Brian McMillen MD
@Teclis82
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Staff Pathologist, Rhode Island Hospital and Newport Hospital. Assistant professor, @Brownmedicine . Views are my own; cases are from study sets.
Providence, RI
Joined September 2019
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Pinned Tweet
#GIpath
#Foodpath
Let’s chop up some cauliflower, and maybe learn something about colon polyps in the process.
@TxicMegacolon
@CArnold_GI
@ALBoothMD
@TheKarenPinto
@JMGardnerMD
@Dr_Brian_Cox
@DrGeeONE
@AyeshaFarooqMD
@Voltaggiol
@LizMontgomeryMD
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#Breastpath
Breast pathology 101: Let’s take a look some intraductal proliferative lesions, and decide what to call them.
Random section from a prophylactic mastectomy, 45 y/o female:
@LuisBlancoJrMD
@RoncinMD
@LizaMQuintana
@ADamronMD
@TheKarenPinto
@DrGeeONE
@jennpincus
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#Breastpath
1. Some basics of breast anatomy/histology, with broccoli, for those starting out.
Thanks to Mrs.
@Teclis82
for donating part of dinner (reluctantly) for science.
@ariella8
@ADamronMD
@TheKarenPinto
@LizaMQuintana
@RoncinMD
@dr_MPrieto
@TxicMegacolon
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#Breastpath
#Surgpath
70 Year old female with an enlarging breast mass; excised.
Some pictures and discussion.
Low power:
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#GIpath
Injury Patterns 101
Interesting slide which shows an area of ischemic colitis next to an area of normal colon mucosa.
I thought this was a nice opportunity to show the features of ischemic colitis.
Added some annotations, which may be helpful to those starting out.
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#GIpath
#LPpath
#Pathresidents
Anyone want to speculate on the organ, and possible diagnoses?
Give it a guess, the scroll down for microscopic correlation & discussion in the replies.
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#Breastpath
#surgpath
#pathresidents
Excisional biopsy for calcifications in a 55 year old woman.
A few pictures, a poll, and some annotated discussion slides.
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#GIpath
#Liverpath
#pathresidents
50 year old man; liver wedge resection. History of indeterminate pancreas lesion by imaging (chronic pancreatitis vs mass).
A few images, a poll, and a
#tweetorial
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Short
#breastpath
#tweetorial
on how mucinous, neuroendocrine, and solid papillary breast tumors are interrelated.
Some definitions, and a conceptual Venn diagram. Explanations and examples of the different categories in the replies.
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A short
#GIpath
#tweetorial
A concerning finding on a colon resection...
@ariella8
@nucleololailo
@DrGeeONE
@kis_lorand
@MAHoureih
@D4L14H
@DraEosina
@SingJamieD
@Pathmath1
@ALBoothMD
@jansen_marnix
@steland011
@Mvgs1706
@RunjanChetty
@drtimbracey
@AllonKahn
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#GIpath
#Pathbracket
68 year old male, right hemicolectomy for an endoscopically unresectable polyp.
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Fun & clinically useful kids activity: calculating Ki67 percentages on WDNETs.
(Disclaimer: they actually quit after like 30 seconds and said my job’s really boring).
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#ENTpath
#Pathresidents
#Surgpath
#Pathtwitter
52 Year old man, hx of tobacco use and leukoplakia, presents with a tongue lesion. How far do you want to go? Poll in reply.
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#Breastpath
101, part 2
“DCIS versus LCIS: What’s in a name, anyway?”
@israhkhan
@ADamronMD
@Chucktowndoc
@samyra_md
@CollinsLauraC
@TeamCaptainJohn
@sarah_glogowski
@jennpincus
@LizaMQuintana
@GuzmanArocho
@JMGardnerMD
@smlungpathguy
@TheKarenPinto
@ariella8
@IHC_guy
@RoncinMD
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#GUPath
#Surgpath
#Pathresidents
70 Year old man; TURP for BPH:
A few images, a poll, and a short annotated discussion.
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#GIpath
#Surgpath
#Pathresidents
68 Year old man, duodenal biopsy to rule out celiac. What do ya think? Some discussion in reply.
(Colleague’s case - and he nailed this diagnosis!)
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#GIPath
#Surgpath
#Pathresidents
This is a slide from a resection of a sigmoid colon tumor. Poll in reply, followed by short discussion.
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#GIPath
#Surgpath
#Pathresidents
#Pathtwitter
65 Year old female, gastric antral biopsy, rule out H. pylori.
Some pictures, a poll, and a short discussion.
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#Breastpath
#surgpath
Before signing out a breast core as “no calcifications identified”, remember to look for calcium oxalate crystals.
@RoncinMD
@kis_lorand
@ADamronMD
@LizaMQuintana
@israhkhan
@dr_MPrieto
@EmoryPathology
@padmapathology1
@Dr_Brian_Cox
@slusagar
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#Breastpath
#Surgpath
#Pathresidents
32 Year old female, breast mass, core needle biopsy.
Boards-style question in reply.
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#GUpath
#Surgpath
#Pathresidents
Representative sections from a prostatectomy specimen in a 70 year old man:
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@TheKarenPinto
@Pathoutlines
@DrGeeONE
@nusrat_xahra
@SwikrityUMD
@ariella8
@smlungpathguy
@Gagandeepk5MD
@NigarAKhurram
@VijayPatho
@luishcruzc
We should do these for every immuno; I’ll start with vimentin.
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Next up in the
#CAPvirtualpath
series is…..me?!
Excited to show some slides from a few great cases I’ve come across. I’ll emphasize common pitfalls and how to avoid them.
Tuesday 6/23 at 11pm ET.
Link to register:
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#GUpath
#BSTpath
#Pathresidents
#Surgpath
Two cases, polls, and some discussion slides. Enjoy!
Case 1: A 30 year old female presents with hematuria and a 3cm bladder mass:
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#GUpath
So many great tutorials lately, I’ll contribute this review on some prostate cancer basics.
Prostate cancer 101
Random section from a prostatectomy for cancer.
@slusagar
@TheKarenPinto
@Williamson_SR
@ariella8
@MELanocyteMD
@TedFarMD
@mhassanaimc
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#Pathresidents
: Anyone wanna show off their
#GIpath
skills by diagnosing this colon tumor just by looking at the slide?
(Will post the H&E tomorrow. Take a guess. If you’re right, you’ll impress everyone on Twitter. If you aren’t, you can just delete the post 👍🏻)
1/2
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#GIpath
Submucosal gastric mass, ~2cm, in a 68 year old female.
#Pathresidents
: How would you approach the case?
@CArnold_GI
@ALBoothMD
@IHC_guy
@MariaWesterhoff
@TristanRutland7
@ariella8
@padmapathology1
@Mvgs1706
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#GIpath
Thread dedicated to PGY1s starting to gross colons. Review of colon gross anatomy and some commonly encountered entities, using a balloon (usually used for balloon animals; kindly donated to science by my daughters)
@IHC_guy
@CArnold_GI
@TxicMegacolon
@Mvgs1706
1/4
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Boards-style
#Liverpath
, case 1 of 2
45 Year old female presenting with pruritis.
Some pictures with a poll in the reply.
@liverpath
@MariaWesterhoff
@luishcruzc
@Caldera60373705
@kkuanMD
@DrEze_pathology
@KristenStashek
@natzpat
@emma_furth
@johnhart20
@pezhouh
@Dr_Brian_Cox
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1.
#Breastpath
, with an
#ENTpath
flavor
A case I had which pairs well with this sweet diagram by
@TheKarenPinto
(linked below)
40 year old woman, invasive ductal carcinoma on one side, undergoing bil. mastectomy. Pictures shown are a random section from the prophylactic side
All you need to know about adenoid cystic carcinoma (
#ACC
) of the breast
Looks the same as the one in the salivary gland but when in the breast, it has an excellent prognosis
#pathology
#BreastPath
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#Breastpath
#surgpath
48 Year old female with architectural distortion on mammography; biopsied.
#Pathresidents
: Diagnosis?
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1.
#Breastpath
Hey all, myofibroblastomas are really sweet. Let’s learn about them.
@ADamronMD
@TheKarenPinto
@KRoSlideReview
@Chucktowndoc
@jennpincus
@LizaMQuintana
@drkennethtang
@dr_MPrieto
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#Pulmpath
#Pathresidents
#Surgpath
#Grosspath
60 year old smoker with a 2cm lung mass of indeterminate nature - wedged out & sent for frozen.
#Pathresidents
: Diagnosis?
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#GUpath
#Surgpath
Two prostate cores, A and B. A in this post, B in the reply. Take a look at both, take a vote in the poll.
@AkgulMd
@drmehrarohit
@GladellPaner
@h_alahmadie
@rajalbshah
@Kiril_T_Can
@barkanga
@LaraHarikMD
@slusagar
@Williamson_SR
@TheKarenPinto
@priyaraomd
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When you are too busy to count Ki67 indexes on neuroendocrine tumors, so you cleverly disguise it as a wholesome childrens activity:
(FYI: She got 21%. I got 18%. Automated count after the case went for consult = 20.8% 😖).
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#GIpath
#Grosspath
#Pathresidents
This is a section from a portion of colon. It was resected from a 38 year old man. A CT scan had noted the presence of a “possible mass lesion”.
See below for boards-style question & discussion.
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#GIpath
#Appendixpath
Appendiceal resection in a 42 year old man for clinical mucocele.
Poll in reply.
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78 year old man, gastric erythema, antral bx r/o HP.
#pathresidents
: Dysplasia? If so, grade? If not, your diagnosis? (1/2)
#gipath
#surgpath
#pathology
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#Grosspath
#GIpath
#Liverpath
40 Year old woman; laparoscopic cholecystectomy for gallstones:
#Pathresidents
: Diagnosis? Clinical significance?
Thank you to our stellar PA Jun Hee Kang for making this gross diagnosis & taking the gross pictures.
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#Tooclosetodiagnose
…or is it?
A person presented with an abnormality in one of his/her bodily organs, which was biopsied.
#Pathresidents
: Diagnosis?
(I’ll follow up with a short discussion)
#surgpath
#Pathresidents
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#GIpath
45 y/o female, dysphasia, mid-esophageal biopsy
#Pathresidents
: How would describe the injury pattern? What disease associations would you consider?
@Mvgs1706
@ggchen_MD
@Dr_Brian_Cox
@RunjanChetty
@MariaWesterhoff
@ariella8
@TristanRutland7
@Vik_deshpandeMD
1/2
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#Gynpath
#surgpath
50 Year old female, ovarian mass.
Boards-style question in reply.
@PoloniaAntonio
@SwikrityUMD
@AnneMillsMD
@Mvgs1706
@RZitwer
@slusagar
@kis_lorand
@CPHpath
@Dramanyhassany1
@vi_monappa
@LaurieGeeMD
@md_kyle
@VandaTorousMD
@JojoPathAdvntrs
@AmlashiF
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Case I nearly eff’ed up,
#2
: 48 year old man, gastric ulcer, r/o H Pylori:
#GIpath
#pathology
@ALBoothMD
@RaulSGonzalezMD
@JMGardnerMD
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#Breastpath
case
#2
Biopsy of a breast mass in a 52 year old female.
#pathresidents
: Ddx? Workup?
1/2
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#ENTpath
#Oralpath
Surgpath
#Pathresidents
This is a lesion from the palate of a 60 year old man:
Poll in reply.
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#GIPath
#Surgpath
#pathresidents
50-ish year old man found to have an incidental enlarged appendix - question neoplasm.
What do you guys think?
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#GIpath
1/3
Sleeve gastrectomy (because sometimes we have to work for those 88307s). Patient is a female, ~40’s.
This case was shown to me as a possible H pylori control, only problem was no organisms were seen on HP IHC stain.
Pics and a poll; comments & tutorial to follow.
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@pathgoing
Excerpt from a recent interview with God-tier surgical pathologist Christopher Fletcher that may make you feel better:
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Before we sign it out as “invasive signet ring carcinoma”, let’s take a look at lower power:
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#Breastpath
#Breastradpath
74 Year old female, breast.
Ultrasound: “smoothly marginated, lobulated nodule measuring 2.1 x 1.8 x 1.2 cm”.
Mammo, U/S, gross pictured.
#Pathresidents
/anyone: Ddx?
Histology & discussion to follow.
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60 y/o man, 10 yr screening colonoscopy.
Cecal polyp.
#pathresidents
: Ddx? If cancer, grade & stage? If not cancer, what’s your interpretation?
#GIpath
#surgpath
@CArnold_GI
@ALBoothMD
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#Gynpath
#surgpath
67 Year old female, polyploid endometrial mass.
#pathresidents
: Ddx? Workup?
@slusagar
@KrutiManiar
@codyscarter
@padmapathology1
@DrSMBean
@pathnoob
@CPHpath
@vi_monappa
@TheKarenPinto
1/2
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#GUpath
Testis case
#2
61 Year old man, testicular mass, radical orchiectomy.
#Pathresidents
: Ddx? Workup?
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#GIpath
#Surgpath
#pathresidents
#pathtwitter
A section from an appendix in a 48 year old man.
#Pathresidents
: Want to speculate on the clinical history?
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#GIPath
#GItwitter
#Surgpath
#Pathresidents
A 45 year old man was found to have a 1.5cm sessile cecal polyp on screening colonoscopy. Pics, a couple polls, and a short discussion.
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An unusual
#GIPath
finding from a GEJ biopsy - ciliated cell heterotopia (/metaplasia?). Per
@LizMontgomeryMD
/
@Voltaggiol
’s ‘Biopsy interpretation of the GI mucosa’ - likely incidental. Good enough for me!
Anyone else seen this before? Any other thoughts?
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#GUpath
#Surgpath
#pathresidents
Anyone up for a Gleason grading lightning round?
Five cases, each with a few pictures & a poll. Take a vote; comments encouraged. Will follow up w/ my thoughts.
Case 1:
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#GUpath
case 3, first set of images
#Surgpath
#Pathresidents
70 Year old man; prostate biopsies; mildly elevated PSA.
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#GUpath
#Pathresidents
70 Year old man, TURP for clinical BPH.
Two pages of pics, and a poll.
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#GIPath
#Surgpath
#Pathresidents
50 Year old man; appendix with abnormal thickening by imaging (? neoplasm).
Appendectomy:
1/2
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Unfortunately Haggitt levels aren’t too practical in everyday use, since polyps rarely come well oriented.
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#LPPath
#Surgpath
A slide from a resection of a tumor in an adult patient.
#Pathresidents
: Diagnosis?
Microscopy to follow.
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Remember that the ischemic injury pattern may be seen in other situations (such as infection and medication injury).
A good pathology report will describe the injury pattern, and give a prioritized differential diagnosis (tailored to the patient’s clinical scenario).
Thanks!
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#GUpath
#Surgpath
#Pathology
#Pathresidents
Case
#2
Radical nephroureterectomy, 60 year old man. History of a renal pelvis mass.
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Bonus
#Breastpath
case, with a boards-style poll question.
Great to see
#pathtwitter
is so pash-ionate about
#breastpath
.
30 year old female, biopsy of a breast mass.
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#Gynpath
#surgpath
#pathresidents
A 37 female was found to have a cervical polyp during IUD removal. The polyp was excised:
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#Gynpath
#surgpath
#pathresidents
An 8cm ovarian mass was removed from a 40 year old woman. Poll in reply.
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#Breastpath
bonus case
#2
(a couple pics and a poll).
@Histopatolomon
@KathiarRosado
@GuzmanArocho
@SarasSreeram
@MAHoureih
@jennpincus
@nusrat_xahra
@NU_Pathology
@ADamronMD
@LizaMQuintana
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#GIpath
#Surgpath
#Pathresidents
35 Year old woman with RLQ pain, imaging describes a “porcelain appendix” (?), which is resected.
#Pathresidents
: Description/differential diagnosis?
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Contrast the nuclear features of signet ring cell change with those of adenocarcinoma.
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Bonus
#GUPath
case
Slide from a TURP in an 80 year old man.
#Pathresidents
: Gleason grade?
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#Surgpath
#Gynpath
33 year old female, cervical polyp.
Pics & a poll
#Pathresidents
: Ddx? Workup?
@padmapathology1
@JNStallMD
@KrutiManiar
@CPHpath
@drkennethtang
@DrSMBean
@sska_path
@ElshaikhMD
@Mvgs1706
@AnneMillsMD
@md_kyle
1/2
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#Tooclosetodiagnose
... or is it?
High-power view of a tumor removed from an adult human.
#Pathresidents
: Diagnosis?
@01sth02
@JMGardnerMD
@MELanocyteMD
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