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
Many years ago I saw a biopsy of well-differentiated invasive squamous cell carcinoma. Let me backtrack and say that I thought it was a squamous cell carcinoma. To my eye, what I saw was a markedly atypical and acanthotic proliferation of keratinocytes invading deeply into the dermis.
But I was wrong. This was a patient with fifty such lesions on her legs, and this lesion, which I swore was a well-differentiated invasive squamous cell carcinoma, melted away after a steroid injection.
C
A busy Friday prevented me from participating in Case 875 of spot diagnosis, but I make a point of getting into the relevant discussion brought up by Dr. Sasi Attili. Foresseing my comment could be the last one, I thought it was a good idea prolong the debate in my own blog.
A number of key principles are enshrined in the medical science, and the fact that tumors are monoclonal proliferations is one of them. That implies any tumor arise from the clonal expansion of a single cell which has und
I have seen pathology colleagues in my career who scoff at the idea of Dermatologists asking for depth measurements for BCC's. There is a valid reason for this as thin (<1mm) lesions are more likely to respond to non-surgical treatments like Imiquimod and PDT, than thicker ones.
This recent paper below in the BJD, however suggests that the cut off should be <0.4mm. However we do need larger studies and re-think how we define superficial BCC. The authors raise very interesting points reg
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
There is much controversy as to whether Keratoacanthoma (KA) is a valid and safe diagnosis to make or whether all KA's should be labelled as SCC. Much of the confusion I believe is because of the lack of consensus regarding the definition of a KA. The [u]main reason[/u] KA was originally thought to be a unique tumour, distinct from SCC, is because of its tendency to [i]spontaneous regression[/i].
Yes, it has certain unique histological features distinct from SCC [1][size=3];[sup] [/sup][size=
When I diagnose things a certain way, the likelihood increases that I will diagnose those things in a similar or same way in the future. We are shaped by our training and our actions. This is akin to Shakespeare’s Macbeth getting more comfortable with murder after he had committed the first one.
It is the first murder (or diagnosis) that is often the toughest one. Remember that Macbeth had to be pushed and bullied by Lady Macbeth before he committed his first murder. Lady Macbeth d
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 had [url="https://dermpathpro.com/blog/12/entry-109-follicular-psoriasis-is-this-a-true-entity/"]recently posted[/url] about a case in the JCP describing a relatively rare variant of Psoriasis, 'Follicular Psoriasis', and expressed my skepticism . I think that we as clinicians are too eager to lump diseases that we don't really know, into known entities, so that we feel elated about making a specific 'diagnosis' rather than admitting to not knowing!
[url="http://www.ncbi.nlm.nih.gov/pubmed
I came across [url="http://onlinelibrary.wiley.com/doi/10.1111/cup.12221/abstract"]this cover quizlet[/url] in the recent edition of the JCP and was debating as to what I would have called this!
The authors called this Follicular Psoriasis on the basis of the histology which showed follicular plugging with abundant parakeratotic keratin and neutrophils. The infundibular epithelium showed mild hyperplasia and minimal spongiosis. The perifollicular epidermis showed mild psoriasiform hyperplasia
Like any other pathologist, I often receive specimens without adequate clinical information on request form. As a consequence, my mobile phone has been a working tool as essential as my microscope.
A few days ago I phoned up to a first-year dermatology resident just to ask about the withhold information concerning a worrisome melanocytic lesion. While I was waiting for her answer, I was thinking of how to explain to a neophyte, as kindly and didactically as I can be, that, in dermatopathology
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
...a rose by any other name would smell as sweet?†Well, on this occasion I don’t agree, Mr Shakespeare. This is particularly the case when the name is “pseudo-lymphomaâ€, an oft used term in dermatopathology, guaranteed to make my hackles rise. Part of my ire stems from the pathologist “diagnosing†pseudo-lymphoma - an oxymoron in my view. To diagnose is to a) recognise a disease or to find the cause of (a problem). So, concluding with pseudolymphoma means that whatever else you mi
We had an interesting conundrum a couple of days ago at our daily lunchtime 'interesting cases meeting', where we looked at a biopsy of a 'Halo Nevus' (Clinical description). H&E stains revealed a small, well circumscribed partly nested melanocytic lesion with epithelioid cells suggesting a spitzoid origin/ features. The tumour was underpinned by dense a lichenoid inflammatory reaction associated with degenerate nevus cells, in places destroying the entire epidermis, in keeping with the clin
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
