not respond to O2 - shunt fraction not exposed to o2. Inflamm alveolar dz (eg PNA) can p/w shunt (imp. vasoconstr.) Think abt PFO w R➡️L shunt in PE, ARDS (elevation in R sided pressures), check bubble study. Aa grad ⬆️
2️⃣V/Q mismatch. More Q than V but regions with low V not entirely excluded from gas exchange. Can improve w increasing FiO2. Probably 75-90% of hypoxemia cases. Wide Aa gradient.
Read 7 tweets
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The results of my #tweetorial poll were pretty clear: from over 350 votes, 38% of you want to know about causal survival analysis. So, pull up a chair and let’s talk time-to-event!
First things first, what do we mean by causal survival analysis?

An answer to the question: How would the average time to event have differed if everyone had received some exposure, versus if everyone had received some other exposure?
We can measure that difference between in time to event in many different ways. I prefer survival curves with risk differences at the end of follow-up, adjusting for baseline and time-varying confounding.
Read 33 tweets
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#Tweetorial on #Diagnostics and #Screening interpretation.
An otherwise healthy 40 year old woman comes to you after reading on the internet about a terrible disease that one in a thousand women get, and a highly accurate test that can save her life.
The test is over 99% accurate in people with the disease. For those without disease, the test is only wrong 5% of the time.

You order this test and it comes back positive. The woman anxiously asks you, do I have the disease? What is the chance this woman has the disease?
Assuming they weren't immediately fooled by the "test is only wrong 5 % of the time," most I've asked correctly recognize the stats provided are Sensitivity = 99% and Specificity = 95%, and that the objective is to determine the Positive Predictive Value.
Read 21 tweets
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Last night I posted this lovely gross picture; I’m now adding a couple of histologic images. Kudos to @kriyer68 and @DrAldehyde for being the first to submit the correct answer- this is indeed a synovial sarcoma! Not a bad time for a #Tweetorial #BSTPath
Synovial sarcoma is actually uncommon in joint cavities & does not recapitulate synovium in any way. Its rare amongst soft tissue sarcomas, representing only 5-10% of the cases. The disease is most prevalent in teenagers & young adults; 50% of cases are seen in pediatric patients
These most commonly present as pain in the affected site with an associated mass. In many cases the duration of symptoms is 2-5 years. They are seen most commonly in the extremities and are often associated with tendons. #BSTPath
Read 12 tweets

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