Pinned Tweet
1.
Introducing a new thread: super basic lung pathology for PGY1s, with arrows. If you are a PGY1, leave a comment and I will tag you in a future post.
A hamartoma is a disorganized mix of overgrown normal tissues (in their normal location) that creates a mass. Good news: they are benign!
#pathology #pulmpath #tweetorial #pathtweetorial #sblppgy1
83
237
663
95,221
Who to follow on #pathology Twitter. This is my updated version for 2018, sorted by subspecialty. #pulmpath gets a long list, obviously! 😜
These are #pathologists whose tweets I ❤️❤️❤️
Apologies to those I inadvertently missed. 🙏🏾 🙏🏾
#whotofollowinpathology
93
499
917
Histiocytes in disseminated histoplasmosis #pulmpath #pathboards #cellfie @AmyHDeekenMD @JMGardnerMD @mannanrifat03
27
374
573
🦚 Does #COVID19 cause ARDS?
🦚 What is the histology of ARDS?
🦚 What is DAD?
🦚 How do hyaline membranes form?
🦚 How does DAD cause hypoxia?
Find the answers in this free YouTube video. Thank you @JMGardnerMD for the idea!
piped.video/vPtH42Lnt_Y
28
358
550
Mini #tweetorial for anyone who wants to learn how to do a good PowerPoint presentation:
Tip 1: Look and sound bored. Sigh a lot.
61
250
545
1/
Are you new to Twitter? Are you a pathology resident or a pathologist? Are you wondering what to tweet about or where to start? This brief tutorial is for you. Pathology on Twitter is awesome 👍🏾❤️✅
#Tweetorial = Tutorial of tweets
#pathtweetorial = Pathology version
46
272
541
I saw a pathologist sign out a case today
No #ihcpath
No molecular
No AI
No clinical correlation
No radiologic correlation
No cyto-histo correlation
She just sat there...looked at the H&E...and signed the case out
Like a psychopath
I saw a guy at Starbucks today.
No iPhone.
No tablet.
No laptop.
He just sat there.
Drinking coffee.
Like a Psychopath.
44
97
451
The “Four Quadrant Rule”
#basicpath
Because many malignant nuclei have irregular contours, if you divide the nucleus into 4 quadrants, each one looks different.
In contrast, benign nuclei tend to be symmetric
8
128
440
Focal
⚫️⚫️⚫️⚫️⚫️⚫️⚫️⚫️⚫️⚫️⚫️⚫️⚫️⚫️🔴🔴⚫️⚫️⚫️⚫️⚫️⚫️⚫️⚫️
Diffuse
🔴🔴🔴🔴🔴🔴🔴🔴🔴🔴🔴🔴🔴🔴🔴🔴🔴🔴🔴🔴🔴🔴🔴🔴
Patchy
⚫️⚫️⚫️⚫️⚫️⚫️⚫️🔴🔴⚫️⚫️⚫️⚫️⚫️🔴🔴⚫️⚫️⚫️⚫️⚫️⚫️🔴🔴
#pathology
20
157
441
1. How do we tell primary lung cancer from metastatic cancers from other sites?
It’s correct to say we should use all available clinical, radiologic and pathologic information, but that’s too vague to be helpful in a practical sense.
Here I offer some tips. #tweetorial
25
203
432
Young pathology resident, approx. 20 years ago: At a private practice lab in Central New York we were required to rotate at as residents. Check out the rockin' computer and the fancy microscope! kikoxp.com/posts/19315
19
12
388
45,935
Dear patient, I spent hours using a microscope to find a super tiny bug in your biopsy so we could figure out what caused that lump in your lung. I can assure you it is an infection, not cancer. You will not meet me but I care for you deeply. I am your #pathologist
Dear parents, i have reviewed hundreds of sections from your baby’s rectal biopsy checking for ganglion cells, so that he can be operated and his #Hirschsprung disease be corrected. You will not meet me but I cared for your child deeply. I am your #PediPath Physician.
4
34
357
Here’s a request to all Tweeples. Please post a video of you saying this in your native language.
1. I am a (what you do)
2. I use a (tool you use in your work)
3. This language is (the language you’re using)
Let’s see how many languages we can get!
@pembeoltulu @chriszioga
132
88
354
There are so many awesome tweets on cryptococcosis on Twitter! I’m going to try linking them all together in one long #Tweetorial (less structure, more tweets!)
#pathtweetorial #pathbugs #crittersontwitter
Follow the thread 👇🏾 if you want to learn about #Cryptococcus
26
207
363
1/
This is the beginning of a #tweetorial or #pathtweetorial on a mystery topic. Fear not, it’ll become evident soon what we’re talking about. But first I’ll show you an image. These serpiginous fibroblast plugs are diagnostic if organizing pneumonia (formerly BOOP)
22
224
367
Hydatid disease = Echinococcosis
Pics 👇🏾 show gross appearance of collapsed cyst, micro of laminated layer (ectocyst) and “hydatid sand” with protoscoleces (baby versions of tapeworm head)
Table explains terminology
#Pathbugs #crittersontwitter @ParasiteGal @kriyer68
22
153
368
If I told my late parents that I would write two textbooks from scratch, they wouldn't believe me. Or maybe they would: parents always overestimate their kids' abilities.
24
17
326
28,293
Yes!!!!!!!! It’s here at last! Months and months of hard work with @Path_Matt and now it’s such a joy to behold the finished product 😊🥰😍
🔥🔥🔥🔥 #thoracicsurvivalguide #pathology #pulmpath
35
33
322
28,156
Placental transmogrification of lung (when lung looks like placenta)
#pathology #pulmpath
18
123
389
For a publication-level gross photograph you need to:
1. Clean the background till it’s spotless
2. Rinse the cut surface of the specimen lightly and blot dry
3. Center the specimen in the pic
4. Ruler in pic but not touching specimen.
5. Show only 1 half of specimen pls!
25
102
306
1. I have a low mag pattern that is instantly recognizable (“spotter”)
2. I metastasize to the lungs, often after many years
3. I have a distinctive translocation
4. My name is a bit of a misnomer
5. Immunos don’t really help to diagnose me
Who am I? #pathology #pulmpath
23
107
299
Tweetorial on carcinoid tumor of the lung. I’ll add to it little by little every week 😊
#pathology #pulmpath
1/
Carcinoid tumor is the lower grade end of the spectrum of neuroendocrine tumors in the lung.
Caution: lung terminology is different from GI tract terminology
43
151
291
The Four Quadrant Rule (Cytology): A feature that helps in distinguishing benign from malignant cells kikoxp.com/posts/18995
7
100
293
22,757
Monocyte in tissue = macrophage = histiocyte
Histiocyte + foamy cytoplasm = Foam cell
Histiocytes fused to form big cell = multinucleated giant cell
Histiocyte + sole-shaped nucleus = epithelioid histiocyte
Tight group of epithelioid histiocytes = granuloma
#basicpath
9
87
287
From 2022 @NCCN guidelines for patients. No mention of pathologists in the “diagnostic team”. 👎🏾
64
76
268
There are 2 types of pathologists: those who have missed a signet ring cell carcinoma and those who will
(I first heard this as a #pearlsfrommymentor post by @DraEosina ) I’d love to hear who the mentor was!
Solitary lung mass. No history of malignancy. #pathology #pulmpath
18
102
281
Attention PGY1s! The chances that your attending/staff/faculty will quiz you about these big cells are inversely proportional to the time you have spent in the program.
These are ganglion cells. #classicpath #Primer4PGY1
11
73
272
Here's a treat for the end of the year: #asbestos bodies in the lung under oil immersion. I tried to #pembify the thin clear core and change plane of focus
Remember: Ferruginous body + thin clear core = asbestos body
#PulmPath #Pathboards #knoworfail
@Missle @Path_Matt
20
148
274
Don’t be jealous Tweeples, but guess who are now my 💥🔥☄️ new colleagues at @CLEClinicLabs ?
#Hemepath superstar @evemariecrane has joined us, along with #GUpath rock star @Williamson_SR (now my next door neighbor!)
❤️❤️❤️ that they are both in Cleveland!!
41
17
273
1. This is the first published report (in the world) of complete COVID-19 autopsies in the peer reviewed English language literature.
2. It shows the underlying pathology in at least some individuals is diffuse alveolar damage and lung inflammation
academic.oup.com/ajcp/advanc…
4
150
275
The term mucoepidermoid makes it seem like there will be a mucoid and an epidermoid (squamous) component in the tumor. Wrong!
PGY1s beware! Here is a picture that attempts to explain what really happens in mucoepidermoid carcinoma. In this pic tumor = top left
14
119
274
Beauty in histology. Bronchial cartilage. Movat pentachrome stain.
#Pulmpath #pathology #histology #movat #lung #pathart
27
89
265
I made these slides to explain ground-glass opacities and ground-glass lung nodules to my medical students and residents. Please feel free to use them to teach yours. 🙏🏾
#pathology #pulmpath #radpath #imaging @howardm19 @TLHM_MD @leticiakawano
15
89
253
1/
#Melanoma can look like anything: a #Tweetorial
Most melanomas are fairly easy to recognize but the outliers are pretty crazy.
Like this example with signet ring cells 👇🏾👇🏾
13
118
248
My new fav #COVID19 paper: letter in @TheLancet by CDC infectious disease pathologists debunking a prior report (also in Lancet) by Varga et al.
Rough ER misinterpreted as virus! More pathologists need to speak up against questionable findings.
thelancet.com/journals/lance…
17
102
247
What do pathologists mean when they say “clinical correlation recommended” in their reports? Here are a few translations into plain English
#tweetorial #pathtweetorial
1. @natasharekhtman and @ENTpathology Version:
Who says pathologists don’t have a sense of humor??
The below illustration — authored by Natasha Rekhtman, Justin Bishop and Diana Molavi — tells us what pathology reports say and what they mean. #curemeso
12
99
253
Mini #Tweetorial on sequestrations of the lung
1/
A pulmonary sequestration is a bit of lung “cut off” from the rest of the lung. MOST helpful for diagnosis is that the blood supply comes from a systemic artery (like the aorta), NOT a pulmonary artery
#PulmPath
21
152
260
1/
Following the lead of others, I’m putting all my Tweetorials in one place: 👇🏾
Follow this thread to find them all
#Tweetorial #pathtweetorial #MedEd #pathology #pulmpath
16
110
246
O brave and wise tweeples, this tumor was seen in a lobectomy specimen. There is a history of breast cancer (invasive lobular). The diffuse #ihcpath is TTF-1. The focal one is GATA-3. What is the site of origin? Should I fill out a lung cancer synoptic template?
53
114
247
Clinician remembers to correlate clinically after reading comment in pathology report
14
40
236
19,367
In 10/2017, Dr. Yale Rosen drove 500 miles from NYC to Cleveland to hand over his life's collection of 16,000 Kodachrome slides to me. It includes gross/micro pics from many organs, mostly lung (1956-2004). Thank you Dr. Rosen 🙏🏾
#yalerosenslidecollection #pathology #pulmpath
17
60
275
Society: science types are so nerdy
Doctors: if we weren’t nerds we wouldn’t be docs
Surgeons: we’re the jockiest of the nerds!
Pediatricians: we’re nerdy but caring
Radiologists: even the other nerds call us nerdy. Can anyone outnerd us?
Pathologists: hold my beer...
14
39
223
10 myths about small cell carcinoma of lung: 1. TTF-1 positivity in small cell carcinoma confirms lung primary (FALSE! 20% of small cell lung carcinomas are TTF-1 negative)2. Large cells exclude... kikoxp.com/posts/20731
16
86
265
36,833
S-100 in melanoma
Tip for residents: this is one of the immunostains that must show nuclear as well as cytoplasmic positivity to be considered positive.
Do you know the other one(s)?
#ihcpath #pathology
23
68
232
I do not use the PAS stain for anything, but I do appreciate the beauty of a positive PAS control.
#pathology #pulmpath
10
34
225
First in a series of free YouTube videos explaining basic lung histology. Pathologists and medical students will find this useful, and other medical professionals who see patients with lung disease might too. 👍🏾🙏🏾
#pathology #histology #lung
piped.video/Zm6lzuozJUc
16
112
232
Lung mass. What’s the diagnosis? What diagnostically helpful clues are seen here?
#pathology #pulmpath
24
75
228
I’m starting a thread on #COVID19 just to keep everything I learn about it in one place.
🌹 New information
🌹 well summarized information
🌹 Things that changed my mind
🌹 Things that I did not expect
##pathology #pulmpath #CoronavirusOutbreak #SARSCoV2
1. Thread 👇🏾👇🏾
15
122
227
Is it unfair to say every pathology resident should know what this is?
#pathology #gipath #pathbugs #crittersontwitter #pathtwitter #pathboards #knoworfail
38
38
223
36,614
Plasma cells 💧make amyloid 🛑
This is multiple myeloma
💧💧💧💧💧💧💧💧💧💧💧💧💧💧💧💧💧💧💧💧💧💧💧💧💧💧💧💧💧💧💧💧💧
This is amyloidosis
💧🛑🛑🛑🛑🛑🛑🛑🛑🛑🛑🛑🛑🛑🛑🛑🛑🛑🛑🛑💧🛑🛑🛑🛑🛑🛑🛑🛑🛑🛑🛑🛑🛑🛑🛑💧💧🛑🛑🛑🛑🛑🛑🛑🛑
@feldstej @BldCancerDoc @evemariecrane
8
47
226
You are trying to explain to a resident why you think a tumor might be neuroendocrine based on H&E. What do you say?
What is the essence of “neuroendocrine morphology” in simple language?
#pathology #pulmpath
31
53
221
First report of complete autopsies in the English language peer-reviewed literature was just published online in @AJCPjournal
Free. Open access. Please read the complete report and share widely.
#pathology #pulmpath
academic.oup.com/ajcp/advanc…
10
132
225
Please watch this 🔥 new #pulmpath video from @CLEClinicLabs
👉🏾 quick overview of ALL the lung tumors in the 2021 WHO book
👉🏾 high quality pics
👉🏾 great review/update for residents
👉🏾 FREE & open access on YouTube
piped.video/4DzXgspyFwc
#pathology #pulmpath #lungcancer
5
98
220
After how many years in existence does “next generation” sequencing become an absurd term?
34
16
214
1/
How about a #Tweetorial on immunotherapy in quiz and answer form? Let’s try it! I’ll post a quiz in one tweet and then the answer in the next, and so on. Scroll down to follow the thread!
#pathology #pulmpath #ihcpath #pdl1 #Immunotherapy #pathtweetorial
15
123
219
Azzopardi phenomenon in small cell carcinoma. DNA encrustation in small vessels #pulmpath #pathology #lungcancer @Missle @pembeoltulu
11
142
220
Inspired by all the pathologists' assistants I met at the @PathAssist annual conference, I'm starting a thread of educational #grosspath images
1. Thymoma (note white fibrous bands)
4
68
242
20,481
Disseminated cryptococcosis is another example where morphologic findings in lung predict disseminated (extrapulmonary) disease
Note yeasts within alveolar septal capillaries
#pathbugs #crittersontwitter #pathology #pulmpath
6
73
219
23,339
10 most influential #pathologists of all time? Off the top of my head:
1. Sidney Farber
2. Virchow
3. Rosai
4. Harald Stein
5. Osler
6. Whipple
7. Hodgkin
8. Elaine Jaffe
9. Rokitansky
10. Papanicolaou
Please share your own list! 🙏🏾
61
36
220
Hot tip: if you see this in a biopsy from an immunocompromised patient, pick up the phone and call the treating physician immediately. This will give you valuable info about clinical context and give the clinician a valuable heads up. Delays in such cases can spell disaster.
13
71
212
Here's my attempt at a 🆒 tweet thread a la @tony_breu
1/
What's the difference between these two lung tumors:
❇️large cell carcinoma
and
❇️large cell neuroendocrine carcinoma
Many pathologists think they are the same. Follow this thread to learn the difference
20
143
218
Replace “med students” with “doctors”
11
21
203
Not common to see asbestos bodies in lymph nodes, but here's an example
Asbestos body = ferruginous body with thin, clear core
#pulmpath
10
135
216