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The Power of writing skills of a Histopathologist 

Dr  Sampurna Roy  MD

 

 

In this post I will not write about patterns and pathology of rare, exotic soft tissue or skin tumours. I have other websites to do that.

Today I will discuss a different aspect of Histopathology - "Writing Skills of a Histopathologist" 

We all know that under microscope tumours look beautiful. So how do you describe that beauty in words?  

One of the most challenging aspects of starting work as a resident histopathologist is knowing how to begin compiling a report of the microscopic findings of a case.

Histopathology reports are completely different from the numerical reports of routine haematology and chemical pathology.

"Histopathology reports are subjective assessment of a specimen expressed in words."

Pathology trainees can often face problems in constructing a report, specially with a complicated specimen. Arriving at the form of words to be used can be very difficult without experience.

There are no absolute rules for compiling reports.

With experience each pathologist develop their own preference for certain phrases. 

During training period junior doctors should gather phrases and constructions from all the consultants with whom they work.

In a histopathology report macroscopic description, is as important as the microscopical findings. The summary is the final diagnosis with mention of any significant finding.

 

I will give 2 examples of my histopathology reports:

First case:

Macroscopic report:

Testis and cord together weighing 50 gms. The cord measures 5.5cms.

Block A = Two sections from proximal end of cord.

Block B = 1 section from mid cord,

Block C = 1 section from cord adjacent to testis.

The testis itself measures  5.5cm x 3.5cm x 3.0cm. The cut surface of the testis reveals a lobulated tumour mass measuring approximately 4 cm in greatest diameter. The residual testis is brown in colour in some areas but paler in others. The testicular mass is adjacent to the rete testis. The tumour does not appear to have penetrated through the the capsule.

Blocks D to J = Complete sections from the tumour mass.

Microscopic report:

Sections of the tumour show appearances of a seminoma of classical pattern with mostly cohesive tumour cells with a prominent nucleoli and delicate cytoplasm with a backround of lymphocytes and fibrous septae.

In addition there are some areas where there is a marked granulomatous reaction.

In a few tubules there is intra-tubular germ cell neoplasia.

Adjacent testis shows areas of atrophy with hyalinised tubules.

The tumour appears confined within the testis and no tumour is demonstrated in any of the sections in the cord.

No tumour is seen outside the capsule.

These are the appearances of a seminoma of classical pattern.

Summary: Seminoma -  Granulomatous reaction. Presence of intratubular germ cell neoplasia. No tumour detected outside testis.

Second Case:

This is a referral case for second opinion.

Microscopic report:

A section of skin bearing a well-circumscribed tumour. The lesion is symmetrical. This is composed of lobules of small to medium sized germinative-type cells arranged peripherally and differentiating into larger sebaceous cell. At the centre of the lobules there is abundant holocrine type necrosis discharging into sebaceous duct-like structures which communicate with surface. Mitoses are present. There is no significant cellular atypia.

These are the appearances of a sebaceous adenoma. Excision is complete in this section.

My opinion: The possibility of an association with underlying visceral malignancy as part of the Muir-Torre syndrome should always be considered in cases of Sebaceous Adenoma. It is commonly associated with colorectal neoplasia. Rare cases of lymphoma as part of the syndrome has also been reported.

Summary: Sebaceous Adenoma.


Visit:  Pathology of Sebaceous Adenoma

A few selective microphotographs of seminoma from my large collection of slides on testicular tumours.

1)       2)     

3)         4)  

1) Macroscopic appearance of seminoma   2) Classical Seminoma  

3) Granulomatous reaction  4) Intra-tubular germ cell neoplasia

 

Reporting of complicating cases can be challenging for even an expert in just one field.

In real life, it is hours and days of hard work and dedication of the histopathologist that makes the diagnosis possible.

It is so much fun and relaxing to write and post pictures in your own website. Glad to get back after a long gap. Hope other pathologists who started with me will also find time to update their own websites. It is difficult but not impossible.


 

Have a relaxing weekend and a great week ahead.

"The life so short, the craft so long to learn - Hippocrates"

Dr Sampurna Roy MD.

What writers can learn from the theory of Work and Energy

 

 

 

Dr  Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)


 

 

 

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