WednesdayIL: An inflamed breast is obviously never someone's idea of a fun time, but in rare cases, it's far worse. The inflammation is usually caused by a bacterial infection, especially during periods where the woman is breast feeding. Unfortunately, the same appearance of inflammation can also be caused by inflammatory breast cancer. This variant of malignant breast cancer is caused by the tumor blocking off the lymphatic drainage from the breast and has a very poor prognosis. If the inflammation progresses far enough, it can cause a peau d'orange or "orange peel" appearance where the breast turns reddish-orange and develops dimples as the swelling tissue pushes out past the hair follicles. I'll let you google that picture on your own.
Thursday: Today was our last gross specimen lab of the year, and we were looking at gynecological pathology. Most of the samples were ovarian and uterine tumors, fairly repetitive over-all. One specimen, however, managed to wake up even the most tuned-out of my classmates. An invasive placenta had grown into the uterine wall, requiring a total hysterectomy - removing the uterus, ovaries, and a 14-week fetus.
Now, we've passed around kidneys the size of a watermelons, lungs as black as coal, and brains of infants, but I've never seen everyone snap to attention as quickly as when we noticed that fetus lying on its side in a pool of preservative in the specimen bin. For me, it re-humanized an already desensitized procedure of looking at bits of dead people. We take for granted that these people lost their organs, and usually their lives, after some valiant but futile effort by our medical colleagues. That's enough to put our minds at ease. But this case provided too much information for us to remain detached. This woman probably went in for a pregnancy check-up and found out that not only would she lose the baby, but with the removal of her reproductive organs, she'd lose the ability to ever try again. Not quite as fun as poking squishy things normally is.
ThursdayIL: A chloasma or melasma is a facial pigmentation change that is associated with pregnancy, hormonal birth control and hormone replacement therapy.
You can develop primary brain cancer (or any cancer, really) from a teratoma. A teratoma, literally "monster-tumor," is a germ cell mass that can grow into any kind of tissue thanks to the undifferentiated nature of its precursor cell type. These tumors are well known for containing fat, hair, lung, bone and teeth, all mushed together at some mid-line place in the body (for embryologic reasons). Teratomas are almost always benign, but any of the tissues within the tumor can, on rare occasions, become cancerous themselves. So, if you're really, really, really unlucky, you can get brain cancer in your teratoma in your uterus. (This story was confirmed by a pathology resident to have actually happened at our hospital in recent years)
TIL: Dermatology lightning round!
Macule: flat, non-palpable lesion less than 1 cm
Patch: same as macule, but >1cm (e.g. café au lait spots)
Papule: raised lesion less than 1cm (e.g. pimples)
Plaque: superficial raised lesion >1cm (e.g. psoriasis)
Nodule: deep/solid raised lesion >1cm
Vesicle: fluid filled less than 1cm (e.g. poison oak/ivy)
Bulla: same as vesicle, but >1cm
Pustule: pus filled lesion of any size
Wheal: firm raised edematous (swollen/red) lesion (e.g. hives)
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