Blog aimed at UCL 2nd Year Medical Student who attended Week 4 on Friday 18th November
The afternoon was spent looking a Surgical Pathology. Specimens regarding Breast , Skin Soft Tissue and Testis. Microscopy focused on Breast pathology and Skin Cancers
The following items where discussed. This is a large area to discuss so classic examples only were shown. When the time comes in clinical dig deeper into the subjects on Medscape.com
Those interested in linking the clinical to the pathology go to pathologyoutlines.com
The learning objectives were as outlined on the weekly timetable sent out
For those interested there are many websites and books
as an example
Breast Surgical Pathology
Abnormal macroscopic appearances
Paget’s disease of the nipple Invasion of the epidermis of the nipple by breast carcinoma cells (differential Eczema of the Nipple). .. Who was Page ?
Peau d’orange Invasion of dermal lymphatic by carcinoma cell leading to dermal oedema.
Discussed tethering of tumors to the skin or deep fascia
Discussed Nipple discharge (bloody is suspicious ; could be malignant or a benign Intraduct Papilloma)
Discussed Nipple inversion
Discussed lymphatic drainage of the breast to axilla, supraclavicular and intramammary nodes
Specimens shown Invasive Ductal Carcinoma Macro and Micro
Invasive Lobular Carcinoma Macro and Micro
Fibroadenoma, Macro and Micro (benign and younger age group)
Benign mammary Changes/Fibrocystic Disease not illustrated
Gynaecomastia of Male Breast
Post Breast Implant Fibrous Capsule Macro discussed
Skin Surgical Pathology
Basal Cell Carcinoma Micro only Nodular and Micrododular BCC discussed
Squamous Cell Carcinoma Macro and Micro . Relevance of length of history emphasised in differential from a Keratoacanthoma
Malignant Melanoma Macro and Micro (Discussed other rare places can occur , eye , oesophagus, anus , soft tissue.
Other rare skin cancers not discuss (<1% Lymphoma, Dermatofibrosarcoma Protuberans. Merkel Cell Carcinoma)
Look up Kaposi’s Sarcoma of the skin. What viruses are associated with it ? Can it occur in none HIV patients ?
Benign common skin lesion shown macro Seborrheic Keratosis (also called Seborrheic Wart and histologically Basal Cell Papilloma. Google a photo of it.
Soft tissue Tumour Surgical Pathology
Specimens shown Lipoma (most common)
Myxoid Neuroma (often related to a nerve)
Rarities Myositis Ossificans (has typical radiology)
Not shown Liposarcoma and numerous other malignant sarcomas
Surgical Pathology of Testicular Tumours
Specimens shown or discussed
Normal testis shown
Inflammation of the Testis – Orchitis (eg Mumps Orchitis, TB, Syphilis)
Testicular torsion, shown
Discussed Yolk Sac tumours (rare – children) (use of Alpha Fetoprotein- AFP)
Teratoma of the Testis – Haemorrhagic , Necrotic can be cystic) AFP and Humangonadotrophin- HCG as tumour markers. Seminoma – solid firm pale appearance .
Staging of tumours
- local invasion eg into Rete, Tunica Albuginea, Tunica Vaginalis or Scrotum
- Invasion of lymphatics (hence tying the cord before resection)
Discussed but not shown rarities Leydig Cell Tumour (yellow) , Sertoli Cell Tumour
Shows rare case but in elderly Lymphoma of the Testis.