Inspired by all the pathologists' assistants I met at the @PathAssist annual conference, I'm starting a thread of educational #grosspath images

1. Thymoma (note white fibrous bands) 2. Laryngeal cancer (with key structures labeled)

Last tweetorial of 2023 (@TristanRutland7 style again!)

Endobronchial biopsy, right lower lobe, elderly man

#pathology #pulmpath #pathtweetorial What is the likely cause of these histologic findings?

Tweetorial in the style of @TristanRutland7

Lung nodule, adult

#pathology #pulmpath #PathTwitter #cytopath



Based on the above, what is your initial thought?

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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 2.
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.

1/4 (4-tweet thread)
A recent study in @ModernPathology
by Xie et el examined the ability of a deep convolutional neural network to diagnose which tumor in pleural effusions? #pathpolls 2/4
Correct answer: lung adenocarcinoma.

nature.com/articles/s4137…

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Announcing a contest to win a free pathology textbook!

Thanks to a brilliant idea by @DrMissWV and a generous offer by @science_press and @LizMontgomeryMD we are giving away a few free textbooks in an educational tweet contest called #pathbracket . See thread 👇🏾

https://twitter.com/jmgardnermd/status/1164900617451724801

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If you want to enter the contest, create a NEW educational pathology tweet between today and March 15 and tag it with #pathbracket

You must tag your own tweet. The tweet must have educational value. Tweetorials are allowed too. Contest is open to all.

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

I’m starting a thread on #COVID19 just to keep everything I learn about it in one place.
🌹 New information
🌹 well summarized information
🌹 Things that changed my mind
🌹 Things that I did not expect

##pathology #pulmpath #CoronavirusOutbreak #SARSCoV2

1. Thread 👇🏾👇🏾 2. Great update with Dr. Fauci
Most interesting tidbit: why is well controlled hypertension a risk factor? Could ACE inhibitors be predisposing to coronavirus infection by increasing ACE receptors?

Link to video 👇🏾

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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 2/
First question. When PD-1 on T cells binds PD-L1 on tumor cells, what happens to the T cells?

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#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 👇🏾👇🏾

https://twitter.com/dermwizguy/status/1217188181914849280

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Melanoma with clear cells

https://twitter.com/smlungpathguy/status/1146566832658288640?s=21

https://twitter.com/smlungpathguy/status/1146566832658288640

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

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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/

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..

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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:

https://twitter.com/raulsgonzalezmd/status/1072861362613903360?s=21

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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:

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

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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.

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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.

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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 2/
Let’s start with a poll regarding a common misconception. What is the predominant inflammatory cell in hypersensitivity pneumonitis?

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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 2/
First step, check out this awesome guide to social media for newcomers. SUPER useful.

pathinfo.wikia.com/wiki/Social_Me…

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 😊

Tweetorial on carcinoid tumor of the lung. I’ll add to it little by little every week 😊

#pathology #pulmpath

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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 2/
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 😜