I came across a nice study in the Journal of Cutaneous Pathology* in which the authors compared diagnostic accuracy between virtual microscopy and traditional glass slide microscopy among dermatology residents. According to this study, the overall diagnostic accuracy was better with glass slides than virtual slides.
I remember in Graz in the Summer Academy of Dermatopathology 2011, I have attended several lectures prepared by the virtual microscope in which scanned slides were presented.
Inflammatory dermatopathology is challenging to dermatopathologists as many diseases usually share one pattern. One should follow meticulously certain algorithms to limit the differential diagnosis to few diseases and also should pay attention to proper clinicopathological correlations to establish a definite diagnosis.
The psoriasiform pattern is one of those difficult patterns. I came across a nice article* which provides some clues to the diagnosis of this pattern and interestingly enough,
Dermatopathology is an important branch in medicine. It is not only crucial for establishment of diagnosis in various skin conditions in which clinical examination alone is not enough, but it is also important in guiding clinicians and surgeons for the subsequent management of various skin tumors.
This puts great responsibility on dermatopathologists in writing their reports. I came across an interesting article in the JAAD* in which the authors found that clinicians are becoming more likely
I came across this interesting research article published in the JAAD, September 2013, 69(3) by Pai-Shan Cheng, MD, and Feng-Jie Lai, MD, PhD. It discusses a new sign for the rapid microscopic diagnosis of hair changes and hair loss with or without pustualr lesions developing with EGFR inhibitors (Gefitinib or Erlotinib); such drugs have been widely used nowadays in treatment of many cancers.
Normal microscopic examination in plucked hair usually reveals a large caliber of hair root wi
Errors can happen during our practice and I believe nobody is exempted from making an error. However, the most important thing is to identify the cause of this error and to work on it to avoid it happening again.
Sometimes the cause of the error is in the dermatopathologist himself. Lack of sufficient skills, overworking and exhaustion or lack of second opinion are the main reasons for such errors. It is a sacred mission for anyone of us who has chosen to be a doctor to continuously upgrade h
In our very busy daily lives, we should not forget our basic job as parents. Our children's need for unconditional love should be adequately fulfilled for them to grow into confident and productive adults.
Many parents suffer misbehaviors from their children, drop in school performances and anti-social attitudes and they cannot explain why their children are not behaving well. Actually if children feel genuinely loved by their parents, they will be more responsive to parental guidance in all
I have been reading a lot last month about T regulatory cells (Tregs) and their role in MF. This subset of T cells are highly specialized subpopulation of CD4+ T cells which exert immunosuppressive effects. They help to check down autoimmune pathways and thus have beneficial effects on the host but being immunosuppressive they also exert suppressive effects on antitumor immune responses in various cancers. Accordingly, they seem to play a role in the etiopathogenesis of various malignancies inc
For all of us, a relaxed work environment is important for optimum productivity. Needless to say that when stressed, people have very low productivity. I have talked before in a previous blog about self management skills that I have adopted from the amazing books of David Allen; Getting Things Done and Making It All Work, but a relaxed work environment requires other things also.
When working as teams, it is important to ensure mutual respect between all members of the team. Teams that have
I was sitting on the beach in front of the clear blue water of the Mediterranean Sea in the amazing Almaza Bay, North Coast, Egypt when I was thinking about a topic to write in this blog. The magnificent color of the sea triggered me to think about things presenting with blue color in dermatopathology practice. I thought of recollecting them in this blog.
The first thing that I remembered was sea blue histiocytosis, a condition that I have never seen!! where the histiocytes are increased in s
Several histopathological types of BCC have been described in dermatopathology text books. However basosquamous carcinoma and keratotic BCC have confusing definitions that vary in different text books and sometimes I find this discrepancy irritating!!!
According to Weedon's skin pathology, a keratotic BCC is a BCC in which the islands show squamous differentiation and central keratinization, while in McKee's pathology of the skin, it is a BCC which contain horn cysts and in some cases may mim
Life styles these days are getting so hectic with too many responsibilities and tasks to finish in all aspects of life. We all spend our days rushing between work demands, family demands and personal demands. Now what is the result? A stressed tired body and an exhausted mind and many tasks that are missed and unaccomplished. No doubt that this stressful life style will eventually affect our productivity. Isn't there a way to achieve a stress free productivity?
The answer is YES. It all star
A female patient, 36 years, presented to me and my colleague, Dr Eman El-Nabarawy, with erythematous to hyperpigmented macules distributed mainly over her lower limbs with only few lesions over her upper limbs. The lesions showed a vaguely perceived reticulate or lividoid pattern over her legs. The lesions were asymptomatic and were present for 8 months. She has been treated with topical steroids with no improvement. The patient was referred to us for or biopsy taking and histopathological verif
It is common in our practice as dermatopathologists to receive specimens with a differential diagnosis of sarcoidosis vs. tuberculoid leprosy for histopathological verification. Interestingly enough, on mere morphological basis, one might be unable to differentiate between these two conditions.
Both present with non caseating granulomas. Whereas, sarcoidosis is typically characterized by discrete uniform naked granulomas, tuberculoid leprosy granulomas tend to be oval and surrounded with dens
Devotion and dedication are keys of success in anything in life, and for you to be devoted and dedicated to something, you should first love this thing. So I believe that no success is achieved without devotion and no devotion is applicable without love. In my opinion this applies so much to work, job and career. I believe in the saying: "lucky this man, whose job is his hobby!!"
What does this have to do with dermatopathology??? It has everything to do with it, actually! Dermatopathology is
For any dermatopathologist, it is of utmost importance to document cases and maintain a slide copy of them. This slide archive represents a valuable asset. However, with the advances in digital technology systems, keeping slide copies of your cases is no more the only way of documentation. Many dermatopathologists have digital camera systems which allow them to capture shots of their cases and keep them stored on computers. This provides a more useful resource. Images can be used in lectures, co
For junior dermatopathologists, the word epidermotropism represents the synonym of MF. However, epidermotropism is not only a lymphocytic phenomenon. The word epidermotropism in medical dictionary means: movement towards the epidermis. It applies to the spread of different types of cells into the epidermis from an underlying dermal or subcutaneous pathology.
A very interesting review article is the one written by Abbas and Bhawan entitled: Epidermotropic lesions, a review*. They discussed all
The world today is advancing so rapidly in the field of communication technology. Both Apple and Samsung companies are competing vigorously and great advances in the smart phone technologies emerge so fast that one cannot keep up with. Nowadays, you can instantly download a wide range of applications on your phone that really can help you in many aspects of your life.
One day I wondered about dermatopathology related applications, are they available?!! Interestingly, I found an application c
Understanding various dermatopathology terms is mandatory for proper interpretation of findings and hence reaching a proper diagnosis. Sometimes residents and trainers find it difficult to discriminate between various terms. A common area of confusion is the concept of horn cysts, horn pearls, squamous eddies and squamous morules.
Horn cysts represent foci of abrupt complete keratinization (with only a very thin surrounding granular cell layer and without retained nuclei). It may be pse
Sometimes in our practice as dermatopathologists we face routine H&E sections that appear to show no abnormality on initial examination. The situation gets complicated when we do not have enough clinical data. The first impression that would come to mind in such conditions is that the biopsy site might have been missed and maybe we are looking at normal skin!!!! However, this is not usually the case. There are dermatological conditions that only show subtle histopathological features that c
Since my early training in Dermatopathology I used to love esinophils! Their characteristic esinophilic granules give them this typical elegant red color making them look so beautiful under the microscope especially when they are conspicuous in the tissue.
Conspicuous esinophils are encountered in many dermatologic conditions that include vesiculobullous disorders, disorders of blood vessels, infections and infestations in addition to many miscellaneous conditions and several tumors suc
Insect bite reactions are frequently encountered in our signing out practice especially in lesions referred from pediatric cases. In such cases one usually see epidermal changes in the form of spongiosis with exocytosis of inflammatory cells. Also spongiotic vesicles can be seen, usually large and multilocular. Edema of the papillary dermis can occur and in some cases this may lead to subepidermal separation. The dermis typically shows a superficial and deep perivascular infiltrate rich in esin
Hypopigmented MF is a rare type of MF that is typically observed in dark skinned individuals of Asian or African origin and is mostly encountered in children.
The phenotype is predominantely CD8+ve and TCR gene rearrangement studies usually show clonal T cell population. From my limited experience, I came across two problems in the diagnosis of hypopigmented MF; both of them have something to do with vitiligo!!!
The first problem is a pitfall when you don’t have enough clinical data and di
My experience in the 1st Dermatopathology Course
in El Bierzo, Ponferrada, Spain, July 19-20, 2012
Mona R.E. Abdel Halim
MD Dermatology, Diploma of Dermatopathology (ICDP-UEMS)
Since establishing my career as a dermatopathologist I found it of utmost importance to keep improving my diagnostic skills. In addition to regular practice and reading, attending specialized courses held by eminent dermatopathologists is a vital skill developing experience. It allows you to share others’ exp
Insect bite reactions (papular urticaria) are the most commonly encountered skin eruptions in pediatric population. However, in many cases, these eruptions are frequently misdiagnosed and parents usually keep going from one dermatologist to another seeking a correct diagnosis.
An interesting article by Hernandez and Cohen was published in “Pediatricsâ€, the official journal of the American Academy of Pediatrics has discussed certain clinical features that represent principles for di
“Biphasic†in medical terminology means: having two phases, parts, aspects, or stages. In dermatopathology, many conditions are described as having a biphasic pattern. However, this term represents three different categories.
The first category of lesions described as having a biphasic pattern represents certain tumors showing two distinct morphological areas. For example, one area shows a hemangiopericytomatous morphology with ramifying vascular spaces with stag horn appearance sur
