Showing one of my cases encountered

in STEMGeekslast year

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HPO3.jpg

Tumor cells arranged in predominantly solid sheets. The cells are characterized by their round, pleomorphic nuclei with inconspicuous to prominent nucleoli with moderate to ample cytoplasm. Few mitosis are observed.


This was a case of Endometrial Cancer, Endometrioid Type, 3cm Widest Tumor Dimension, with more than 50% myometrial wall invasion. FIGO Grade 3.



I mentioned the steps it takes before signing out a diagnosis on my previous post. There are more sentences attached to the signed out case but those details serve little purpose here. It's just show and tell without going deeper and just dumbing down several details here. I'm a few days in the beginning of the hell week cycle again but this time it's more manageable than the first time.

Not going to bore you with medical jargon. I know less of the terms mentioned would ever stick to memory. Sharing with you how my case ended up being picked for presentation for the OB-Gyne Department. They got this regular monthly set of presentations for interesting cases in collaboration with the Pathology Department.

So we just lend a hand with our colleagues in making the presentation because we get asked if they can't answer for us. Not a pleasant experience by the way. We do inter-department rehearsals prior presentations.

Front.jpg

The specimen (Uterus and attached organs) with an endometrial mass that has a fungating appearance. Came from an old female on their menopausal years.


Scanner View.jpg

I took a sample of the mass and this is what the slides prepared had to show me (40x magnification). The upper left side shows some tubular glands but the mass is composed predominantly of solid sheets (occupying most of the picture) which makes the prognosis worse. The normal histology of the endometrium


Low Power View.jpg

This is at 100x magnification focusing on the solid sheets


HPO3.jpg

At 400x magnification.


Scanner 3.jpg

This is at 40x magnification. You can see the tumor's solid sheets penetrating the myometrial wall. If it exceeds more than 50% of the wall, we class is as FIGO Grade 3. (Grade 1: <6% invasion, Grade 2: >6-<50% invasion). The serosal layer is not visible on this slide as it's difficult to accommodate it on the field due to it's size.


The tumor invades the myometrium until it expands to other areas locally until it metastasizes. The grading system is used to prognosticate and guide clinical decisions in tackling the problem of how to treat these patients after removal.

The highest (Grade 3) may mean some extensive chemotherapy and radiotherapy depending on the patient's condition. The Endometrioid type of cancer (Type I) is 80% to 85% more common compared to Serous Type which has a worse prognosis. It derives it's name endometrioid because of the semblance it has with the normal endometrial lining while the Serous type tends to be bizarre (poorly differentiated).


References:
Robbins and Cotran Pathologic Basis of Disease10th Ed
Rosai and Ackerman's Surgical Pathology 11th Ed.


If you made it this far reading, thank you for your time. This is a creative footer by @adamada.

Posted with STEMGeeks

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 last year 

Haha, I don't think I've ever gone more than 100x magnification for my job before.

That's a surprise. I thought you do go beyond those levels. I know work comes varied for your field when aside to different areas. Are you in the Bacteriology and Chem lab Dept? or do you also rotate to Molecular Lab? (Still a scrub at all those areas as it's beyond my pre-med field compared to my peers.

I go x1000 on peripheral blood smears most of the time. Those blast cells can be a bitch to spot on High Power and to use high power most of the time is a mark of being lazy (I do it when I got like a lot of slides to run through).

I forgot to take a shot at x1000 magnification of the specimen but it's not like I'll run out of it or anyone would be asking post presentation for more views. It's an interesting case but not rare.

 last year 

By 100X I meant the lens, not total magnification. I erroneously thought you meant you had access to 1000X lens.

Or maybe I'm the one confused. lol

I thought it was total magnification. And now I'm confused as well.

We use this model for show and tell, endorsement and review.

 last year 

Yes, I've seen pathologists use that when giving education moments to the lab scientists.

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