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.