A week in the life...Wednesday

The breast MDT started at 8am and most of the pathology was straightforward ductal carcinoma this week. There was one pleural fluid specimen which contained metastatic carcinoma in a patient with a previous mastectomy for a grade 3 carcinoma, who has now developed a pleural effusion. After the MDT there were some cervical smears to look at. Luckily the cytoscreeners report the majority of them and only pass them to the pathologists if they aren’t sure about something. The department will be changing over to liquid-based cytology soon which promises far fewer ‘inadequate’ smears but means learning what normal and abnormal smears look like all over again due to the differences in the way the cells look using the new technique.

Over lunch in the office Cecil checked and signed some histology reports, and added SNOMED codes to them. After lunch he made sure the registrars weren’t too swamped with work and offered to report the unexciting looking tray of basal cell carcinomas so that they could concentrate on a laryngectomy case instead.

Cecil picked up the slides that had arrived for him. He put the cases marked ‘urgent’ at the top of the pile. The first was a bronchial biopsy from a patient with suspected lung cancer. It was only a small piece of tissue but there were some odd looking cells in the submucosal tissue at the edge of the specimen. Cecil asked the lab staff to cut some more slices from the tissue block to see if there were more of those cells in the specimen. The next two bronchial biopsies looked inflamed but there was no cancer visible. The next specimen was a lymph node with nodular sclerosing Hodgkin’s lymphoma. A Reed-Sternberg cell (large purplish cell with two nuclei), characteristeric of Hodgkin's can be seen in the middle of this picture.

Cecil dictated a report, requested some immunohistochemistry to confirm the diagnosis, and put the slides aside to show the registrars later.
When he had finished the afternoon’s reporting, he went into to the cut up room to open any large specimens that had arrived during the day so they would fix overnight. There was a gastrectomy which Cecil opened along the greater curvature, and a kidney containing a large tumour which he cut into two pieces, leaving them connected at the hilum. The kidney tumour looked like a typical renal cell carcinoma – it was yellow and lobulated with areas of haemorrhage.

The specimens would fix much better now the formalin could get inside.

Pathology pictures are from the Pathology Education Instructional Resource.