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Archive for November, 2011

Cytotechnologist Requirements in USA

Does anyone know if ASCP certification is essential for working as a
Cyotechnologist
in the U.S.?  Are there other societies certification that are
acceptable (eg, American Society of Cytology, Internatinal Academy of
Cytology, etc.)?  I an a Canadian Cytotechnologist, I have a B.Sc. with
a major in biology and a two year Diploma in Cytotechnology and five
years experience.  I am currently registered with the Canadian Society
of Lbaratory Technologists.  The ASCP won’t let me write their exam
because I don’t have a four year B.Sc. (which is an honours degree in
Canada, a B.Sc. is a three year progam here).

   It seems a shame that there appears a shortage of Cytotechnologists
in the US and there are plenty of good cytotechs up here looking for
work.  I have five years of post secondary education and five years
experience and all I want is a chance  to write the exam, I am not
asking to be certified.  I understand that in the U.S. you need two or
three years of a B.Sc. and one year of cytology training then you write
the exam after a year of on the job experience, can anyone clarify this
for me?

   if anyone has any information which maybe helpful, or wishes to
discuss cytology, please e-mail me.
Thanks.                                              
                                                                  Scott

.
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Nicotine toxicology

##PLEASE POST REPLIES ###

Hi

My apologies to any one who thinks this is not appropriate for this
group, remember it easier to forgive than write an email!

I am a writer, so I like to think :-), doing some crime/thriller short
stories.  I need some background to one of my plots.  The victim is
killed by a lethal dose of Nicotine.  This nicotine would be almost
pure, stolen form a lab, so extremely dangerous.

I have established that Nicotine in its pure(ish) form is extremely
lethal. A drop could kill, even by being absorbed through the skin.

Peter Anderson told me that:

>From: "Peter Anderson" <p…@iol.ie>
> I am sure that a competent Pathologist would request that toxicology tests
> were performed. You see death would be fairly rapid, unexplained, and
> therefore potentially suspicious. I have no doubt that modern methods of
> thin layer chromatography screening would detect the presence of an
> alkaloid substance which would then be subjected to systematic
> identification and quantification, Here you should talk to the toxicology
> types.

Is this true?

I need the person to nearly get away with it, otherwise there is no
suspense.  If the victim had heart problems, say arrhythmia, and just
dropped dead would they run toxicology tests?

How does Nicotine and why does the death look suspicious?

Is toxicology a normal procedure in the post mortem?

Would they always find the Nicotine?

Can they go back at a later stage, say a week or two, and still run
the tests?

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PATHOLOGY SERVICE

~~~~~~~~~~~~~~~~~~~~SERVICE ANNOUNCEMENT~~~~~~~~~~~~~~~~~~~~~~
We are an International pathology organisation with over 14 laboratories
in 6 different countries.
Our main geographical areas of interest are UK, Ireland, Middle East
(all regions) and Canada.
We have many "marketing" facilities in many other countries/regions.
As a service, we market many "niche" products and services related to
pathology from our establishments.
If you have a "test" or "product", medically recognised, proven and
preferably accredited, which you would like marketed world-wide with
samples sent back to your laboratory (if applicable) then please contact
us.
You may wish to avail of our international referral service to
perform any of your "referral" work.
Lastly, as a function of management, we are always keen to look at
management contracts for pathology laboratories.
=================================================================
For more information on our service, contact me at a…@technologist.com
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

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In search of … Cell counter with a multisizer ….USED of course

In search of … Cell counter with a multisizer ….USED of course

I have an infectious disease lab in which I need to count and size cells
and I am in the market for a refurbished/used unit that can still be
supported by a manufacturer.

If you have such a unit and/or know of a lead on one please respond to
this and/or send me e-mail directly at:
not…@hlsun.redcross.org

Thanks,
Ed Notari
Transmissible Diseases Department
American Red Cross – Holland Lab

"Wherever you go, There you are!"   _B.Bonzai_

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HELP!! A GIRL IS DYING AND WE DON'T KNOW WHY

Cagliari (Italy) 5/14/1997

A 6 years-old girl has got a sick. Her blood is ipercoagulated, it creates
red with white center thrombs every 15 seconds; Dimension: 2-3 cm (1 inch)
Doctors cutted her a leg. She is going bad.
If you have got a clou reply as soon as you can, please.
THANK YOU

I am sorry for my english and I am not a doctor.

to…@diee.unica.it
       or
TManc…@Hotmail.com

——————-==== Posted via Deja News ====———————–
      http://www.dejanews.com/     Search, Read, Post to Usenet

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Glasgow MLSO 1 position

 Glasgow  Medical Laboratory Scientific Officer  MLSO One – Full Time
post – c UKP 13,300 ++ generous  benefits

 Medical Laboratory Scientific Officer  MLSO required to work in
multi-disciplinary laboratory.Should be Transfusion/Haematology
qualified with a minimum 2 years experience.Other disciplines
welcomed.Flexible attitude essential.

WRITTEN applications should be addressed to :

The Hospital Manager
Glasgow Nuffield Hospital
Beaconsfield Rd
Glasgow
G12 0PJ

Closing date 23 May 1997

Why not visit Glasgow at
http://web.ukonline.co.uk/charles.houston/glasgow.htm

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Advice needed to explain rash

About two weeks ago, my wife had an epilepsy crisis. I was not to sure what
it was and I had her transported by ambulance to an hospital where she
remained for a week. They confirmed that it was epilepsy but they found
other things wrong with her as well. Like her leucocytes level is only 2
and her blood sedimentation rate is 54.  Looking back at her old blood
tests, they found that these values were the same as far back as two years
ago.They performed an ecography of her abdomen and they found that her
spleen is enlarged and her kidneys look abnormal.One of the doctors thinks
that she might have systemic amyloidosis, but this is not confirmed since
many other tests need to be done. They put her on 300 mg dilantin and
discharged her from the hospital about a week ago. She will need to go to
the external clinic for further tests.

What now baffles me and her doctors is the fact that over the weekend, she
has developed a rash in the lower portion of her body and she continuously
runs a high fever from 37.5 to 39. This has been going on for over three
days now. The rash consists in a reddening of the skin from her ankles up
to the waist. Her feet are the worst, they are almost purple in places and
her ankles are slightly swollen. The rash consists almost only in a
redenning of the skin with no sores but it is itchy. Above the knees, her
normal skin colour starts to appear in places and the skin above her waist
looks completely normal.

Her doctor thought that she might be allergic to dilantin, and yesterday he
has changed her to tegretol but this did not produce any improvements yet
after more than 24 hours.

Has anyone out there ever come across something similar?

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Chutzpah

Chutzpah.

For those un-Jewish, one fine definition is "unmitigated gall."

My favorite story to illustrate this phenomenon, used to be this one:

A 15 year old "pathologist to be" murders both of his parents and
then pleads to the court for clemency because he’s an orphan.

@–>>>>->>

I now have a new one that even tops this.

A grown up pathologist becomes an omnipresent irritant on one of the
only places in the world where people harmed by silicone can come for
support and references (alt.support.breast-implant).

After insulting the women, their husbands, doctors who disagree with him,
and the creator of this group, he then rudely and 100% inappropriately
barks at Pearl, one of the exact people for which this group was formed:

"Your puerile inanities simply waste bandwidth."

This is gall (Webster: gall = bile obtained from an animal and used in the
arts or medicine; something bitter to endure, rancor, a cause of state of
exasperation, a swelling of tissue due to fungi or other parasites . . .)

Once again, classic projection for the little puerile (means juvenile or
childish, BTW)  pricktologist, oooops, I mean pathologist.

My apologies to Pearl for little eddie’s gall and to other pathologists
for having him represent their profession.

Best regards,
Ilena Rose
Non*Moderator, alt.support.breast-implant

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Autopsy-A Screenwriter's Guide (monthly posting, 27K, v. 1.004)

Version: 1.004
Last-modified: September 2, 1996
Archive-name: pathology/autopsy-screenwriters-guide
Posting-Frequency: monthly (first Wednesday)
URL: http://www.neosoft.com/~uthman
Maintainer: Ed Uthman <uth…@neosoft.com>

                     THE ROUTINE AUTOPSY
                        ————-
           The Procedure Related in Narrative Form
           A Guide for Screenwriters and Novelists
              Ed Uthman, MD <uth…@neosoft.com>
           Diplomate, American Board of Pathology

PURPOSE

The purpose of this paper is to make available to
screenwriters, novelists, and other interested individuals
an authentic detailed narrative account of a routine
postmortem examination (autopsy) as performed by a
pathologist on a patient who has died in hospital. I have
based this on my experiences as a practicing pathologist in
both academic and community practice settings in several
U.S. cities. I have deviated from the dispassionate,
unbiased language of my profession to present a more
subjective, sensorial view, which I think should be of
greater benefit to those using this information for the
purposes of entertainment.

BACKGROUND

Most patients who die in the hospital do not undergo
autopsy. In recent years, there has been a decreased
interest in the autopsy in the medical community. When an
autopsy is requested, it is either by the attending
physician or the patient’s family. The hospital’s
pathologist performs those cases of the former type for the
educational benefit of the medical staff. Cases requested by
the family are best left to an independent pathologist hired
by the family. Autopsies performed by the hospital
pathologist do not result in cost to the patient’s estate;
rather, the cost is absorbed by the hospital and the
pathologist. "Private" autopsies hired by the family
generally cost between US$1200 and US$2500.

After the patient is pronounced dead by a physician, the
body is wrapped in a sheet or shroud and transported to the
morgue, where it is held in a refrigeration unit until the
autopsy. Autopsies are rarely performed at night, but they
are typically performed between 8 am and 4 pm every day,
including weekends and holidays. In medium-size and large
hospitals, the autopsy is done on the premises in a autopsy
suite, which is either within or adjacent to the morgue.
Small hospitals that do not have autopsy suites may arrange
for autopsies to be done at a larger hospital. Yet other
hospitals out in the country can only offer autopsies by
having them done at funeral homes. Doing an autopsy at a
funeral home is one of the most dreaded things a pathologist
has to face, as a funeral home typically is not as well
equipped as a hospital autopsy suite.

DRAMATIS PERSONAE

Immediately before the autopsy, the body is removed from the
cooler by a morgue attendant who will help with the autopsy.
This individual is called a DIENER (DEE-ner), which is
German for "servant." Most dieners do not realize the
derivation of this word and would probably object to being
called "diener" if they did. Dieners are not formally
trained, but many have some background of employment in the
funeral industry. For some reason, in the southern U.S.
anyway, about ninety per cent of dieners (my estimate) are
African-American. I would estimate that less than ten per
cent of dieners are female. Dieners tend to work at their
job for decades. I think this is because 1) management types
don’t know what goes on in the morgue, and would not care to
mess around with its staffing come belt-tightening time, and
2) dieners are pretty much left alone by management and
enjoy a much greater degree of autonomy than most workers at
their pay grade and level of education. My own impression of
the "diener personality" is that they are somewhat secretive
and cliquish, and one gets the idea that they have a lot
more going on in their lives than they tend to let on. It is
not uncommon for them to receive a variety of strange
visitors in the morgue, some of whom have a less than savory
appearance. For fiction writers, I think there is a lot of
character development potential for dieners.

There has been a general belief that some dieners also take
payment under the table for notifying funeral homes of
deaths in the hospital (so that the funeral home can send an
agent out to approach the family), but I am not aware of any
cases where this allegation was proved. From my own
experiences, I know that in some cities the funeral home
business is extraordinarily competitive, and I am aware of
one case where agents of two funeral homes got into a
physical altercation in the morgue over the disposition of a
body that each claimed.

The other individual directly involved in the autopsy is the
PROSECTOR. This is the individual who is in charge of the
actual dissection. In small hospitals, the prosector is a
Board-certified pathologist, an MD or DO (osteopath) who has
undergone a four- or five-year residency in the specialty of
pathology, specifically anatomic pathology. In university-
based hospitals with teaching programs, the prosector is a
pathology resident (a physician who is training to be a
pathologist) or a medical student taking an elective
rotation in pathology. In larger non-university-based
hospitals covered by large pathology groups, the prosector
may be a pathologist’s assistant. The "PA" is typically a
graduate of an associate or baccalaureate program which
provides training in several areas of pathology, especially
those that involve "hands-on" activities, such as autopsy
dissections, dissections of specimens removed at surgery,
specimen photography, and video applications. PA’s enjoy
excellent pay and benefits (US$40,000 to start) in their
little-known area, and the demand for PA’s continues to
exceed supply.

Other individuals may be present at the autopsy, usually for
educational opportunities. These may include the attending
or consulting physicians, residents, medical students,
nurses, respiratory therapists, and others involved in
direct patient care.

The prosector and diener wear fairly simple protective
equipment, including scrub suits, gowns, gloves (typically
two pair), shoe covers, and clear plastic face shields. Some
facilities have sealed-environment "space suits," but I
think one is more likely to infect himself as a result of
the clumsiness lent by these suits than if he were dressed
more lightly in the interest of nimbleness.

THE EXTERNAL EXAMINATION

The body is taken from the cooler by the diener and is
placed on the autopsy table. Experienced dieners, even those
of slight build, can transfer even obese bodies from the
carriage to the table without assistance. Since the comfort
of the patient is no longer a consideration, this transfer
is accomplished with what appears to the uninitiated a
rather brutal combination of pulls and shoves, not unlike
the way a thug might manhandle a mugging victim.

The body is then measured. Large facilities may have total-
body scales, so that a weight can be obtained. The autopsy
table is a waist-high aluminum fixture that is plumbed for
running water and has several faucets and spigots to
facilitate washing away all the blood that is released
during the procedure. Older hospitals may still have
porcelain or even marble tables. The autopsy table is
basically a slanted tray (for drainage) with raised edges
(to keep blood and fluids from flowing onto the floor).
After the body is positioned, the diener places a "body
block" under the patient’s back. This rubber or plastic
brick-like appliance causes the chest to protrude outward
and the arms and neck to fall back, thus allowing the
maximum exposure of the trunk for the incisions. The
prosector checks to make sure that the body is that of the
patient named on the permit by checking the toe tag or
patient wristband ID. Abnormalities of the external body
surfaces are then noted and described, either by talking
into a voice recorder or making notes on a diagram and/or
checklist.

OPENING THE TRUNK

The diener takes a large scalpel and makes the incision in
the trunk. This is a Y-shaped incision. The arms of the Y
extend from the front of each shoulder to the bottom end of
the breast bone (called the xiphoid process of the sternum).
In women, these incisions are diverted beneath the breasts,
so the "Y" has curved, rather than straight, arms. The tail
of the Y extends from the xiphoid process to the pubic bone
and typically makes a slight deviation to avoid the
umbilicus (navel). The incision is very deep, extending to
the rib cage on the chest, and completely through the
abdominal wall below that.

With the Y incision made, the next task is to peel the skin,
muscle, and soft tissues off the chest wall. This is done
with a scalpel. When complete, the chest flap is pulled
upward over the patient’s face, and the front of the rib
cage and the strap muscles of the front of the neck lie
exposed. Human muscle smells not unlike raw lamb meat in my
opinion. At this point of the autopsy, the smells are
otherwise very faint.

An electric saw or bone cutter (which looks a lot like
curved pruning shears) is used to open the rib cage. One cut
is made up each side of the front of the rib cage, so that
the chest plate, consisting of the sternum and the ribs
which connect to it, are no longer attached to the rest of
the skeleton. The chest plate is pulled back and peeled off
with a little help of the scalpel, which is used to dissect
the adherent soft tissues stuck to the back of the chest
plate. After the chest plate has been removed, the organs of
the chest (heart and lungs) are exposed (the heart is
actually covered by the pericardial sac).

Before disturbing the organs further, the prosector cuts
open the pericardial sac, then the pulmonary artery where it
exits the heart. He sticks his finger into the hole in the
pulmonary artery and feels around for any thromboembolus (a
blood clot which has dislodged from a vein elsewhere in the
body, traveled through the heart to the pulmonary artery,
lodged there, and caused sudden death. This is a common
cause of death in hospitalized patients).

The abdomen is further opened by dissecting the abdominal
muscle away from the bottom of the rib cage and diaphragm.
The flaps of abdominal wall fall off to either side, and the
abdominal organs are now exposed.

REMOVING THE ORGANS OF THE TRUNK

The most typical method of organ removal is called the
"Rokitansky method." This is not unlike field dressing a
deer. The dissection begins at the neck and proceeds
downward, so that eventually all the organs of the trunk are
removed from the body in one bloc. The first thing the
diener does is to identify the carotid and subclavian
arteries in the neck and upper chest. He ties a long string
to each and then cuts them off, so that the ties are left in
the body. This allows the mortician to more easily find the
arteries for injection of the embalming fluids.

A cut is them made above the larynx, detaching the larynx
and esophagus from the pharynx. The larynx and trachea are
then pulled downward, and the scalpel is used to free up the
remainder of the chest organs from their attachment at the
spine. The diaphragm is cut away from the body wall, and the
abdominal organs are pulled out and down. Finally, all of
the organs are attached to the body only by the pelvic
ligaments, bladder, and rectum. A single slash with the
scalpel divides this connection, and all of the organs are
now free in one block. The diener hands this organ bloc to
the prosector. The prosector takes the organ bloc to a
dissecting table (which is often mounted over the patient’s
legs) and dissects it. Meanwhile, the diener proceeds to
remove the brain.

REMOVING THE BRAIN

The diener takes the body block out from under the patient’s
back and places it under the back of the head. This elevates
the head so that it is positioned as if it were on a very
thick, stiff pillow. The diener uses a scalpel to cut from
behind one ear, over the crown of the head, to behind the
other ear. Like with the trunk incisions, this one is deep,
all the way to the skull. The skin and soft tissues are now
divided into a front flap and a rear flap. The front flap is
pulled (this takes some strength) forward (like being
"scalped") over the patient’s face, thus exposing the top
and front of the skull. The back flap is pulled backwards
over the nape of the neck. The whole top hemisphere of the
skull is now exposed.

The diener takes an electric saw (typically called a
"Stryker saw," even if it’s not manufactured by Stryker) and
makes cuts around the equator of the cranium. This cut must
be deep enough to cut all the way through the skull, but not
so deep that the brain is cut (this takes some skill).
Typically, the cut is not totally straight but has a notch
so that the skull top (calvarium) will not slide off the
bottom half of the skull after everything is sewn back up.
After this cut, the calvarium is removed and set aside. As
the calvarium is lifted off, there is a very characteristic
sound that is sort of a combination of a sucking sound and
the sound of rubbing two halves of a coconut together. The
best recorded representation of this sound that I have heard
is in the brain transplant scene of the film _Robocop II_.

The outer layer of the meninges (the coverings of the
brain), called the dura, stays with the calvarium, so that
the top of the brain is now fully exposed. After the chore
of getting to it, it is a relatively easy matter to get the
brain out. There are no tough ligaments that hold the brain
in, so really all that needs to be done is to cut the spinal
cord and the dural reflections that go between the
cerebellum and cerebrum (called the tentorium). The brain is
then easily lifted out.

Since the brain is very soft and easily deformable, it is
not manipulated at the time of the autopsy. Instead it is
hung up by string in a large jar of formalin (a 10% solution
of formaldehyde gas in buffered water) for two weeks or
longer. The action of formaldehyde is to "fix" the tissue,
not only preserving it from decay, but also causing it to
become much firmer and easier to handle without deforming
it. The reason that it is suspended by string is to prevent
it from having a flattened side from lying in the bottom of
the jar (the brain is heavier than water and therefore
sinks).

EXAMINATION OF THE ORGANS OF THE TRUNK

At the dissection table, the prosector typically dissects
and isolates the esophagus from the rest of the chest
organs. This is usually done simply by pulling it away
without help of a blade (a technique called "blunt
dissection"). The chest organs are then cut away from the
abdominal organs and esophagus with scissors. The lungs are
cut away from the heart and trachea and weighed, then sliced
like loaves of bread into slices about one centimeter thick.
A long (12" – 18"), sharp knife, called a "bread knife" is
used for this.

The heart is weighed and opened along the pathway of normal
blood flow using the bread knife or scissors. Old-time
pathologists look down on prosectors who open the heart with
scissors, rather than the bread knife, because, while the
latter takes more skill and care, it is much faster and
gives more attractive cut edges than when scissors are used.
The coronary arteries are examined by making numerous
crosscuts with a scalpel.

The larynx and trachea are opened longitudinally from the
rear and the interior examined. The thyroid gland is
dissected away from the trachea with scissors, weighed, and
examined in thin slices. Sometimes the parathyroid glands
are easy to find, other times impossible.

The bloc containing the abdominal organs is turned over so
that the back side is up. The adrenal glands are located in
the fatty tissue over the kidneys (they are sometimes
difficult to find) and are removed, weighed, sliced, and
examined by the prosector.

The liver is removed with scissors from the rest of the
abdominal organs, weighed, sliced with a bread knife, and
examined. The spleen is similarly treated.

The intestines are stripped from the mesentery using
scissors (the wimpy method) or bread knife (macho method).
The intestines are then opened over a sink under running
water, so that all the feces and undigested food flow out.
As one might imagine, this step is extremely malodorous. The
resultant material in the sink smells like a pleasant
combination of feces and vomitus. The internal (mucosal)
surface of the bowel is washed off with water and examined.
It is generally the diener’s job to "run the gut," but
usually a crusty, senior diener can intimidate a young first-
year resident prosector into doing this ever-hated chore.
Basically, whichever individual has the least effective
steely glare of disdain is stuck with running the gut.

The stomach is then opened along its greater curvature. If
the prosector is lucky, the patient will have not eaten
solid food in a while. If not, the appearance of the
contents of the stomach will assure the prosector that he
will not be eating any stews or soups for a long time. In
either case, the smell of gastric acid is unforgettable.

The pancreas is removed from the duodenum, weighed, sliced
and examined. The duodenum is opened longitudinally, washed
out, and examined internally. The esophagus is similarly
treated.

The kidneys are removed, weighed, cut lengthwise in half,
and examined. The urinary bladder is opened and examined
internally. In the female patient, the ovaries are removed,
cut in half, and examined. The uterus is opened along either
side (bivalved) and examined. In the male, the testes are
typically not removed if they are not enlarged. If it is
necessary to remove them, they can be pulled up into the
abdomen by traction on the spermatic cord, cut off, cut in
half, and examined.

The aorta and its major abdominal/pelvic branches (the
renal, celiac, mesenteric, and iliac arteries) are opened
longitudinally and examined.

Most of the organs mentioned above are sampled for
microscopic examination. Sections of the organs are cut with
a bread knife or scalpel and placed in labeled plastic
cassettes. Each section is the size of a postage stamp or
smaller and optimally about three millimeters in thickness.
The cassettes are placed in a small jar of formalin for
fixation. They are then "processed" in a machine that
overnight removes all the water from the specimens and
replaces it with paraffin wax. Permanent microscopic
sections (five microns, or one two-hundredth of a millimeter
thick) can be cut from these paraffin sections, mounted on
glass slides, stained, coverslipped, and examined
microscopically. The permanent slides are usually kept
indefinitely, but must be kept for twenty years minimum.

Additional small slices of the major organs are kept in a
"save jar," typically a one-quart or one-pint jar filled
with formalin. Labs keep the save jar for a variable length
of time, but at least until the case is "signed out" (i.e.,
the final written report is prepared). Some labs keep the
save jar for years. All tissues that are disposed of are
done so by incineration.

A note on dissection technique: All of the above procedures
are done with only four simple instruments — a scalpel, the
bread knife, scissors, and forceps (which most medical
people call "pick-ups." Only scriptwriters say "forceps").
The more handy the prosector, the more he relies on the
bread knife, sometimes making amazingly delicate cuts with
this long, unwieldy-looking blade. The best prosectors are
able to make every cut with one long slicing action. To saw
back and forth with the blade leaves irregularities on the
cut surface which are often distracting on specimen
photographs. So the idea is to use an extremely sharp, long
blade that can get through a 2000-gram liver in one graceful
slice. Some old-time purist pathologists actually maintain
their own bread knives themselves and let no one else use
them. Such an individual typically carries it around in his
briefcase in a leather sheath. This would make an excellent
fiction device, which, to my knowledge, has not been used.
Imagine a milquetoast pathologist defending himself from a
late-night attacker in the lab, with one desperate but
skillful slash of the bread knife almost cutting the
assailant in half!

Note on the appearance of the autopsy suite: Toward the end
of the autopsy procedure, the room is not a pretty sight.
Prosectors vary markedly in how neat they keep the
dissection area while doing the procedure. It is legendary
that old-time pathologists were so neat that they’d perform
the entire procedure in a tux (no apron) right before an
evening at the opera (pathologists are noted for their love
of classical music and fine art). Modern prosectors are not
this neat. Usually, the autopsy table around the patient is
covered with blood, and it is very difficult not to get some
blood on the floor. We try to keep blood on the floor to a
minimum, because this is a slippery substance that can lead
to falls. The hanging meat scales used to weigh the organs
are usually covered with or dripping with blood. The chalk
that is used to write organ weights on the chalkboard is
also smeared with blood, as may be the chalkboard itself.
This is an especially unappetizing juxtaposition.

CLOSING UP AND RELEASING THE BODY

After all the above procedures are performed, the body is
now an empty shell, with no larynx, chest organs, abdominal
organs, pelvic organs, or brain. The front of the rib cage
is also missing. The scalp is pulled down over the face, and
the whole top of the head is gone. Obviously, this is not
optimal for lying in state in public view. The diener
remedies this problem. First, the calvarium is placed back
on the skull (the brain is not replaced), the scalp pulled
back over the calvarium, and the wound sewn up with thick
twine using the type of stitch used to cover baseballs. The
wound is now a line that goes from behind the ears over the
back of the skull, so that when the head rests on a pillow
in the casket, the wound is not visible.

The empty trunk looks like the hull of a ship under
construction, the prominent ribs resembling the
corresponding structural members of the ship. In many
institutions, the sliced organs are just poured back into
the open body cavity. In other places, the organs are not
replaced but just incinerated at the facility. In either
case, the chest plate is placed back in the chest, and the
body wall is sewn back up with baseball stitches, so that
the final wound again resembles a "Y."

The diener rinses the body off with a hose and sponge,
covers it with a sheet, and calls the funeral home for pick-
up. As one might imagine, if the organs had not been put
back in the body, the whole trunk appears collapsed,
especially the chest (since the chest plate was not firmly
reattached to the ribs). The mortician must then remedy this
by placing filler in the body cavity to re-expand the body
to roughly normal contours.

Ultimately, what is buried/cremated is either 1) the body
without a brain and without any chest, abdominal, or pelvic
organs, or 2) the body without a brain but with a hodgepodge
of other organ parts in the body cavity.

FINISHING UP

After the funeral home has been called, the diener cleans up
the autopsy suite with a mop and bucket, and the prosector
finishes up the notes and/or dictation concerning the
findings of the "gross exam" (the part of the examination
done with the naked eye and not the microscope; this use of
the term "gross" is not a value judgement but a direct
German translation of "big" as opposed to "microscopic").
For some odd reason, many prosectors report increased
appetite after an autopsy, so the first thing they want to
do afterwards is grab a bite to eat. The whole procedure in
experienced hands, assuming a fairly straightforward case
and no interruptions, has taken about two hours. Complicated
cases requiring detailed explorations and special
dissections (e.g., exploring the bile ducts, removing the
eyes or spinal cord) may take up to four hours.

AFTER THE AUTOPSY

Days to weeks later, the processed microscopic slides are
examined by the attending pathologist, who renders the final
diagnoses and dictates the report. Only the pathologist can
formally issue the report, even if he or she was not the
prosector (i.e., the prosector was a resident, PA, or med
student). The report is of variable length but almost always
runs at least three pages. It may be illustrated with
diagrams that the prosector draws from scratch or fills in
on standard forms with anatomical drawings. The Joint
Commission for the Accreditation of Healthcare Organizations
(JCAHO), which certifies hospitals, requires the final
report to be issued within sixty days of the actual autopsy.
The College of American Pathologists, which certifies
medical laboratories, requires that this be done in thirty
days. Nevertheless, pathologists are notorious for tardiness
in getting the final report out, sometimes resulting in
delays of years. Perhaps the non-compensated nature of
autopsy practice has something to do with this. Pathologists
are otherwise very sensitive to turnaround times.

THE BRAIN-CUTTING

Remember the brain? We left it suspended in a big jar of
formalin for a few weeks. After the brain is "fixed," it has
the consistency and firmness of a ripe avocado. Before
fixation, the consistency is not unlike that of three-day-
old refrigerated, uncovered Jello. Infant brains can be much
softer than that before fixation, even as soft as a flan
dessert warmed to room temperature, or worse, custard pie
filling. Such a brain may be difficult or impossible to hold
together and can fall apart as one attempts to remove it
from the cranium.

Assuming good fixation of an adult brain, it is removed from
the formalin and rinsed in a running tap water bath for
several hours to try to cut down on the discomforting, eye-
irritating, possibly carcinogenic formalin vapors. The
cerebrum is severed from the rest of the brain (brainstem
and cerebellum) by the prosector with a scalpel. The
cerebellum is severed from the brainstem, and each is sliced
and laid out on a tray for examination. The cerebrum is
sliced perpendicularly to its long axis and laid out to be
examined. Sections for microscopic processing are taken, as
from the other organs, and a few slices are held in "save
jars." The remainder of the brain slices is incinerated.

_____________________________________________________________

An HTML version of this FAQ, with a few hypertext links, is
available through the author’s home page at:

           <http://www.neosoft.com/~uthman/>

Please send any constructive comments concerning this FAQ to
Ed Uthman, MD <uth…@neosoft.com>.

Copyright (c) 1994-96, Edward O. Uthman. This material
may be reformatted and/or freely distributed via online
services or other media, as long as it is not substantively
altered. Authors, educators, and others are welcome to use
any ideas presented herein, but I would ask for
acknowledgment in any published work derived therefrom.

END

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Biopsy Report Guide (monthly posting, 30K, v. 1.004)

Version: 1.004
Last-modified: September 2, 1996
Archive-name: pathology/biopsy-report-guide
Posting-Frequency: monthly (first Wednesday)
URL: http://www.neosoft.com/~uthman
Maintainer: Ed Uthman <uth…@neosoft.com>

                      THE BIOPSY REPORT

                      A Patient’s Guide
           Edward O. Uthman, MD <uth…@neosoft.com>
           Diplomate, American Board of Pathology

INTRODUCTION

     Many medical conditions, including all cases of cancer,
must be diagnosed by removing a sample of tissue from the
patient and sending it to a pathologist for examination.
This procedure is called a biopsy, a Greek-derived word that
may be loosely translated as "view of the living." Any organ
in the body can be biopsied using a variety of techniques,
some of which require major surgery (e.g., staging
splenectomy for Hodgkin’s disease), while others do not even
require local anesthesia (e.g., fine needle aspiration
biopsy of thyroid, breast, lung, liver, etc). After the
biopsy specimen is obtained by the doctor, it is sent for
examination to another doctor, the anatomical pathologist,
who prepares a written report with information designed to
help the primary doctor manage the patient’s condition
properly.

     The pathologist is a physician specializing in
rendering medical diagnoses by examination of tissues and
fluids removed from the body. To be a pathologist, a medical
graduate (M.D. or D.O.) undertakes a five-year residency
training program, after which he or she is eligible to take
the examination given by the American Board of Pathology. On
successful completion of this exam, the pathologist is
"Board-certified." Almost all American pathologists
practicing in JCAHO-accredited hospitals and in reputable
commercial labs are either Board-certified or Board-eligible
(a term that designates those who have recently completed
residency but have not yet passed the exam). There is no
qualitative difference between M.D.-pathologists and D.O.-
pathologists, as both study in the same residency programs
and take the same Board examinations.

TYPES OF BIOPSIES

     1. Excisional biopsy. A whole organ or a whole lump is
removed (excised). These are less common now, since the
development of fine needle aspiration (see below). Some
types of tumors (such as lymphoma, a cancer of the
lymphocyte blood cells) have to be examined whole to allow
an accurate diagnosis, so enlarged lymph nodes are good
candidates for excisional biopsies. Some surgeons prefer
excisional biopsies of most breast lumps to ensure the
greatest diagnostic accuracy. Some organs, such as the
spleen, are dangerous to cut into without removing the whole
organ, so excisional biopsies are preferred for these.

     2. Incisional biopsy. Only a portion of the lump is
removed surgically. This type of biopsy is most commonly
used for tumors of the soft tissues (muscle, fat, connective
tissue) to distinguish benign conditions from malignant soft
tissue tumors, called sarcomas.

     3. Endoscopic biopsy.This is probably the most commonly
performed type of biopsy. It is done through a fiberoptic
endoscope the doctor inserts into the gastrointestinal tract
(alimentary tract endoscopy), urinary bladder (cystoscopy),
abdominal cavity (laparoscopy), joint cavity (arthroscopy),
mid-portion of the chest (mediastinoscopy), or trachea and
bronchial system (laryngoscopy and bronchoscopy), either
through a natural body orifice or a small surgical incision.
The endoscopist can directly visualize an abnormal area on
the lining of the organ in question and pinch off tiny bits
of tissue with forceps attached to a long cable that runs
inside the endoscope.

     4. Colposcopic biopsy.This is a gynecologic procedure
that typically is used to evaluate a patient who has had an
abnormal Pap smear. The colposcope is actually a close-
focusing telescope that allows the physician to see in
detail abnormal areas on the cervix of the uterus, so that a
good representation of the abnormal area can be removed and
sent to the pathologist.

     5. Fine needle aspiration (FNA) biopsy.This is an
extremely simple technique that has been used in Sweden for
decades but has only been developed widely in the US over
the last ten years. A needle no wider than that typically
used to give routine injections (22 to 25 gauge) is inserted
into a lump (tumor), and a few tens to thousands of cells
are drawn up (aspirated) into a syringe. These are smeared
on a slide, stained, and examined under a microscope by the
pathologist. A diagnosis can often be rendered in a few
minutes. Tumors of deep, hard-to-get-to structures
(pancreas, lung, and liver, for instance) are especially
good candidates for FNA, as the only other way to sample
them is with major surgery. Such FNA procedures are
typically done by a radiologist under guidance by ultrasound
or computed tomography (CT scan) and require no anesthesia,
not even local anesthesia. Thyroid lumps are also excellent
candidates for FNA.

     6. Punch biopsy. This technique is typically used by
dermatologists to sample skin rashes and small masses. After
a local anesthetic is injected, a biopsy punch, which is
basically a small (3 or 4 mm in diameter) version of a
cookie cutter, is used to cut out a cylindrical piece of
skin. The hole is typically closed with a suture and heals
with minimal scarring.

     7. Bone marrow biopsy. In cases of abnormal blood
counts, such as unexplained anemia, high white cell count,
and low platelet count, it is necessary to examine the cells
of the bone marrow. In adults, the sample is usually taken
from the pelvic bone, typically from the posterior superior
iliac spine. This is the prominence of bone on either side
of the pelvis underlying the "bikini dimples" on the lower
back/upper buttocks. Hematologists do bone marrow biopsies
all the time, but most internists and pathologists and many
family practitioners are also trained to perform this
procedure.

     With the patient lying on his/her stomach, the skin
over the biopsy site is deadened with a local anesthetic.
The needle is then inserted deeper to deaden the surface
membrane covering the bone (the periosteum). A larger rigid
needle with a very sharp point is then introduced into the
marrow space. A syringe is attached to the needle and
suction is applied. The marrow cells are then drawn into the
syringe. This suction step is occasionally uncomfortable,
since it is impossible to deaden the inside of the bone. The
contents of the syringe, which to the naked eye looks like
blood with tiny chunks of fat floating around in it, is
dropped onto a glass slide and smeared out. After staining,
the cells are visible to the examining pathologist or
hematologist.

     This part of procedure, the aspiration, is usually
followed by the core biopsy, in which a slightly larger
needle is used to extract core of bone. The calcium is
removed from the bone to make it soft, the tissue is
processed (see "Specimen Processing," below) and tissue
sections are made. Even though the core biopsy procedure
involves a bigger needle, it is usually less painful than
the aspiration.

SPECIMEN PROCESSING

     After the specimen is removed from the patient, it is
processed in one or both of two major ways:

     1. Histologic sections. This involves preparation of
stained, thin (less than 5 micrometers, or 0.005
millimeters) slices mounted on a glass slide, under a very
thin pane of glass called a coverslip. There are two major
techniques for preparation of histologic sections:

        a. Permanent sections. This technique gives the best
quality of specimen for examination, at the expense of time.
The fresh specimen is immersed in a fluid called a fixative
for several hours (the necessary time dependent on the size
of the specimen). The fixative, typically formalin (a 10%
solution of formaldehyde gas in buffered water), causes the
proteins in the cells to denature and become hard and
"fixed." Adequate fixation is probably the most important
technical aspect of biopsy processing.

     The fixed specimen is then placed in a machine that
automatically goes through an elaborate overnight cycle that
removes all the water from the specimen and replaces it with
paraffin wax. The next morning, a technical professional,
called a histologic technician, or "histotech," removes the
paraffin-impregnated specimen and "embeds" it in a larger
bloc of molten paraffin. This is allowed to solidify by
chilling and is set in a cutting machine, called a
microtome. The histotech uses the microtome to cut thin
sections of the paraffin block containing the biopsy
specimen. These delicate sections are floated out on a water
bath and picked up on a glass slide.

     The the paraffin is dissolved from the tissue on the
slide. With a series of solvents, water is restored to the
sections, and they are stained in a mixture of dyes. The
most common dyes used are hematoxylin, a natural product of
the heartwood of the logwood tree, Haematoxylon
campechianum, which is native to Central America, and eosin,
an artifcial aniline dye. The stain combination, casually
referred to by pathologists as "H and E" yields pink,
orange, and blue sections that make it easier for us to
distinguish different parts of cells. Typically, the nucleus
of cells stains dark blue, while the cytoplasm stains pink
or orange.

        b. Frozen sections. This technique allows one to
examine histologic sections within a few minutes of removing
the specimen from the patient, but the price paid is that
the quality of the sections is not nearly as good as those
of the permanent section. Still, a skilled pathologist and a
knowledgeable surgeon can work together to use the frozen
section’s rapid availability to the patient’s great benefit.

     2. Smears. The specimen is a liquid, or small solid
chunks suspended in liquid. This material is smeared on a
microscope slide and is either allowed to dry in air or is
"fixed" by spraying or immersion in a liquid. The fixed
smears are then stained, coverslipped, and examined under
the microscope.

     Like the frozen section, smear preparations can be
examined within a few minutes of the time the biopsy was
obtained. This is especially useful in FNA procedures (see
above), in which a radiologist is using ultrasound or CT
scan to find the area to be biopsied. He or she can make one
"pass" with the needle and immediately give the specimen to
the pathologist, who can within a few minutes determine if a
diagnostic specimen was obtained. The procedure can be
terminated at that point, sparing the patient the discomfort
and inconvenience of repeated sticks.

PATHOLOGIC EXAMINATION

A. THE GROSS DESCRIPTION

     The pathologist begins the examination of the specimen
by dictating a description of the specimen as it looks to
the naked eye. This is the "gross exam" or the "gross." Some
pathologists may refer to the gross exam as the
"macroscopic." Most biopsies are small, nondescript bits of
tissue, so the gross description is brief and serves mostly
as a way to code which biopsy came from what area and to use
for troubleshooting if there is a question of specimen
mislabeling. A typical gross description of an endoscopic
colon biopsy follows:

     "Polyp of sigmoid colon." An ovoid, smooth-
     surfaced, firm, pale tan nodule, measuring
     0.6 x 0.4 x 0.3 cm. Cassette ‘A’, all,
     bisected.

     In the above example, the first item (in quotes) is an
exact recitation of how the specimen was labeled by the
doctor who took the biopsy. After that is a textual
description of what the specimen looked like, followed by
measurements indicating its size. The "Cassette ‘A’, all,
bisected" phrase indicates that the specimen was cut in half
("bisected"), submitted for tissue processing in its
entirety ("all") in a small container (cassette) labeled
"A," which will eventually be placed in the tissue
processor.

     Larger organs removed as biopsies have correspondingly
longer and more detailed gross descriptions. The following
is the gross description of a spleen removed to assess
whether Hodgkin’s disease (a cancer of lymph tissues) has
spread into it:

     "Spleen". An entire spleen, weighing 127 grams,
     and measuring 13.0 x 4.1 x 9.2 cm. The external
     surface is smooth, leathery, homogeneous, and dark
     purplish-brown. There are no defects in the
     capsule. The blood vessels of the hilum of the
     spleen are patent, with no thrombi or other
     abnormalities. The hilar soft tissues contain a
     single, ovoid, 1.2-cm lymph node with a dark grey
     cut surface and no focal lesions

     On section of the spleen at 2 to 3 mm intervals,
     there are three well-defined pale-grey nodules on
     the cut surface, ranging from 0.5 to 1.1 cm in
     greatest dimension. The remainder of the cut
     surface is homogeneous, dark purple, and firm.

     Summary of cassettes: 1, hilar blood vessels; 2,
     hilar lymph node, entirely submitted; 3 – 6 spleen
     nodules, entirely submitted; 7 – 8, spleen, away
     from nodules.

     In the spleen described above, the pathologist found a
few lumps (nodules), representing the most important data in
this gross examination. These possibly represent the tumors
of Hodgkin’s disease, subject to confirmation by the
microscopic examination. Much of the remainder of the
verbage relates to "pertinent negatives," or things that
were routinely looked for but not found, such as a rupture
of the spleen capsule (suggesting an intraoperative
accident), blood clots ("thrombi") in the vessels supplying
the spleen, and evidence of an infection (in which case the
cut surface of the spleen would be soft instead of firm). In
addition, a lymph node was serendipitously found adherent to
the spleen, and this was briefly described as having a
normal appearance.

     The last paragraph of the gross description gives the
identifying "codes" of the slices of the specimen submitted
for microscopic examination in cassettes. The microscope
slides prepared from the processed samples will be labeled
with the same numbers as the cassettes, and the pathologist
doing the microscopic examination can, by referring to the
typed gross description, know from what part of the specimen
the tissue on the slide came.

B. THE MICROSCOPIC EXAMINATION

     The microscopic description, or the "micro" is a
narrative description of the findings gained from
examination of the glass slides under the microscope. The
micro is considered somewhat "optional" in a written report.
In such a case, the diagnosis (see below) is considered to
speak for itself. Here is a the microscopic description on
the report of the colon biopsy given above:

     Specimen A: The sections show a polypoid structure
     consisting of a central fibrovascular core,
     surrounded by a mantle of mucosa showing an
     adenomatous architecture with a predominantly
     tubular pattern. The tubules are lined by tall
     columnar epithelium showing nuclear
     pseudostratification, hyperchromasia, increased
     mitotic activity, and loss of cytoplasmic mucin.
     There in no evidence of stromal invasion.

     It can be readily seen that the language of microscopy
is much more arcane than that used for gross descriptions.
It is way beyond the scope of this monograph to cover the
nuances of descriptive microscopic pathology. In general,
microscopic descriptions are communications between
pathologists for referral and quality assurances purposes.

C. THE DIAGNOSIS

     This is analogous to the "bottom line" of a financial
report. The purpose of the gross examination, the processing
of the tissue, and the microscopic examination is to build a
logical argument toward a terse assessment of what
significance the biopsy has in regard to the patient’s
health. Here is the diagnosis for the colon biopsy, above:

          Colon, sigmoid, endoscopic biopsy:
          tubular adenoma (adenomatous polyp)

     This format is widely used, but variations occur. The
first term is the organ or tissue involved ("colon"). The
second term ("sigmoid") specifies the site in the colon from
which the biopsy was obtained. The next term ("endoscopic
biopsy") denotes the type of surgical procedure used in
obtaining the biopsy. Then follows the diagnosis proper, in
this case "tubular adenoma," a common benign tumor of the
large intestine and rectum, which increases the risk for
developing colorectal cancer in the future. In this
particular case, an older synonym for tubular adenoma,
"adenomatous polyp," follows in parentheses.

GLOSSARY OF IMPORTANT DIAGNOSTIC TERMS

     Finally, it may be useful to present a brief glossary
of important terms used in pathologic diagnoses. Terms in
the definition that are in ALL CAPS have their own entry.

ABSCESS. A closed pocket containing pus. Some abscesses are
  easily diagnosed clinically, as they are painful and may
  "point out" such that pus becomes visible, but deep and
  chronic abscesses may just look like a TUMOR clinically
  and require biopsy to distinguish them from neoplasm.

ATYPICAL. The simple, straightforward definition would be
  "unusual," but "atypical" means much more than that. In a
  diagnosis, the use of the term atypical is a vague
  warning to the physician that the pathologist is worried
  about something, but not worried enough to say that the
  patient has cancer. For instance, lymphomas (cancers of
  the lymph nodes) are notoriously difficult to diagnose.
  Some lymph node biopsies are very disturbing but do not
  quite fulfil the criteria for cancer. Such a case may be
  diagnosed as "atypical lymphoid HYPERPLASIA." Other
  important atypical hyperplasias are those of the breast
  (atypical ductal hyperplasia and atypical lobular
  hyperplasia) and the lining of the uterus (atypical
  endometrial hyperplasia). Both of these conditions are
  thought to be precursor warning signs that the patient is
  at high risk of developing cancer of the respective organ
  (breast and uterus).

CARCINOMA.  A malignant NEOPLASM whose cells appear to be
  derived from EPITHELIUM. This word can be used by itself
  or as a suffix. Cancers composed of columnar epithelial
  cells are often called adenocarcinomas. Those of squamous
  cells are called squamous cell carcinomas. The type of
  cancer typically recapitulates the type of epithelium
  that normally lines the affected organ. For instance,
  almost all cancers of the colon are adenocarcinomas, and
  columnar epithelium is the normal lining of the colon.
  There are exceptions, however.

DYSPLASIA.  An ATYPICAL proliferation of cells. This may be
  loosely thought of as an intermediate category between
  HYPERPLASIA and NEOPLASIA. It finds its best use as a
  term to describe the phenomenon in which EPITHELIUM
  proliferates and develops the microscopic appearance of
  neoplastic tissue, but otherwise tends to "behave itself"
  and continues to line body surfaces without actually
  invading them, as a true malignant neoplasm would do. It
  may be convenient (but not totally accurate) to consider
  dysplasia as a "pre-cancer" or an incipient cancer.
  Probably the most commonly occurring type of dysplasia is
  that of the cervix of the uterus, where a progression
  from dysplasia to neoplasia can be clearly demonstrated.
  Other dysplasias, such as those of the breast and
  prostate, are more difficult to clearly relate to
  neoplasia at this time.

EPITHELIUM.  A specialized type of tissue that normally
  lines the surfaces and cavities of the body. There are
  three main types: 1) columnar epithelium, which lines the
  stomach, intestines, trachea and bronchi, salivary and
  other glands, pancreas, gallbladder, nasal cavity and
  sinuses, uterus (including inner cervix), Fallopian
  tubes, kidneys, testes, vasa deferentia, and other ductal
  structures, 2) stratified squamous epithelium, which
  lines the skin, oral cavity, throat, esophagus, anus,
  outer urethra, vagina, and outer cervix, and 3)
  transitional epithelium (urothelium), which lines the
  urine-collecting part of the kidneys, the ureters,
  bladder, and inside part of the urethra.

GRANULOMA.  A special type of INFLAMMATION characterized by
  accumulations of macrophages, some of which coalesce into
  "giant cells." Granulomatous inflammation is especially
  characteristic of tuberculosis, some deep fungal
  infections (like histoplasmosis and coccidioidomycosis),
  sarcoidosis (a disease of unknown cause), and reaction to
  foreign bodies.

HYPERPLASIA.  A proliferation of cells which is not
  NEOPLASTIC. In some cases, this may be a result of the
  body’s normal reaction to an imbalance or other stimulus,
  while in other cases the physiologic cause of the
  proliferation is not apparent. An example of the former
  process is the enlargement of lymph nodes in the neck as
  a result of reaction to a bacterial throat infection. The
  lymphocytes which make up the node divide and
  proliferate, taking up more volume in the node and
  causing it to expand. An example of hyperplasia in which
  the stimulus is not known is benign prostatic hyperplasia
  (BPH), in which the prostate gland enlarges in older men
  for no known reason. While hyperplasias do not invade
  other organs or METASTASIZE to other parts of the body,
  they can still cause problems because of their local
  physical expansion. For instance, in BPH, the enlarged
  prostate pinches off the urethra and interferes with the
  flow of urine. If untreated, permanent kidney damage can
  result.

INFLAMMATION.  A reaction, usually mediated by the immune
  system, to noxious stimuli, manifested clinically by
  swelling, pain, tenderness, redness, heat, and/or loss of
  function of the affected part. To a pathologist, however,
  inflammation means the infiltration of certain immune
  system cells into the tissue or organ being examined.
  These inflammatory cells include 1) neutrophils, which
  are the white blood cells that make up pus and are seen
  in acute or early inflammations, 2) lymphocytes, which
  are typically seen in more chronic or longstanding
  inflammations, and 3) macrophages (histiocytes), which
  are also seen in chronic inflammation. Some types of
  inflammation are readily diagnosable by the primary care
  physician, such as an infected skin wound that is tender,
  hot, and draining pus. Other types of inflammation are
  not so readily apparent clinically and require biopsy to
  distinguish them from neoplasms. The suffix "-itis" is
  appended to a root word to indicate "inflammation of
  _____." For example, cervicitis, pharyngitis, gastritis,
  and thyroiditis are inflammations of the cervix, pharynx
  (throat), stomach, and thyroid gland, respectively.

LESION.  This is a vague term meaning "the thing that is
  wrong with the patient." A lesion may be a TUMOR, an area
  of INFLAMMATION, or an invisible biochemical abnormality
  (like the abnormality of the sensitivity of the body’s
  cells to insulin in adult-onset diabetes).

METAPLASIA.  The phenomenon by which one type of tissue is
  replaced by another type. This often results from chronic
  irritation of an EPITHELIAL lining. A good example is the
  cervix, in which chronic irritation and INFLAMMATION
  causes the relatively delicate normal columnar epithelium
  to be replaced by tougher squamous epithelium (similar to
  that which normally lines the vagina, which is naturally
  "built tougher" for obvious reasons). This phenomenon is
  called "squamous metaplasia." In it’s pure state,
  metaplasia is not harmful, but some metaplasias are
  markers for increased risk of more serious diseases. For
  instance, a type of intestinal metaplasia of the stomach
  (in which columnar epithelium of the intestinal type
  replaces that of the gastric type) is considered a risk
  factor for the subsequent development of cancer of the
  stomach.

METASTATIC.  Of or pertaining to METASTASIS, or the process
  by which malignant NEOPLASMS can shed individual cells,
  which can travel through the lymph vessels or blood
  vessels, lodge in some distant organ, and grow into
  tumors in their own right. There are two major routes of
  metastasis, 1) hematogenous, in which the cells travel
  through the blood vessels, and 2) lymphogenous, in which
  the lymphatic vessels conduct the cancer cells. In the
  case of lymphogenous metastasis, the metastatic tumors
  can grow from cancers cells entrapped in the lymph nodes
  that collect the lymph draining from the organ where the
  original cancer has developed, causing the nodes to
  enlarge. In the case of breast cancer, the axillary
  (underarm) nodes are the first to become involved. In the
  case of cancer of the larynx (voice box), the nodes on
  either side of the neck (cervical nodes) are first.
  Hematogenous metastases tend to deposit in the lungs,
  liver, and brain. Many cancers metastasize both
  lymphogenously and hematogenously. Most cancer operations
  attempt to remove not only the cancerous organ, but also
  the lymph nodes that drain that organ. Some types of
  cancer, especially the most common ones (lung, breast,
  colon, and prostate cancers) tend to metastasize to lymph
  nodes first. Pathologic examination of these nodes is
  important in "staging" the cancer, which gives the
  patient and the doctor some idea as to the odds of curing
  the cancer and how to best treat it. A typical diagnosis
  of a specimen of a "radical" removal of a cancer may read
  like,

          Breast, left, mastectomy: infiltrating
          ductal cancinoma; three of fifteen
          axillary nodes contain metastatic
          carcinoma.

NECROSIS.  Death of tissue. Necrosis may be seen in
  inflammatory conditions, as well as in NEOPLASMS.

NEOPLASM, or NEOPLASIA.  A "new growth" of the body’s own
  cells, a proliferation of cells no longer under normal
  physiologic control. These may be "benign" or
  "malignant." Benign neoplasms are typically tumors (lumps
  or masses) that, if removed, never bother the patient
  again. Even if they are not removed, they are not capable
  of destroying adjacent organs or "seeding" out to other
  parts of the body. Malignant neoplasms, or "cancers," are
  those whose natural history (i.e., behavior if untreated)
  is to cause the death of the patient. Malignancy is
  expressed by 1) local invasion, in which the neoplasm
  extends into vital organs and interferes with their
  function, 2) METASTASIS, in which cells from the tumor
  seed out to other parts of the body and then grow into
  tumors themselves, and/or 3) paraneoplastic syndromes, in
  which the neoplasm secretes metabolic poisons or
  inappropriately large amounts of hormones that cause
  problems with functions of various body systems.

-OMA.  This suffix means "tumor" or "lump." It typically,
  but not invariably, refers to a NEOPLASM ("GRANULOMA" is
  an exception). In referring to neoplasms, benign ones are
  typically referred to by a word, the prefix of which
  refers to the organ or tissue of origin, followed by the
  suffix "-oma." For example, leiomyoma, osteoma,
  chondroma, adenoma, and hemangioma, refer to benign
  neoplasms of smooth muscle, bone, cartilage, glandular
  tissue, and blood vessel tissue, respectively. The
  analogous terms for malignant versions of these neoplasms
  are, leiomyoSARCOMA, osteosarcoma, chondrosarcoma,
  adenoCARCINOMA, and angiosarcoma.There are exceptions to
  these vocabulary rules. For instance, hepatomas and
  melanomas are all malignant. Other tumors, such as those
  of the adrenal glands, cannot be classified into benign
  or malignant categories based on pathologic appearance.
  Only their behavior in time shows their true colors. An
  example is pheochromocytoma (a tumor of the adrenal
  medulla), ten per cent of which are malignant, but we
  don’t know just by looking at the tumor if a given case
  will fall into that ten per cent.

POLYP.  A structure consisting of a rounded head attached to
  a surface by a stalk (also called a "pedicle" or
  "peduncle"). A mushroom growing from the soil is an
  excellent example of what a polyp looks like. Polyps my
  be HYPERPLASTIC, METAPLASTIC, NEOPLASTIC, INFLAMMATORY,
  or none of the above. The typical polyps removed from the
  colon of adults during colonoscopy are benign neoplasms
  called tubular adenomas or adenomatous polyps. The
  typical nasal polyps that develop in people with
  allergies are inflammatory. The common benign polyps
  removed from the cervix are of uncertain origin.

SARCOMA.  A malignant NEOPLASM whose cells appear to be
  derived from those other than EPITHELIUM. The connective
  tissues of the body (fibrous tissue, muscle, bone,
  cartilage, fat, and lining of joints) tend to give rise
  to sarcomas. In adults, CARCINOMAS are much more common
  than sarcomas. This makes sense, because as we age, our
  body linings are assaulted by one noxious substance after
  the other. So it is no surprise that those epithelial
  cells on the forefront of our battle with the environment
  are the first to lose control of their growth and
  development. In children, sarcomas make up a greater
  proportion of cancers. While the connective tissues of
  adults are rather stable and protected from environmental
  assault, those of children are still growing and
  developing, the cells dividing, raising the likelihood
  that something will go haywire and cause a cell to lose
  control over its growth.

SUPPURATION, SUPPURATIVE INFLAMMATION.  A type of acute
  INFLAMMATION characterized by infiltration of neutrophils
  at the microscopic level and formation of pus at the
  gross level. ABSCESS is special type of suppurative
  inflammation.

TUMOR.  A mass or lump that can be felt with the hand or
  seen with the naked eye. This may be a NEOPLASM,
  HYPERPLASIA, distention, swelling, or anything that
  causes a local increase in volume. The thing to remember
  is that not all tumors are cancers, and not all cancers
  are tumors.

________________________________________________________________________

An HTML version of this FAQ is available through the author’s home
page at:

               <http://www.neosoft.com/~uthman/>

Note: Please send all constructive comments regarding this
  FAQ to Ed Uthman, MD <uth…@neosoft.com>.

This article is provided as is without any express or implied warranties.
While every effort has been taken to ensure the accuracy of the
information, the author assumes no responsibility for errors or
omissions, or for damages resulting from use of the information herein.

Copyright (c) 1994-96, Edward O. Uthman. This material may be reformatted

and/or freely distributed via online services or other media, as long as
it is not substantively altered. Authors, educators, and others are
welcome to use any ideas presented herein, but I would ask for
acknowledgment in any published work derived therefrom.

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