Adjectives of the Pathology lexicon

?Foreword:

Pathology terminology has evolved over time since Virchow coined the term ‘leukemia’ after being impressed by the large buffy coats that he was diligent enough to observe in leukemic samples. Unique puns, words & figure of speeches line the avenues of the Pathology lexicon. These subtle nuances of rhetoric, wordplay & grammar find their way to our day to day reporting. The creativity & imagination of the observer result in such typical findings with striking terminology.

While clinical medicine is replete with triads, aphorisms & signs named after the doyens of medicine, pathology does not lag behind. In fact the ‘father of pathology’ features in many a medical eponym. (1)

Fig: Bizarre nuclei in a sarcoma (Image from Apollo Diagnostics, RRL,Chennai)

Histopathologist's use words such as ‘interspersed’ & ‘amidst’, while describing blood vessels present in between stromal cells. While adjectives such as ‘brisk’ & ‘bizarre’ find their way to describe mitoses' or the nuclei of certain sarcomas, terms such as ‘hyaline’ & ‘myxoid’ can be challenging to interpret, prompting the reader to fish about in a search engine. (2 &3).

Tongue twisters such as ‘ciliocytophthoria’ & ‘pulmonary placental transmogrification’ are very much part of pathology parlance. While the former can be prosaically described as loss of cilia & latter definitely deserves more elaboration. (4)

Metaphors of sophisticated prose are often used by sagacious teachers so that the corresponding morphology stays entrenched in mind of their budding wards. ‘Carrot shredded collagen’,’staghorn vessels’ & ‘raindrops falling from the sky’ are typical analogies. (5)

The recognition of patterns on low power is a key skill without which tumour’s can whisk away undetected in a wink. Spindle cell lesions in histopathology are akin the ‘Aladdin’s cave’ in pathology & harbor boundless treasure. A multitude of patterns are described, while storiform ?& fascicular are commonplace,’ herring bone’ & ‘tissue culture like pattern’ border on the exotic. (6)

Considering that the microscopic images are essentially a window to a world in which a chosen few revel .A gamut of awe evoking appearances such as ‘starry sky appearance to the poetic ’butterflies sitting on a fence appearance’ can be evoke memories of Shakespeare's sonnet 18 ?? (7)

There could be a separate write up on bodies alone as pathology is well stocked with the same. Many bodies are named after people who described them first, such as Mallory body. Some could be meekly abbreviated but yet be profoundly important in the context of reporting. (8)

Footnotes :

1.????Eponyms named after Rudolf Virchow : Virchow’s triad, Virchow – Robin space, Virchow node, Virchow cells, Virchow – Seckel syndrome, Virchow’s theory, Virchow’s technique of autopsy?& Virchow’s law

2.????The numbers of mitoses are commonly reported per high power field (HPF).The malignant cells of certain sarcomas such as undifferentiated pleomorphic sarcoma can have bizarre nuclei.

3.????Hyaline is terms used to describe acellular material which is eosinophilic & glassy. Myxoid is used to describe tissue rich in mucopolysaccharides which on routine H & E sections takes up a distinct pale blue hue which is best appreciated when seen than described.

4.????Ciliocytophthoria is a degeneration of the respiratory epithelium characterized by loss of cilia & decapitation of the apical part of the ciliary epithelium, following adenovirus infection. Placental transmogrification or placentoid bullous lesion of the lung is an unusual condition in which the alveoli develop a peculiar villous configuration that resembles placental villi at low microscopic magnification.

5.????Carrot shredded collagen is used to describe the stroma of neurofibromas. The stromal vessels in hemangiopercytoma resemble the antlers of a deer.The vertically oriented melanocytes of a Spitz nevus bear semblance to raindrops falling from the sky!

6.????Many spindle cell tumours can have a storiform pattern, but it is typically seen in solitary fibrous tumour. Tissue culture like pattern is described in nodular fasciitis.

7.???Sonnet 18 – William Shakespeare

Shall I compare thee to a summer’s day?

Thou art more lovely and more temperate:

?Starry sky appearance is described in Burkitt’s lymphoma.

Butterflies sitting on a fence can be seen in bronchoalveolar carcinoma!

8.????Mallory bodies(MB's) are named after Frank Burr Mallory. They are seen in many other conditions in which MB's are seen apart from the commonly described alcoholic liver disease. EGB is the a common abbreviation used for ‘eosinophilic granular bodies’.