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Microscopic Lesion Description - Tips

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Microscopic Lesion Description - Tips

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Rachel Autran
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Microscopic Pathology Dr. Howerth MICROSCOPIC LESION DESCRIPTION - TIPS ding it against a white background (the old shirt es/of tise on the slide, estimate their size,identify their shape, color jdt'examine the slide grossly before you examine it microscopically, Ypulmay miss apiece of tiss i Use the objective with & west magnification’ (2.4% or 43 of the pieces on the slide. (or higher magnification). @ ;. The description may systematic, so Wc may be based on begin with the mo ‘gistUealSeanization (€-g. describing the skin from epidermis and progressing inward to the subcutis). Your purpose is to convey the information to the reader in an orderly or systematic jijproceddiré because you need to examine Each organ has basic anatomic structures and many have specialized anatomic structures. We may describe a normal structure if we are uncertain as to its significance, but we ean not describe all anatomic structures in a slide due to space and time limitations. Thus it is important that you “know the normal to recognize the abnormal” because our descriptions are generally concerned with the abnormal, However, we may make a statement concerning the absence of lesions such as “the blood vessels and interstitium are normal”. © The actual descriptive writing must be inicomiplete sentences “tense. The inforntation you give in a description will sometimes depend On thie intent joa tedden. For instance a clinician may want to know if adequate tissue was obtained during a biopsy. For renal biopsies we can relay information on the adequacy of the sample by counting the glomeruli and making that our frst statement (ic. there are 30 glomeruli in this section). The size of the sample may be important. Thus our opening statement for an endometrial biopsy might be, “there are 2 sections of endometrium approximately 3em long”. “What you are loolting’at. A good example is pink hyalin material you may see on many H&E stained sections. Hyaline material that stains pink may be albumin, fibrin, amyloid, or other protein. Special stains may be needed to differentiate the specific type of material. If your description read “the glomeruli contain fibrin” instead of “all glomeruli are enlarged and contain eosinophilic hyaline material” your interpretation is wrong if the material stains red with congo red and has a green birefringence with polarized light microscopy. The material would then be amyloid - not fibrin. Also, be specific in j6fis:' For example, don’t just say that foci of necrosis are present, indicate what type of necrosis is present (e.g. coagulative vs. Liquefactive).. the IESG Lastly your descriptions need not be wordy to be complete. )Deséii ly: Significant findings may be lost among verbal garbage! DESCRIBING MICROSCOPIC SPECIMENS Instructor: Bruce H. Williams, DVM, DACVP (202) 782-2650 Email: Williamsb@[Link] GENERAL 1, There is NO ONE WAY to describe a slide. Develop a style that is comfortable and consistent. 2. Be concise. Almost all slides can be described in 7 sentences or less. 3. Describe in an "inverted pyramid or from big to little. Place the main event first; leave the ancillary changes for last. 4. Write with the reader in mind, If, after reading your description, the reader can give you the diagnosis, then you have done a good job. 5. List the tissue first (i.e., kidney). Do not embellish ("We have a triangular section of kidney measuring 2X2X3 centimeters) - this is unnecessary verbiage. 6. Describe organs in a consistent manner. If you can break each organ down into ‘components which you describe for EVERY slide, you will never overlook a major lesion. (For instance, when describing a section of lung, always look at these five components: alveolar space, alveolar septa, airways, vasculature, and pleura. All hollow organs have both a lumen and a wall, which generally has multiple distinct layers.) Make sure to look at each part, even if you don't describe them. 7. You do not have to describe every cell or every pattern that you see on the slide. This will only serve to confuse the reader. (If most cells have indistinct cell borders, while some have distinct cell borders, describe the cells as having indistinct cell borders rather than "primarily indistinct, but rarely distinct". Go with the majority of the cells.) 8. Don't describe normal, except when interpreting electron micrographs. This simply wastes your time - you're a pathologist, not an anatomist. Also avoid any negative comments, (i., "There is no evidence of vascular invasion." If you would have seen it, you would write it down. ) These sentences add nothing to your descriptions and take time to write. 9. Know your terminology and use it in your descriptions. This includes names of anatomic locations (which are often species-specific), features of protozoans and metazoans, and specific descriptors for varying types of inflammation and necrosis, as well as many other instances. Specificity in terminology imparts to the reader that you know what you are talking about, even if you are not quite sure. The use of buzzwords can cover up a tremendous amount of uncertainty. 10. Use size and shape whenever possible in your descriptions; these are powerful descriptors. Sarcocystis zoites can be described as "1 X 2 basophilic banana- shaped zoites”. ("Guesstimations” are acceptable in testing situations - it is better to be little off on your estimate than not to have tried at all.) 11. Do not be afraid to interpret lesions, but make sure to separate this from your descriptions by a set of parentheses. ( i.e. "Covering the pleura is a mat of loosely arranged eosinophilic beaded material (fibrin)....) 12. Avoid redundancies or otherwise useless terms that do not add anything to your description, like "blue in color", or "characterized by", or "associated with". These terms mean nothing and take up your valuable time while writing them down 13. Little things are important - spelling, punctuation, grammar. All of these help your descriptions "flow". Descriptions that flow pick up all of the points awarded for style. 44, Work on your handwriting. If the audience can't read it, you won't get credit for either your effort or your genius. 16, Time, time, time. Youll never get credit for slides you don't get to look at. This one factor is the major stumbling block for people on the ACVP exam. Train yourself to ake no more than twelve minutes per slide, and stick with your schedule. That will give you thirty minutes to come back to slides that you have had difficulty with. If you don't get to several slides, you're sunk. 16. When all else fails, go back to the basics. Look for something added, and if you don't see it, look for something lost. (Actually, when you add something to many organs, you generally lose something, namely parenchyma, or at least architecture. "... here is multifocal loss of hepatocytes with replacement by nodular aggregates of foamy macrophages admixed with lesser numbers of lymphocytes and rare neutrophils.” NEOPLASMS |. Organ. Most slides will be obvious. For those of which you are unsure, give a brief description and an interpretation Il SENTENCE ONE: Subgross description. This is THE most important sentence in any neoplasm description. You will receive a lot of points from this one sentence, and set the tone for the rest of the description. 1. Location. Does it extend to cut borders? Is it limited to one anatomical part of the tissue, such as the grey matter or the renal cortex? 2. Size (a powerful descriptor) 3, Densely or sparsely cellular. 4, Well-demarcated or poorly demarcated 5. Shape. (Nodular, multilobular, verrucous, etc.) 6. Expansile or infiltrative 7. Encapsulated or unencapsulated Also, this is the place to state two populations of cells, or one population differentiating along several lines. Ill, SENTENCE TWO: Patterns of cells and type of stroma. A. Different broad classifications of neoplasms have fairly characteristic patterns. 1. Carcinoma - Nest, packets, lobules, cords 2. Adenocarcinoma - Tubules, acini 3. Sarcomas - Bundles, streams 4. Round cell tumors - Sheets. Avoid mixing patterns - "Nests, packets, and bundles". This sends mixed signals, and confuses the reader. B. Modify your pattern description with adjectives such as closely-packed, loosely arranged, etc. C. Stroma - fibrovascular, fibrous, pre-existing, fine, coarse, etc. This should be the last part of EVERY second sentence of EVERY neoplasm description that you do. (Almost always worth a point). IV. SENTENCE THREE: Cytologic features. ‘A, Shape (round, spindled, oval, cuboidal, columnar, polygonal, pleomorphic) B. Size (a powerful descriptor) C. Cell borders (distinct or indistinct). D. Cytoplasm 1. Amount (scant, moderate amount, abundant). 2. Color (eosinophilic, basophilic, red, blue, etc.) 3. Character (homogenous, fibrillar, granular) E. Nucleus. 1. Shape (round, oval, elongate, spindled, crimped, etc.) 2. Location in cell (central, paracentral, eccentric) 3. Chromatin distribution (vesicular, finely stippled, coarsely stippled, clumped, etc.) 4. Chromatin staining (hyperchromatic) F. Nucleolus 1. Number 2. Color V. SENTENCE FOUR. Unique features - multinucleate cells, variation in cells, (anisokaryosis, anisocytosis, karyomegaly, etc.) VI. SENTENCE FIVE. Mitotic activity A. Mitoses are _ per _ HPF. B. Mitoses range from _ to _ per HPF, averaging _ per HPF. C. Bizarre mitoses. Vil. SENTENCE SIX. Evidence of malignancy. A. Vascular invasion B. Capsular invasion C. Necrosis D. Hemorthage (if applicable) Vill. SENTENCE SEVEN (and more if necessary. Cleanup. These are observations not directly related to the neoplasm. A. Inflammation B. Ulceration Hemorrhage Mineralization moo Others NON-NEOPLASTIC LESIONS Organ. (One word set off from your description by a period. As before, if you are unsure of the organ, describe it briefly and give an interpretation.) Location, distribution and size. This is an important first sentence. If you aren't including the all of the above descriptors, chances are your first sentence has little substance. Components. AA. List all cell types seen in order of prevalence, and relate the numbers to each other. (.e., large numbers of viable and degenerate neutrophils surrounded by lesser numbers of macrophages, lymphocytes, and plasma cells, and rare eosinophils and Langhans’ type multinucleate giant cells. B. Cellular components. Use the names of the cells. Refrain from using the terms "mononuclear cell infitrate", non-suppurative inflammation” or “subacute inflammation” C. Non-cellular components. These are often as important as the cellular components - fibrin, edema, hemorrhage, and that most commonly overlooked denizen of the inflammatory focus -- cellular debris. D. Quantify everything. (Small amount, moderate amount, abundant amount; few neutrophils, moderate numbers of neutrophils, many neutrophils, myriad or innumerable neutrophils, etc.) E, Do not be afraid to interpret your descriptions. ("Vessel walls contain a small brightly eosinophilic granular material admixed with a few neutrophils and cellular debris (fibrinoid necrosis)... Causative agent. A. Location B. Size and shape (powerful descriptors) C. Interpretation (bacilli, cocci, fungal hyphae, etc.) D. Inclusion body (eosinophilic, basophilic, or amphophilic, ICIB or INIB) MORPHOLOGIC DIAGNOSIS General. There are many ways to formulate a morphologic diagnosis, and they often ‘vary from institution to institution. The "AFIP diagnosis" is well-known for its thoroughness, and often its length. For us, it works; its not for everyone. Site. This should match the organ listed in the morphologic description, however, you should localize it further, if possible ("Kidney, glomeruli:" or "Brainstem, paraventricular nuclei.” or simply "Liver:” Il. _Lesion. Be as specific as you can by adding applicable modifiers to characterize the cellular infiltrate (Dermatitis, suppurative" or "Myocarditis, granulomatous and eosinophil ic") Ill Duration. Acute, subacute, chronic. (Perhaps its a combination such as a lesion with a lot of fibrosis and scattered areas of suppuration, so you may want to use the term "chronic-active". I's a short list of modifiers here, though.) IV. Distribution. Focal, multifocal, multifocal to coalescing, diffuse. (There are a few others - massive, disseminated, etc. You can even combine some: “multifocal and random’, V. Severity. Minimal, mild, moderate, severe, and everything in between - "mild to moderate”, etc. VI. Neoplasms. The morphologic diagnosis for a neoplasm is simply the site and type of neoplasm, i.e. (Femur: Osteosarcoma or Haired skin: Plasmacytoma.) Ancillary changes seen in the tissue as a result of the presence of a neoplasm are usually not included in the morphologic diagnosis. Type of Diagnosis: Morphologic diagnosis (naming the lesion) Etiologic diagnosis (naming the cause) Definitive diagnosis (naming the specific disease entity involved) - usually will be asked Name the Disease Morphologic diagnosis: Subacute multifocal nonsuppurative interstitial nephritis Etiologic Diagnosis: Leptospiral nephritis agent + -Hssuee CAssue) Cause: Leptospira canicolas Ke dy Name the disease: Leptospirosis Morphologic Diagnosis: Chronic multifocal granulomatous yher pneumonia with intralesional budding yeast Dean sy Blasto on ad Etiologic Diagnosis: Fungal or Blastomycotic pneumonia [fh fds Cause: Blastomyces dermatitidis % cl MW i Nane the disease ~ Blastomycosis e morph dy 1 Morphologic diagnosis: Epidermal ard pilosebaceous atrophy with hyperkeratosis Etiologic diagnosis: Endocrine dermatosis Cause: hypothyroidism Name the disease: hypothyroidism Morphologic diagnosis: Segmental enamel hypoplasia Etiologic diagnosis: Viral enamel hypoplasia Cause: Canine distemper virus Morphologic diagnosis: Esophageal fibrosarcoma Wane Cause: Spirocerca lupi waa seer Wee hanea Lote Naud" & “uot tn won dx — if adishet dy ornere, Can separate ‘Morphologic Description: In this full-thickness section of colon, inflammatory cell infiltrates occur throughout the wall but are ‘most severe within the submucosa and cause mild expansion of the lamina propria, The infiltrates are ‘composed primarily of macrophages with fewer lymphocytes and plasma cells. Many macrophages contain numerous (often 10 or more), intracytoplasmic, swnall (2 to 4 jum diameter), round to oval yeasts surrounded by a clear halo (Histoplasma capsulatum). Colonic glands are usually mitotically active and the surface epithelium is generally intact; rare glands contain desquamated cells. Infiltrates within the tunica muscularis and serosa are usually around vessels ‘Morphologie Diagnosis: Large intestine: severe, diffuse, granulomatous colitis with phagocytized yeasts Etiology: Histoplasma capsulatum 2. Teaching slide # 35: Species not specified. ‘Morphologic Description: ‘This longitudinal section of long bone includes epiphysis, growth plate, and metaphysis. Preexisting corticat and trabecalac bone is thickened and extensively replaced by fbrovascular tissue containing small trabeculae of woven bone. The periosteum and cortex is markedly thickened by this new fibro-osseous tissue and only small marrow cavities remain within the epiphysis end metaphysis. Remmants of pre- existing bone have scalloped margins lined by large osteoclasts, Newly-formed spicules are lined by flattened to plump osteoblasts and intervening spaces consist of loosely cellular fibrovascular tissue. Many osteoclasts are also within this fibrous tissue. ‘The growth plate varies in thickness and is partially dissected by fibrovascular tissue. Along the scalloped interface of cartilage and fibrovascular tissue are numerous osteoclasts. ‘There isa relatively normal patter of growth plate chondrocyte maturation, but there is no primary spongiosa and trabeculae of woven bone in the subphyseal metaphysis are oriented transversely. Islands of disorganized articular cartilage within the epiphysis contain clusters of 4 to 8 chondrocytes (Chondrones) and cartilage matrix is eosinophilic (degenerate) in some areas. Morphologic Diagnosis: ‘Long bone (epiphysis, physis, and metaphysis): fibrous asteodystophy, severe, with disruption of growth plate cartilage Pathogenesis; Fibrous osteodystophy is usually due to secondary hyperparathyroidism stimulated by the hypocalcemia associated with nutritional imbalance (nutritional secondary hyperparathyroidism) or chronic ‘renal failure (renal secondary hyperparathyroidism). Ko? versio Histopathology Slide # 998 Descriptio Cerebellum and brain stem (2 sections): Both sections are similar with diffuse degeneration of the cerebellar white matter characterized by vacuolation, axonal swelling with dilation of axonal sheaths, and massive infiltrations of gemistocytic astrocytes that contain intranuclear and rare intracytoplasmic eosinophilic inclusion bodies. Many astrocytes also contain phagocytized eosinophilic globular to fibrillar material interpreted to be myelin. Cerebellar blood vessels have moderate lymphoplasmacytic perivascular cuffing and mild infiltrations of lymphocytes and plasma cells are in the meninges. Mild vacuolation is present in the cerebellar peduncles and brain stem. Morphologic diagnosis: Severe, focally extensive lymphoplasmacytic demyelination and intranuclear inclusion bodies. Cause: Morbillivirus, Paramyxovirus Name the disease: Canine Distemper A NOTICE: This materia! may be protected by copsight la? {Titis 17, U.S. Covey Path, vet, 3: 169-177 (1966) Editorial A little over a decade ago, one of the editors read and was im- pressed by an article, “Descriptions in Pathology”, which appeared in the A.M.A, Archives of Pathology (59: 612-617 (1955)}. A reprint of this article has never been far from his desk, and in the intes- vvening years, far from losing its timeliness, the wisdom expressed in these trenchant, witty phrases has come to have increasing signi- ficance. The author, Roserr W. Paicuann, is Professor of Pathology at the Bowman Gray School of Medicine in Winston-Salem, North Carolina. The editors share his belief that it is hard to get practice in desctiption in the pathology training programs. Yet the need for 4 guide to concise and lucid expression demands that pathologists in training should have some source to refer to, and we cannot think of a better mentor than Dr. Parcriarn. At the invitation of the editors, he has graciously consented to have his article reprinted in Pathologia Veterinaria as a guest editorial, and it is a pleasure to express our thanks for his kindness. We also thank Dr. Joun H. Tavaort, who Kindly granted permission for reprinting on behalf of the American Medical Association, publishers of che Archives of Pathology. ‘The article is reprinted essentially unaltered; i.e., the examples which illustrate the authot’s points are all drawn from human patho- logy. Our wish was not to tamper. with what Dz, PRicHaRD was saying so well; once they grasp his principles, our readers will find it easy to apply them to veterinary pathology. . Descriptions in Pathology Avoiding Pathological Descriptions Ronear W. ParcHarn Surgical house officers tie knots, and budding psychiatrists spend much time capturing ideas in words. But where can one find similar practice in description, a daily chore for the pathologist, ia the 170 Eprronrat pathology training programs? Although we deal in ideas and convey them with words, itis hard to find much in the books and journals devoted to pathology concerning the technique o€ description. These is a great deal of information available on the technique of autopsy performance, less on the handling of surgical specimens, and almost nothing on description itself. It is apparently geaeral opinion that physicians training in pathology have sufficient command of com- Position and vocabulary to do a creditable job of recording ia words ‘what is found grossly and microscopically, but sample readings from anyone's department will probably change this opinion. Now: srequently'one wil hear pathologistseoRNblibinipAGroneanotier tae clinicians tai t5Fe4a' thie descriptions, and callsthemoupraboitdetails whichstheyshuive embedded insctheitsreposesxbowsmaniyeetinicians (cripathologists)shavecthezsoulsandathestomacherousead WHat we glaciouia haste ate fil totepencsatdcisuzedJn this brief communica tion an outline of one man’s technique of description will be presented with the full realization that this is just one man’s opinion. Style is too personal to fit hard-and-fast rules. For the technique of doing autopsies the reader is refecced to ‘one of the standard works on the subject, as he is in the handling of surgical specimens. Two of the current works on autopsy technique! contain a few paragraphs on description, and i is mentioned in a work on surgical pathology. A book devoted to postmortem de- scriptions’ does not deal with description itself. This paper deals only with description. ‘The recording of pathological material in words is not a literacy exercise, but a utilitarian method for the preservation of certain features of gross and microscopic examination. Despite its humble nature, it should be orcisejngeammacicalaiapespecallys“pretise, ‘No interpretation ’should-sppeardiieesctiptionisy and itis theoretically Possible for a person with a command of the language to describe perfectly a surgical specimen or an autopsy, although he knows nothing of its significance. The time such a tasle would require of the unturored would be great, and special knowledge permits a rapid choice of words,.IF description and interpretation are intermingled, the total value of the effort declines rapidly; their separation is hygienic, forcing the observer to check himself and to east the scales Of preconceived diagnosis from his eyes. ‘The power of the latcer should not be underestimated. For a thousand years anatomists saw pores in the interventricular sepram of the heart because they believed Ct Eprroniat 1 Galen, and he said pores were there. One good way to foster this objectivity in gross description, until experience makes it second nature, is frst, tosloobthe™materiabmovery-then,:describe,itcas-itis gone\iovertasecondstimey:andy:tinally, read. he. description. back to: conieSelivas thie material is'seatinied again 0:see if what is described can bbe demonstrated. The practically universal convention of putting AREEIPHB BAH present TEAL recognizes the necessity of immediate objective description. Brevity is not only the soul of wie but the siga of a mind in good training when it comes to descriptions in pathology. ‘The beginner, who must grope for words which he wishes would roll off his tongue, stufs his descriptions full of sentences such as, “When the uterus is opened, it is seen that a polypoid projection of endometcium is present, which when lifted up is seen to attach to the right cornu”. As the final word is reached, one has either lost the reader or bored ‘him. One’s audience is only rarely interested in the mechanics of dissection; they look for one's findings and know full well that the uterus had to be cut open to see inside it, ete. The sentence would be more readily digestible as, “A polypoid endometrial projection is attached to the right cornu”, It is hard to carry such trimming too far, It is my own view, opposed by some of my colleagues, that itis also supetfious:toyprecede weights ‘and neasurements:byzconfessign ofitheiacy e. g., “The thyroid weighs 22 gmand measures 5.0 x 3.0 x1.0 em”. When one records a weight or measurement, res ipselagidtir, as ‘our legal confreres would say. Ta the same vein, it is not a matter of taste to point out that itis sheer redundancy'to follow: statenientiof eslortbystinicolon” as, “The tissue is blue in color”. What else would it be blue in? We are not given to describing the mood in which we find tissue. ‘The ends of brevity are best served if one launches ata description with an outline of what one will say ia mind. For the beginner, a moment of sober reflection before the mouth is opened, or the pen moved, is in order. As I intimated previously, the bégitiset is anxious to clear the air with a mighty stroke and, in describing things, he oy estistallingyawhichrignorance:makesinecessary-byadding itlalSWORAEHPor example, when one begins to describe the general appearance of a cadaver, one should have a mental outline of the features to be recorded—development, nourishment, length, approximate weight and age, race and sex—all in the first sentence. With this outline in mind, and in most other instances it is not so m Eprronsat ‘obvious, it is safe to proceed. In the description of most organs, a useful outline is an anatomic one, with the features of each organ described as they would be encountered in anatomic dissection. The usual proceduse followed with various organs is discussed in standard works on technique, ‘Having the outline of what one isto say in mind, the next hurdle is the choice of adjectives to express it, che nouns being fiely easy to come by. Ontinustspleadfortheabandonmeitofipodtry. A fairly small:stock of leamand firadjectivesstioitld Beollected and chevistiéd™ from the first days one is in pathology. The bulk of them should be common parlance in the medical world, and the remainder, the best of the newer terms which represent a real advance in communi- cation, A few words may be used out of the common run which are nonetheless trade stand-bys, like “grumous” and “whorled,” while such aberrant terms a8 “cerise,” “helioteope,” and “frustums ‘of cones” are hardly meaningful to the average reader. The foregoing remarks apply principally to gross description, a Geld jn which one’s auditors usually consider themselves as competent as the pathologist. In he case of microscopic description, the general medical reader expects a steady diet of specialized words hence usually does ot zead it). For our purposes the matter of a choice of words will be discussed under the headings ofiisize? shapetolormconsistencysiand:special:fearurespall applying to grbssee ‘deseziptions. primarily. Microscopic descriptions will be dealt with separately. Size is conveyed to the reader by weight, lineal measurements and occasionally volume. Experience is the best guide in a given instance, and a good starting point for the beginner is a standard ‘work on autopsy technique. Size strikes diferent people in different units, bur there is some standardization in pathology. Generally, ‘organs having a variable or nondescript outline are quantitated for the reader by weight, For example, there is ao poiat in measuring the length, breadth, and thickness of a lung, since it varies within wide limits in che normal; this organ is universally thought of in terms of weight. On the other hand, an amputated extremity would raise the question of length in the reader. The heazt demands weighing and measurement of the thickness of its chambers s0 that the distribu- sion of weight may be judged. Following isa list of minimum accepted units of size for various organs “measurement” indicates linear measuzement): mt van Eosro 173 Gall bladder: Length, masimum diameter, thickness of wall, volume of contained bile, Spleen: Weight. ‘Stomach: Note as normal, decreased, or dilated, which ace really diagnoses Dutare the ooly intelligible comments owing to lack of generally known standards. In surgieal specimens, length along the lesser and greater curvarrcs. Simall and large ineestnes: Same as stomach, with maximum diameter of any dilated or constricted portion. Appendix: Length and diameter, thickness of wall Kidneys: Weigh, and usual ehtee dimensions (f sbnormalies of outline exist Urinary bladder: Nothing of ie per se, but height above symphysis should be measured or presence below symphysis noted, Thickness of wall may be smeasuced optionally Prostate: Weight, whether it isthe whole gland or ransuretheal “chips” “Tester: Weight. Uterus: Overall mesurements of height, width, and chickness, the last ‘evo the maximums; wall thickness, diameter of pars vaginalis and os, depth of cervical and uterine cavities Uterine eurettings: Volume in milters, estimated or measured Ovaries: Length, wideh, and thickness, all maximums. Uterine tubes: Length and greatest diameter ‘Thyroid: Weight and greatest diameters of any nodules present. Parathyroide: Weight. ‘Adrenals: Weight and, if abnormal, the measurements stripped of fat. Greatest diameter of nodules, ‘Piuieary: Weight and measurements Baio: Weighe, Same for surgically removed portion, if of significant size Spinal cord: Lengeh, diameter maximums in various regions, weight. Eyes (surgical cr autopsy): Diameter of globe, depth of chambers. Fragments of intervertebral dize: Weight. Skin ellipses: Length, maximum width, thickness of subcutaneous tissue, nearest resected margin when a focal lesion is present on the surface. ‘Brest: Dimensions of ein ellipte and greatest dimension of attached tue. Extremities: Length Nondeseript portions of various tissues (cortical biopsies, heenia sacs, hhemorehoids, ete): A variety of approsches is used, The favored ones are a statement of the number of fragments, ehece-dimensional measurements of the largest plece, weight of the largese piece or an aggregate weight ofall, Above all, oneidoeswelkto-avoidvealingithings:tismalltlarge:” “ shaunibeneioxetenlatiged!wwhereipossiblexSuch decisions should be made, of course, but theysatecespressedbestainsthesdiagnosissor RREWEEIOR: An objective expression of size is a fact, to be doubted 1% Eprrontat cnly by quetiosing fundamental things about te obeiver, Later observers may take issue with the interpretation while finding the facts useful; as Buttercup said, “Things are seldom what they seem”, ‘The shapeof o¥gaas and other specimens isfeequenely assured s-nosmil when it sppeas So to the cbueves and aR aC ‘ititithimquality of a specimen entirely. 1 think thiscistolien ‘Beers sake:thar de0s108 TORRE reader: by ‘Satigh“GFene-Ghtal shal,” or something simila, This i not inter pretation; theze is no need to recapitulate the history of liver anatomy in every description of a liver, and one has a right to assume a mini- mum backgrouad of knowledge in things written for a special audience; any other attitude would be absurd, Whidatthexpraduers, "SPARE SrisurgenycarerencanaTereR Meisel xorstariatleE the shapecofishingsinrsmtementszstichas/[Link]!oxisappproxi mately ectaagalar,” rather thanstrying:to picturerieieompletelyciti'a ‘GroupOF Gommplesephitases, since the power of words is limited. It Js often in this part of the description that otherwise sound efforts fail for lack of a brief period of quiet contemplation. Color should be a fairly simple matter, but occasionally it is dealt with uathinkingly. The matter of unusual color terms has been touched on, and also the redundancy of referring to colors as colors, as though they would be used in any other sense ia pathology. The reverse is true; the practice of decorators and paint manufacturers of referring to certain yellow-white paints as “egg-shell” and similar ‘weddings of things and their colors are to be deplored in pathology. Several years ago I heard of someone who considered the abandon. iment of the usual names of colors for a systematic chart of colors to be referred to by number. This seems to me ia the nature of casting pearls before swine, since the matter at hand probably does not need such magnificent quantitation. ‘Consistency xequires only -a'small:-VoeabularyeSoRyhard etn, “andi sésilient are useful basic terms, royQeiinedified By slightly, med, ‘“elitelysormarkedly. Others are Muid, compressible, and plastic (in it f being capable of shaping by deformation). This is 4 good area in which to avoid description by comparison, as dealt with iva later paragraph, Special featuces of organs ace usually the products of disease and their anatomic location isthe frst poiat in describing them, where that is possible. They are. then dealt with as specimens:in themselves, using the general principles being discussed here. on Eprrontar 15 _Micsoscopie® deseripsion ise eoUaalyooio PAE CoimplON a Top, nec “superior aspect of" Halves, aot “two equal halves” Changed, not “undergone transformation” Is pale, not “shows pallor” 1s chronie. not “a course of long duration” Before, not “prior to" 7. Avoid tic (allowing worn-out words: they gre often obscure, Ar best. (hey have only general meaniags that are noninformative, Basically 2 Really Actually Jus Detinitely Quite Primarily Wiogsthic Essentially Marked Sclengide

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