Sanjay Mukhopadhyay Profile picture
Dad. Director of Pulmonary Pathology at Cleveland Clinic. Associate Editor (Pulmonary), @AJCPJournal Author of lung pathology textbook. Opinions mine.
Giuseppe Ingravallo Profile picture allous Profile picture Javier Laurini Profile picture gustavo zanelli Profile picture Rockyang MD Profile picture 8 added to My Authors
7 Jun 20
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
18 Mar 20
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 👇🏾

3. Podcast episode 3/17 by @nytimes . Very moving interview with a pulmonologist who has treated dozens of patients in Bergamo, Italy. Warning: it will make you cry.

“Nothing is as before”

They see 50-70 patients with severe pneumonia every single day
Read 22 tweets
7 Mar 20
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
28 Jan 19
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
27 Jan 19
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
24 Jan 19
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.
Read 11 tweets
17 Nov 18
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
11 Nov 18
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
4 Nov 18
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
16 Oct 18
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
13 Oct 18
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
18 Aug 18
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
16 Aug 18
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 16 tweets