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

https://meded.ucsd.edu/clinicalmed/breast.htm

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

https://cancerstaging.org/references-tools/quickreferences/Documents/BreastSmall.pdf

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.

See http://www.bad.org.uk/shared/get-file.ashx?id=231&itemtype=document

 

Soft tissue Tumour Surgical Pathology

Specimens shown           Lipoma (most common)

Myxoid Neuroma (often related to a nerve)

Rarities   Myositis Ossificans  (has typical radiology)

Leiomyosarcoma

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.

 

 

 

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