Crude Approach on A Bunch of Weirdo Cells

Cells. (Human cells at least, XD.) Whatever their form has become, they all started from a single cell --  a single cell which came from the fusion of spermie and eggie.

So if you are faced with a slide with a bunch of weirdo cells that you cannot identify, think of their origin.

Zygote matures and, later, forms ectoderm, mesoderm and endoderm.

We can narrow down the possible origin of the weirdo cells by trying to classify them based on germ cells layers or maybe a germ cell .

Ectoderm gives rise to skin, neural tissues and melanocytes.
Mesoderm gives rise to mesenchymal and hematologic cells. 
Endoderm gives rise to epithelial lining (GI and respiratory).

Randoms: Walthard Cell Nest and Forceys Granules

Walthard cell rest/nests, is a small cyst usually found in the serosa of fallopian tube. Grossly, they present as cream nodules measuring around 1-2 mm. Microscopically, the epithelial lining of the cyst has a "coffee-bean" nucleus.

Image from Wikipedia.

Image from Wikipedia.

Significance: Walthard Cell Nest is associated with Brenner Tumor.


Fordyce granules are sebaceous glands found in the area of the body where they are not expected to be there (e.g. oral cavity, lip vermillion, etc). Ectopic sebaceous gland is good description for it.

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Of slides: When you look at a picture, don't look for something that you want to see. Look at what the picture wants you to see. :) Else, you will miss a lot of things and just be limited on what you expect of the world. 

How to Approach a Slide

Treat your slide like your patient. You do physical examination on it. You have to do it in an organized manner.

1. Know the patient profile: age, sex, diagnosis, pertinent history. Most clinicians treat a pathologist like a lab test like CBC or electrolytes. They do biopsy and they send it to the lab for "testing". But actually they are referring to you because they want your expertise on the "physical examination" of a previous body part from a patient. Why are they referring to you? Based on the information shared by the clinician, think of your differentials.

2. Gross specimen. Examine. Is the specimen in fragments? Mass? What is the color? How's the surface? The consistency? Check the cut surface. Capsule? Measure it! Or.. is it too thin? Describe :D. Is the cut surface solid? cystic? gelatinous? hemorrhagic? Narrow down your differentials once you see the specimen.

Once you have the slide..
3. Naked eye slide exam: 1x or no magnification. Examine the specimen just by looking at the slide.

4. ARCHITECTURE. Scan the slide. Think of it like you're looking from the bird's eyeview. What's happening in this slide?

• Contained? Encapsulated?
• War? Inflammation?
• Recent
1. Early immune soldiers = Neutrophils
2. Immune soldiers run to the battle site = Vascular congestion
3. Extravasation of the fluids brought by the soldiers’ transport to the site = Edema
4. Blood vessel pathway is destroyed allowing fibrinogen to pass through  = Fibrinous exudates
5. Tissue damage
• Long-time
1. Long term immune soliders = Lymphocytes, macrophages, plasma cells, eosinophils
2. Developed more pathways over time = Increased vascularity
3. Already had time to fix destruted areas = Fibrosis (attempts to heal)
4. Prolonged damage = Tissue destruction
• Insanity? Invasion? Disorganized?
• Needy of supply? Vascular?
• Etc etc.

5. CYTOLOGY. Once you appreciate the architecture, check for the abnormal parts. Zoom in and see. What are the types of cells involved? What is the background? (Myxoid: pinkish with some cells floating on its sea. Mucoid: pinkish with some glandular structures floating.) Never scan the slide using low-power or high-power or you might miss a lot of things.

• Who! Who are the characters? Cell differentials depending on the shape, how they are grouped and their background.

a.   Polygonal? Round?

b.   Spindle-shape?

The Spindle Cells. Use their shape to get a clue of what these cells could probably be.

c.   Squamoid?

d.   Glands?

e.  Myxoid background?

• .    What do they want?! What’s happening in the minds of these characters? Jump to high power.

a. Nucleus

                                          i.      Reactive changes = prominent nucleolus

                                          ii.      Hyperchromatic = busy mind/nucleus

                                          iii.      Enlarged nucleus

b. Cytoplasm: clear? pink? blue? foamy?

         Hydropic degeneration = Reversible 

                 - RNA gives the blue tint and with cellular damage, the ribosomes are reduced

                                               - loss of staining due to swelling of membraned organelles

                                               - swelling of mitochondria and ER adds more pallor

                                               - more swelling: waterlogged cell  à vacuolation

                      

c.      Nucleus-cytoplasm ratio = High in basal skin layer, lower if more mature (except in atrophic prostate)

d.       Mitosis – cell giving birth to another cell

e.      Vacuole? Grainy? 

f.      Etc etc. 

Read read Molavi (Practice of Surgical Pathology). :D. Practice!

(Based on MCA's advice).


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Randoms:
For hemorrhoids, don't only check the rectal and the anal mucosa. Check for the viral cytopathic effect -- check for koilocytes. :D.

LTO Student License

Pumunta ako ng LTO sa East Avenue para sa aking student licenseWirdo lang na tapos na 'ko magdriving school bago ko pa nakuha ang ID ko, haha.

Sa pagkuha ng Student License, kailangang magdala ng NSO Birth Certificate at photocopy nito. Magtanong na lang sa guwardiya kung saan banda pupunta. Napakaraming guwardiya sa LTO. :D. (Kaso ang bilis nila magsalita, nakatatlong tanong pa ako bago ako nakarating sa building para student license kasi nahiya akong ipaulit yung sinabi nung ibang mga guard..)

Pag nando'n na sa building na 'yon. Sabihin ninyo sa information/guard na for Student License kayo para ituro niya kung saan ang pila. Sa Step 1, ipepresent ang NSO birth certificate at photocopy, tapos bibigyan kayo ng form na sasagutan ang ng number kung pang-ilan sa pila. Tingnan niyo kung pang-ilan kayo, nakadisplay siya sa harap ng window para sa student license. Kung may 100 pa ang layo, may isang oras ka pa para magliwaliw. Kaya wag bulukin ang sarili sa loob ng LTO. Haha. Sa kaso ko, 10 AM ako dumating, mga 11:45 pa ako natawag. Mga 105 ang layo ko sa pila. Namasyal muna ako at gumawa ng iba pang mga bagay, at pagbalik ko, malapit na ako sa pila. :D

Ibibigay ang form at NSO (+ copy) sa window. Susunod ay kukunan na ng litrato at pipirma na para sa ID. Mula sa parte na ito, mahirap na umalis, dahil tatawagin na mismo ang pangalan niyo. Kailangang nandoon lang kayo at naghihintay. Pagkatapos ng picture, bayad naman. Hantayan uli at kailangang tawagin muna ang pangalan. Pagkatapos ng bayaran, maghintay uli para sa releasing ng ID. Inabot ako ng kulang-kulang tatlong oras sa parte na ito. Kaya dapat medyo handa sa mapagkakalibangan. 3G, games, libro, o kung anumang ibang p'wedeng gawin. Sa kaso ko, nanood ako ng tao, naglaro ng kaunti sa selpown at nagdrowing nang nagdrowing.

Bila kong napasalamatang mahilig akong magdrowing dahil mula pala pagkabata e lagi na 'kong sinasalba ng drowing sa posibleng pagkabagot. :D

Hapi kuha ng student license! :D

Parada sa isipang walang magawa

Ugh

Sana hanggang n years mula ngayon!

Littman Classic II S.E. Rainbow

Yay! My cousin gave me a gift for passing the board exam. :D A new stethoscope! I'm not an clinician but of course I will use it! :D Very exciting to receive gifts via package! Haha.

Rainbow! Hihi.

Rainbow on the inside. XD

It is a Littman Classic II with Rainbow Finish Chestpiece. I think it's artistic and it fits my eclectic personality. Haha. :D. It also has a green tube which makes it more unique (compared to black).

I have a Cardio III stethoscope which was also given to me as a gift. I have used it to thousands of patients and it has maximized its use after monitoring sooo many patients in the ward. It's cool because its bell can be converted to a pediatric steth. Of course, it's also very sensitive when listening to murmurs. What's also good about it is that it's heavy. So when people borrow it, they tend to return it immediately. xD. However, since it's heavy... it's .. heavy.

What I like about the Classic steths is that they are lightweight :D. As a pathology resident, I will just use my stethoscope to screen patients in the Blood Bank. I might do some medical missions too. Hopefully, I can keep my new stethoscope new, lol. :D

DIY: Key Holder

Because most of the people here at home always forget where they put their car keys, I decided to make a key holder.

Materials:
Scrap wood (free: found it outside)
Pencil and eraser (free: found it in my drawer)
Ruler (free: found it in my toolbox)
Markers (free: found them in my cabinet)

Uh, question mark thing. I don't know what it's called. I bought it in Handyman for ~40 pesos.

I started by measuring the wood and dividing it to equal areas depending on how I want it. I then drew my design.

Montero = Monty!
Pajero = Pajie!
Captiva = Capty!
Tucson = Tucsy!
JAC = JAC
... = Tamiya!

I aligned and put the hooks to see if the car drawings will be affected.

I used ordinary markers to outline the sketch I made.

I used colored markers to color the letters. I wanted to color the cars too but I don't have the available colors to do it. I put the hooks after. :)

Simple and funny, haha. Doesn't look good but it does its purpose, haha. My mistake is I wasn't able to put enough space for the keys.

Make sure that your key holder is located in a secure place. You don't want robbers to enter your house and get all your car keys.

Pathology

Okey, excited na ako. Natanggap ako sa patho. Gusto kong simulan nang tama ang buhay ko, haha. Pero syempre, di ibig sabihin ay di ko na gagawin ang mga gusto ko. Sobrang saya ko nang dumating ang padala ni T na Arduino. Ang saya-saya. Kung interesado ka sa electronics at programming at wala ka pang karanasan, mahusay na start ang Arduino Uno. :D. Tapos s'yempre gusto ko pa ring tapusin ang computer science na course sa edX at matutunan ang Python. :)

Excited na rin ako gumawa ng research sa pathology. Gusto ko paglaruan ang computational pathology. Tingin ko napaka-interesante. Gusto ko ring ipasok ang electronics sa research. Hindi ko alam kung alin ang feasible pero nakakatuwa na may mga possibilities.

Pero s'yempre, nakakatakot kung gaano katarik ang learning curve na kailangan para maging pathologist. Pero interesting talaga. :D. Sana naman!

Owel papel. :)