A week in the life....Friday

Friday started with more reporting including a biopsy of a liver metastasis (the lesion on the right of this picture)

that needed some immunohistochemistry to determine the most likely site of the primary tumour, numerous gastrointestinal and bladder biopsies and a placenta. There was a tray full of urine cytology specimens with several slides from each patient and Cecil wished the urologists would read the RCPath document Histopathology of limited or no clinical value. There was a skin specimen marked urgent which was a possible melanoma. Cecil found it difficult to decide and went to show it to some of the other consultants, they all decided it probably was a melanoma.

The post arrived with a reply to the referral Cecil had sent to the tertiary centre for bone tumours. He had asked for an opinion on a soft tissue biopsy from the thigh. Everybody in the department had seen it and there were various theories as to what it was. They had thought of osteosarcoma, Ewing’s sarcoma, lymphoma and metastatic small cell carcinoma. The slides and blocks had come back with a letter confirming the diagnosis as a rare small cell osteosarcoma. Cecil dictated a supplementary report to go with the preliminary one they had issued saying there was a malignant tumour which had been referred for a second opinion; and rang the patient’s surgeon.

At lunchtime it was time for the registrars’ slide seminar. Cecil had given them a set of slides last week and wondered if they had correctly diagnosed the Spitz naevus – a benign lesion easily confused with a malignant melanoma.

After that Cecil had a quick look through the latest issue of Histopathology and signed some more reports before the slides from yesterday’s cut up started arriving. The stomach had a poorly differentiated adenocarcinoma (the groups of large cells in this picture)

with a few malignant cells invading through the wall to the serosa. Before he went home he dug out the autopsy report for a patient who had died due to acute alcohol poisoning after a night out and was having an inquest next week. The last thing he wanted was a last minute panic on his way to the coroner’s court.

Pathology pictures from the Pathology Education Instructional Resource.