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1/
 #Melanoma can look like anything: a #Tweetorial

Most melanomas are fairly easy to recognize but the outliers are pretty crazy.

Like this example with signet ring cells 👇🏾👇🏾
2/
 Melanoma with clear cells

3/
 Melanoma with gland formation

4/
 Melanoma with nests mimicking neuroendocrine tumor

5/
 This melanoma looks a bit rhabdoid to me

6/
 Ok not all melanomas are crazy. Here’s a spindly one with melanin. Straightforward.

7/
 This melanoma mimics other spindle cells or pleomorphic malignant neoplasms

8/
 Melanoma with myxoid change (Gulp!)

9/
 Melanoma mimicking lymphoma

10/
 And if you really want to be scared, there’s desmoplastic melanoma (you’ll never look at a scar the same way again)

11/
 More desmoplastic melanoma (nightmare material)

12/
 Desmoplastic melanoma can look like neurofibroma (or sit next to a neurofibroma..gulp!)

13/
 Is this melanoma epithelioid, rhabdoid or plasmacytoid?

14/
 All these morphologic variants of melanoma are so much prettier on #cytopath

15/
 More melanoma on Diff-Quik (or similar Romanovsky stain)

16/
 And now we check out melanoma with balloon cells 😢😳

17/
 I’ll add more examples of “melanoma can look like anything” with time but if you have some good pics, please tweet them and I will add to this Tweetorial 🙏🏾🙏🏾🙏🏾🙏🏾

#pathtweetorial
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#Melanoma #Tweetorial #cytopath #pathtweetorial

More from @smlungpathguy see all

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Sanjay Mukhopadhyay
@smlungpathguy
How about a #Tweetorial with no ending? A document that can be added to at any time? Can it work? Let’s find out!

1/
This #pathtweetorial will address the entity know as “talc granulomatosis” and review the literature, including old papers!

#pathology #pulmpath #granuloma
2/
 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

ncbi.nlm.nih.gov/pubmed/5410600/
3/
 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
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Sanjay Mukhopadhyay
@smlungpathguy
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
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Sanjay Mukhopadhyay
@smlungpathguy
1/
Here are the 4 winners for #PathTweetAward All will get awards but we need to rank, so pls pick your favorites! First, the 2 winners in the open category. Please scroll down in the thread to see the actual award winning tweets. Scroll further down to see trainee awardees.
2/ Here is the Raul Gonzalez tweet:

3/ And this is the Angel Panizo tweet:
Read 11 tweets

Related threads

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Stephen Conn (he/him)
@holympus
#Tweetorial time! Today's topic: insulin!

We all know that insulin release is stimulated by glucose. So, let's start with a question.

You give a patient the same amount of glucose, either orally or via IV. Does one method cause a more robust insulin response than the other?
The insulin response is much greater to the oral glucose, even though both cause the same increase in blood sugar (Lindgren et al., 2011)! To understand why, we need to explore the wild world of incretins. But first, let's circle back to insulin!
#highyield review: Insulin is a peptide with an alpha and beta chain connected by three disulfide bonds. The most important insulin-dependent glucose transporter is GLUT-4, expressed on adipose tissue and striated muscle. But, many tissues don't need insulin to uptake glucose!
Read 17 tweets
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Steven Chen
@DrStevenTChen
Syphilis! RMSF! Hand-foot mouth!

Slow down there, Tiger! Let's dive deeper into:

ACRAL RASHES - a #tweetorial/#medthread
(aka rashes on the "palms and soles" - kind of 😉).

#MedEd #FOAMEd #medtwitter #dermtwitter #dermatology #dermatologia pc:@dermnetnz
1/
No where else on the body does a rash evoke more of a knee-jerk differential. That's not wrong per se, as we all learn this in med school, but it's more complicated then starting doxycycline and checking an RPR!

Let's start with a definition - what does "acral" actually mean?
2/
Technically, "acral" just means our distal body parts. So while we often think of palms and soles, it's actually inclusive of the whole hand, the whole foot, ears, and some include even the nose!

I actually didn't learn this until #derm residency, which was shocking to me.
3/
Read 20 tweets
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Steven Chen
@DrStevenTChen
A #tweetorial/#medthread on…

CONSULT ETIQUETTE – for the consultant!

(This is the 2nd in a series on consult etiquette. See the end of this thread for a link to my other tweetorial for primary teams calling consults).

#MedEd #FOAMEd #dermtwitter #medtwitter #dermatology
1/
So you just got paged for a consult…. What do you do?

2/
Of course we all think #1, yes?! Realistically though, it can be stressful to get consults. They are unpredictable, can come at any time, & the primary team may or may not listen to what you have to say. Here are some tips I’ve come up with from my time on #dermconsults.
3/
Read 12 tweets
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Pauli Ohukainen
@POhukainen
#Tweetorial time! 🚨 Looks like there’s another misconception about #cholesterol and #atherosclerosis making rounds again. This one has to do with the process of #LDL particles entering the arterial wall. So gather round friends and let me science the s*it out of this 🤓 (1/24)
For background, here’s a widely cited series of figures by Nakashima et al. (2007). They performed autopsies on 38 people aged 7-49, who died of non-#cardiovascular causes (2/24)
ncbi.nlm.nih.gov/pubmed/17303781
Nakashima et al. looked for atherosclerotic lesions at different stages, according to a previously published morphological classification scheme. They found them, took slices, stained them to find #lipids and #macrophages and organized them nicely (3/24)
Read 25 tweets
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Prof Darrel Francis ☺ Mk CardioFellows Great Again
@ProfDFrancis
RELATIVE RISK, ODDS RATIO, HAZARD RATIO
=============================

What are they?
Why do we need 3 of the damn things?
Which should I use?
Are they the same, or different, or a bit samey?

An #ORBITA-HQ #tweetorial.
#Meded #FOAMed
All 3 of these are about comparing the scale of dangerousness of one thing AGAINST ANOTHER.

Suppose you are walking through an unfamiliar forest and the road comes to a fork: you have to choose one path.

As you stand, uncertain, a troll pops out of the ground.
You ask for advice on which path is safer.

As always, the advice he offers is scrupulously correct, but not necessarily instantly interpretable to the layperson.
Read 65 tweets

Trending hashtags

#oncology #dermpath #Tweetorial #internalmedicine #Tcells #ICUreadings #tweetorial #HLA #LeuSM #UME #lipids #dermatologia #medthread #2wk #pleuralbiopsy #ASMClinMicro #meded #UnsolicitedAdviceThread #LungCancer #SoMeDocs #FOAMEd #pLACO #obgyn #HFNC #LesionSegregation
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