Discover and read the best of Twitter Threads about #GIpath

@guerreroespejo

A 29-YO♂️, 6 months before, HIV + & non–drug-resistant pulmonary tuberculosis, antiretroviral & 4-drug antituberculous therapy initiated but soon reduced to rifampin & isoniazid only: abdominal pain on the L side
CT: ?
1/5

DOI: 10.1056/NEJMicm2206174
#radiologist #GITwitter

CT: an enlarged spleen with numerous hypodense lesions (A).
CD4 cell count: 119/mm3
VIH viral load: 1778 copies/mm3

A splenectomy was performed to evaluate for cancer:
numerous necrotic nodules with purulent discharge (B).
2/5

#microbiology #gastroenterology #IDtwitter

🔬granulomatous inflammation with caseous necrosis (C) and acid-fast bacilli (D, arrowheads).
A tissue🧫: ➖

PCR: ➕for Mycobacterium tuberculosis

SPLENIC TUBERCULOSIS
3/5

#bacteriology #MedTwitter #GIPath

Read 5 tweets

Antonio Guerrero

@guerreroespejo

An 81-YO👵, type 2 DM: malaise, fever & anorexia, with oral pain & odynophagia, yellowish-white, pseudomembranous lesions on the tongue (A)

#endoscopy showed multiple shallow ulcers with a white coating (B)
1/6

doi.org/10.1503/cmaj.2…
#emergency #gastroenterology #MedEd

Glossal & esophageal🔬: multinucleated cells with moulded, ground-glass nuclei

PCR & immunohistochemical staining of the specimens: ➕ for herpes simplex virus type 1 (HSV-1)

HERPETIC GLOSSITIS AND ESOPHAGITIS
2/6

#GIPath #IDtwitter #microbiology

Her hemoglobin A1c was 7.2%.

Doctors treated her with a 7-day course of acyclovir, intravenously because of her odynophagia, and the oral and esophageal lesions completely resolved.
3/6

#MedStudentTwitter #MedicalStudents

Read 6 tweets

Raul S. Gonzalez, MD

@RaulSGonzalezMD

01/ Buckle up, everyone, it’s time for a Tweetorial. Been working on this one for a while. This time, I’ll focus on the most common mesenchymal malignancy of the digestive tract: gastrointestinal stromal tumor (GIST). #pathology #gipath #PathTwitter

02/ GIST arises from the interstitial cells of Cajal. It can originate anywhere in the GI tract, though most cases occur in the stomach or small bowel. Rectum cases are uncommon, and GIST is very rare in the esophagus, colon, or appendix.

03/ Old terms for GIST include GANT (gastrointestinal autonomic nerve tumor) and leiomyoblastoma. These terms are no longer used, though you may run across them in older literature.

Read 80 tweets

Víctor

@vicvisePGY4

#PathResidents #MustRead #MustReads

#DermPath

#BreastPath

Read 35 tweets

Dheera Grover

@GroverDheera

@yaransarkis @MondayNightIBD @AmerGastroAssn @Spencerkelley7 @ayshaslam999 @jalpa_devi @purnie_mae @dunleavy_katie @KanikaGargMD @MarcelYibirin @JHaydek @DCharabaty @mjayoushe @AmCollegeGastro @ASGEendoscopy @Realcecum 8/ What’s in a C-scope ?
💎 #B2BPearl💎New guidelines @AmerGastroAssn
🔹Use High Def scope+++
🔹HDef scope ➕ Chromo (dye spray or virtual) if h/o dysplasia
🔹If using Standard Def: SD scope ➕Chromo dye spray only (not virtual)
🔗journals.lww.com/ajg/Abstract/2…

@yaransarkis @MondayNightIBD @AmerGastroAssn @Spencerkelley7 @ayshaslam999 @jalpa_devi @purnie_mae @dunleavy_katie @KanikaGargMD @MarcelYibirin @JHaydek @DCharabaty @mjayoushe @AmCollegeGastro @ASGEendoscopy @Realcecum 9/ What to biopsy ?
➕Targeted Bx🎯 of abnormal mucosa
➕Resection of polypoid lesion
➕Random Bx to document histologic extent/ healing
➕Extensive Random 4 quadrant bx every 10 cm IF no chromo, h/o dysplasia, poor visualization, PSC, foreshortened colon

@yaransarkis @MondayNightIBD @AmerGastroAssn @Spencerkelley7 @ayshaslam999 @jalpa_devi @purnie_mae @dunleavy_katie @KanikaGargMD @MarcelYibirin @JHaydek @DCharabaty @mjayoushe @AmCollegeGastro @ASGEendoscopy @Realcecum 10/ What’s next after dx of Invisible dysplasia ?
💎 #B2BPearl💎
🔹Invisible dysplasia
→ Get 2nd opinion from expert #GIPath
→ HD CLN + dye chromo by expert endoscopist + Extensive non-targeted Bx if no resectable lesion seen

Read 9 tweets

Tristan D Rutland

@TristanRutland7

Ampulla tumour, adult

#GIpath #BSTpath #Pathtwitter #Pathresidents

Question:

Based on the initial images, which of the following do you favour?

* Gastrointestinal stromal tumour
**Gangliocytic Paraganglioma

Read 14 tweets

Trupti Mandalia

@Pathmath1

M 60ish. Caecal tumour ! Poorly differentiated , typical dMMR morphology ! MMR IHC - all four stains negative with adequate internal control ! How would you approach this? What would you do next in terms of work up or advice to clinicians ? #gipath #frcpath #PathTwitter

Thank you all for engaging. This is really rare but once in a while, we do come across cases showing more than two markers' loss. Previously I had recommended genetic referral in such an instance thinking loss of MSH2/MSH6 is almost always germline i.e syndromic. 1/2

However, recently heard a talk on MSI & became aware that in most such cases, the MLH1 hypermethylation is a primary event and loss of MSH6 is secondary sporadic mutation. These patients in fact do not harbor germline mutation. Subsequently, I also found the following reference.

Read 5 tweets

Raul S. Gonzalez, MD

@RaulSGonzalezMD

1/ Hello again, everyone. I have finally put together my third Tweetorial, and I will be focusing it on one single entity, the enigmatic and often frustrating Low-Grade Appendiceal Mucinous Neoplasm (LAMN). #pathology #GIpath

2/ For starters, what is a LAMN? The name gets you most of the way there. It technically is an appendiceal adenocarcinoma, because it is an epithelial malignancy composed of glandular epithelium.

3/ The key distinction is that LAMN invades by pushing rather than trickling/destructive invasion, so it’s not a low-grade “adenocarcinoma” like those we often see in the colorectum.

Read 64 tweets

Tristan D Rutland

@TristanRutland7

Appendix A

#GIpath #Surgpath #PathTwitter

Question:

Based on the above image, what is your preferred diagnosis for this appendix?

*Low-grade appendiceal mucinous neoplasm
**High-grade appendiceal mucinous neoplasm

Appendix B

Read 17 tweets

Tristan D Rutland

@TristanRutland7

Gallbladder, female

@ZHOUSEH @MattieFarzin @DrJPLow @pembeoltulu @DrGeeONE @Dr_Brian_Cox @Teclis82 @ariella8 @MAHoureih @TheKarenPinto @Meghna0630 @Divya_Madhala @Kashifhazim

#GIpath #surgpath #pathtwitter

PAS/PASD

CD34

Read 12 tweets

Tristan D Rutland

@TristanRutland7

GOJ mass, older patient.

@ZHOUSEH @MattieFarzin @pembeoltulu @RunjanChetty @ariella8 @Dr_Brian_Cox @ALBoothMD @DrBMcGinn @DrGeeONE @MAHoureih @TheKarenPinto

#GIpath #PathTwitter #Surgpath

Further Hx for @Meghna0630

Male,
PMHx: skin cancer, DM type2, BPH

Presents with SBO. Nodule in stomach and small bowel (below).

Read 15 tweets

Vidya Monappa

@vi_monappa

#gipath #granulomas #pathology
Ruptured crypt granuloma in UC.
1. LP - ruptured crypt; giant cell +
2. Deeper- histiocyte aggregate with only part of crypt seen (crypt loss)
@kriyer68 @smlungpathguy @pembeoltulu @RunjanChetty @ariella8 @DraEosina @DrMarkOng

TB granulomas are large and confluent, may show necrosis.
AFB + confirms the diagnosis
@vhnguyenmd @anueru432 @anugnya_ran

Here is a foreign body (food particle) granuloma in peritoneal aspect secondary to rupture.

Read 5 tweets

Majdoline Jayoushe, MD

@mjayoushe

@MondayNightIBD @SobiaMujtabaMD @DuekerJeffrey @DCharabaty 25y/oM quit🚬3 mos ago, now 3🩸loose BM/day,mild abdo cramps;Cousin w Crohns;Stool➖for infection;CLN: erythematous granular mucosa rectum+sigmoid, superficial ulcers;BX:Acute cryptitis,crypt abscess,crypt architecture distortion. What helps most dx UC vs Crohn’s?
#B2B #IBDPoll

@MondayNightIBD @SobiaMujtabaMD @DuekerJeffrey @DCharabaty UC and CD:

🔻Chronic inflammation of the GI tract

🔻Affects all ages: Typically starts between age 20-39

🔻Second peak of incidence age >50

🔻Flares of GI symptoms +/-systemic symptoms +/- EIM

@MondayNightIBD @SobiaMujtabaMD @DuekerJeffrey @DCharabaty 3/ CD:

💡Skipped lesion, any part of GI tract

💡Most common:Colon+ileum
Hallmark➡️ulcers: aphthous,deep large/linear/serpiginous

💡Transmural inflamm -> stricturing, perforating dis.

🚩#B2BPearl
👉🏼Rectum can be involved in CD;➕anorectal ulcers → ⬆️risk of perianal disease

Read 16 tweets

Mark Ong

@DrMarkOng

How best to classify this gastric tumour? #GIpath

>95% of tumour is a WD NET (like picture 1), <5% shows mucin & goblet cells (pictures 2-4). Complicated by neoadjuvant chemotherapy for adenocarcinoma (presumably index biopsies looked more epithelial). IHC next tweet...

Synaptophysin -ve in epithelial component. Chromogranin strong +ve in NE component, weak in epithelial component. Ki67 high in epithelial component, low in NE component.

Are the mucin-producing areas amphicrine (dual differentiation in 1 cell) or a separate epithelial component?

Definition of mixed neuroendocrine, non-neuroendocrine neoplasm:
⏺️2 discrete components (morphologically & immunohistochemically)
⏺️Each component >30% (small cell carcinoma is an exception)

Read 5 tweets

Elmira Vaziri Fard, MD, MPH 🌸

@EVFPathMD

Any guesses? Site? Diagnosis?#SurgPath #GIpath #PathTwitter @Teclis82 @pezhouh @CArnold_GI @mhassanaimc @ac_pathgal @ALBoothMD @SwikrityUMD @D_KumarMD @Gagandeepk5MD

Here are the gross pictures of the same case. The above section is from appendix. On the left there are sections of the appendix and on the right is small bowel.

This is a hamartomatous (Peutz-Jeghers type) polyp grown in an appendicial diverticulum. Here are microscopic pictures of the appendix showing loss of muscularis propria in the diverticulum.

Read 4 tweets

KevinKuan

@kkuanMD

Resident Midnight Horror:
My colleague (PGY-1) received this specimen while on call:
A whipple specimen resected with roux-en-Y procedure, right nephrectomy, and right hemicolectomy, all attached together!!
Try orient the specimen. #grosspath #GIpath #PathTwitter #SurgPath

Here's the annotations:

@gtevaristomd @GagandeepkMD @DrVish @ALBoothMD @ac_pathgal @AmberMBerumen
@pembeoltulu @D_KumarMD

Read 5 tweets

Monika Vyas

@Mvgs1706

Young lady with weakness and anemia.
Endoscopy – diffuse scalloping of the duodenal mucosa
Biopsy – Mucosal flattening
Crypt hyperplasia
Intraepithelial lymphocytosis.
IgA anti-tissue transglutaminase (anti-TTG) NEGATIVE.
So, is this not celiac disease (CD)?
#GIpath #pathboards

High clinical suspicion for CD -check IgA levels
In IgA deficiency, IgA-TTG and IgA-EMA (anti-endomysial Ab) will be negative
Alternative tests - IgG-DGP (deaminated gliadin peptide)/ IgG TTG
HLA-DQ typing - HLA-DQ2 (~95% pts) and HLA-DQ8
#GIpath #pathboards

Lastly, here's the colon bx of this pt showing lymphocytic colitis pattern
Microscopic colitis is more prevalent in pts w/ CD
Pts w/ MC and CD often have more severe histologic features, may require steroid rx
Response of MC to gluten free diet is not known.
#GIpath #pathboards

Read 3 tweets

Daniela Hermelin, MD

@HermelinMD

🤩I am constantly marveled by the endless ways in which we #Pathology and #LabMedicine, can use Twitter to engage, share, support & learn from each other. Here is the link to my presentation that celebrates the unlimited opportunities to harness Twitter👉🏽
bit.ly/39kA627

https://twitter.com/HermelinMD/status/1226891913472741376

Like the #SolarEclipse that occurred in August 2017, to me, Twitter has been a community wide experience of marveling a visual process that can create a burst of awe at an organic velocity. It's really exciting to be engaged in this global experience.

#AcademicTwitter is using Twitter at the University and Research setting to teach. It has wide range benefits and I recommend reading the following article written by @soragnilab and @Aiims1742 published in @nature that describes this phenomenon. doi.org/10.1038/s41568…

Read 12 tweets

Sanjay Mukhopadhyay

@smlungpathguy

1/
Necrosis = cell death (unlike apoptosis, it does not occur naturally and is not programmed)

This short #Tweetorial shows you some of the histologic flavors of necrosis. The stain in each of these pics is hematoxylin-eosin (H&E)

#pathology #pulmpath #pathtweetorial

2/
First a question to test your knowledge. Necrosis with large numbers of neutrophils is called:

3/
And now a few examples. Necrosis in colorectal carcinoma is often described as “dirty” because it contains nuclear debris. This makes it look purplish instead of pink.

#gipath #MedEd

Read 14 tweets

Discover and read the best of Twitter Threads about #GIpath

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Discover and read the best of Twitter Threads about #GIpath

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