Philippe Stephenson, MD
@TotalCytopath
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Cytopathologist and breast pathologist at the Centre hospitalier de l'Université de Montréal (CHUM).
Joined May 2020
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Pinned Tweet
My tweets are NOT medical advice. Do NOT perform FNA on yourself and diagnose yourself at home based on my tweets.
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My review of the Barbie movie: Too much eosin.
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The replies are full of people outraged that these immunologists believe in the immune system.
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Please do not confuse your Google search with my Pathology Outlines search (powered by Google).
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Tweetorial on diagnosing Warthin tumour. It's an easy diagnosis, right?
Oncocytes, lymphocytes, cyst content - what could go wrong?
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Thyroid is confusing. There's a follicular variant of papillary carcinoma, a papillary variant of medullary carcinoma, but no medullary variant of anything else?
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For the cyto people out there:
Owls Eyes
Most beautiful Reed Sternberg cell I have found on the net
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@Doctor_Eric_B
I think whatever you might say about Kevin, the attitude you're showing in your tweet is why public health lost so much respect over the past few years.
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Nothing complicated - just a pretty finding you aren't lucky enough to see for this
#FNAFriday
. Here's some intact papillary architecture in a thyroid FNA:
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@lisa_iannattone
Since we're coming up with analogies: Avoiding natural immunity (i.e., avoiding any exposure to SARS-CoV2) is like shutting yourself indoors forever to avoid any risk of skin cancer.
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Clinicians when you write a long microscopic description in your report.
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Surgical pathologists: When you sign out a biopsy with adenocarcinoma, do you write "Malignant: adenocarcinoma"?
Or do you just write "Adenocarcinoma" like a normal person?
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Early
#FNAFriday
in case I'm busy tomorrow. Subcutaneous posterior cervical nodule in a young man:
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A clinician wanted a quick read on an FNA specimen. I ROSE to the occasion.
I'll see myself out.
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Internal mammary chain lymph node FNA for suspected recurrence of breast carcinoma. What other primary, unknown to the radiologist performing the case, did this turn out to be?
Early
#FNAFriday
before the long weekend. Happy Fourth of July to American colleagues!
#cytology
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Public Service Announcement: For pleural fluid specimens, "pleural effusion" is NOT really clinical information beyond what I already knew from receiving the specimen!
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Classic cytologic image - I probably don't even need to give a history or location.
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Tweetorial on lymph node FNA - beauty in the benign.
Some features will keep you from misinterpreting germinal centre fragments as metastatic carcinoma, or vice versa.
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Reminder that I'm also a breast pathologist, and I just thought this was a particularly nice example of a radial scar.
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Tweetorial on sub-typing non-small cell lung carcinoma in cytology samples - essentially, how to tell a squamous carcinoma from an adenocarcinoma.
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Classic cytomorphology in this case of EBUS-FNA for mediastinal lymphadenopathy for
#FNAFriday
.
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To illustrate the concept of metachromasia to residents, I did scrape-preps from a pleomorphic adenoma, one stained with Diff-Quik (left), the other stained only with the blue solution from Diff-Quik (right).
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For adenocarcinoma:
- Acinar formations; the nuclei are in the periphery, the border is often (though not always) smooth, the cytoplasm toward a central point
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FNA of a cervical lymph node in a woman with a history of breast carcinoma of apocrine type.
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This isn't remotely true, and only serves to illustrate how bad ZeroCovid cultists are at math.
Chances are, if you got Covid and were in public, you’ve killed someone.
That’s why no one wants to acknowledge reality.
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How many pathologists do I have to invite to my wedding to write it off as a business expense?
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Fairly straightforward images for this
#FNAFriday
- beautiful Romanowsky stains of features that allow classification as adenocarcinoma in the setting of NSCLC.
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OK I guess I was kidding yesterday - I'm still going to post today, for
#FNAFriday
, this mediastinal lymph node, in which we see metachromatic mucin in the tumour cells...but it isn't an adenocarcinoma!
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A retropharyngeal mass in a patient with a history of thyroid carcinoma for this
#FNAFriday
.
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Fun tidbit for
#FNAFriday
: Endoscopic ultrasound-guided FNA, "coeliac axis lymph node", in the context of staging an oesophageal adenocarcinoma.
Positive for malignancy?
#cytopath
#cytology
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I should have known what this was right at ROSE. Mediastinal lymph node FNA.
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Having discovered pathology Twitter, what should I discover next? Pathology Instagram? Pathology Snapchat? Pathology TikTok?
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Following Dr Ali's (
@sza_jhcyto
) beautiful case of FNA of a clear cell carcinoma of gynecologic origin, here are some striking images from a pleural fluid, including hyaline globules you sometimes see in this entity.
#cytopath
#pathtwitter
#cytology
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High-power views are for low-power coffee.
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Not an FNA for this
#FNAFriday
, but here's a beautiful catheterized urine specimen:
#cytology
#cytopath
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@vigneshr11
@dch1309
People can have pointed disagreements on these sorts of policies, while being animated by the same universalist, humanistic principles all physicians ought to share.
I find it unprofessional to insinuate that the people who disagree with you mistreat their patients.
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No mystery here - just a beautiful benign lymph node with reactive follicular hyperplasia.
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Another fun tidbit for
#FNAFriday
:
"Peripancreatic lymph node FNA" for lung cancer staging. What is this?
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People critical of public health officials aren't the reason laypeople distrust public health officials. It's because public health officials are so clearly biased, even laypeople can easily spot it.
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I suppose I don't have to skip
#FNAFriday
, even if I'm on vacation.
Here are some images I use to teach about cyst-lining cells in thyroid FNAs, including one showing a reparative look, with a mitotic figure. Haemosiderin-laden macrophages show the context.
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Like most people, no I never did.
#breastfeeding
in an
#mri
‼️
Ever wondered what this might look like?
#neoTwitter
#medTwitter
Credit: MRIology
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When one urological pathology society sees the other one walking by at USCAP.
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Had some very interesting cases recently, which I'll be posting after wedding/honeymoon. Priorities, you see.
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@tylerblack32
That would be a relevant comparison if the vaccinations offered something approaching 100% protection against the illness.
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I'm becoming more senior - I now have an office with a view.
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Journalist
#LaurieGarrett
has lost her journalistic sense, due to
#COVID19
and will no longer be able to produce insightful reporting.
Musician
#PaulSimon
has lost his hearing, due to
#COVID19
and will no longer be able to perform.
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I'd like people's opinions on this image - poll in the following tweet.
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Fun challenging thyroid case - what would be your DDx?
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Classic presentation for this
#FNAFriday
- PET+ periparotid lymph node noted in the context of lung cancer staging.
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Rapidly enlarging thyroid mass, fine needle biopsy. Representative fields shown.
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Mediastinal lymph node FNA - it's subtle, but it's there.
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A well-circumscribed peripheral lung nodule for this
#FNAFriday
@gildasantoscyto
@thoracicpath
@DrGeeONE
@aakasharmand
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If I liked a medical student who did a rotation in pathology, and want to write a good letter, can I just say she's great, programmes should definitely take her?
Or does it have to be an epic poem about the unparalleled joy it was to have had the privilege to work with her, etc?
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For today's
#FNAFriday
, again something simple. From a mediastinal lymph node, an example of targetoid mucin that's "read the textbook":
- Perfectly round
- Peripheral enhancement
- Targetoid mucin in the centre
- Displaces the nucleus
Glandular differentiation - adenocarcinoma
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Interesting breast case here - enhancing lesion on MRI with architectural distortion:
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So, I'm also a breast pathologist, in addition to mostly cyto.
Here's a case of what was otherwise a typical intraductal papilloma, aside from this focus. Last image is p63.
Thoughts?
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And this is why we often don't see intact papillae in FNA of papillary thyroid carcinoma - a papilla that's been entirely denuded of its epithelium, leaving only arborizing vessels.
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Did I really get the vaccine if I didn't take a selfie?
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Early entry for
#FNAFriday
. Mediastinal lymph node FNA - what do you think is the clinical setting?
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When I was a trainee, a radiologist told my attending "A good cytopathologist can make a diagnosis with two cells."
Without skipping a beat, the reply: "And a good radiologist gets the right two cells."
@mdlozanoe
@SECitologia
@slac2020
@PVielh
@tlabiano
@nucleololailo
@MauroSaieg
As I always say "you can run but you cannot hide" ;) One cell is enough. One of my radiologist used to get into a friendly argument with me with such scant FNAs, always challenging me that that "reading individual cells is what distinguishes cytologists from histopathologists".
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Such an ugly cell in a BAL - should I be worried?
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What does everyone think of these cells in a "gastro-hepatic lymph node" by EUS-FNA?
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Same here, different reasons.
Back from a long Twitter break for sign outs, boards studying and detox from Twitter! Back and excited to be here!
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Periodic reminder that "pleural effusion" doesn't count as clinical information for a pleural fluid specimen.
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Not an FNA for
#FNAFriday
but a Pap test (conventional). Was a little confused until I saw the history.
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In an otherwise generically "positive for adenocarcinoma" pleural fluid, here is a telling structure.
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Middle-aged man with an ill-defined process envelopping nerves on the inner aspect of the mandible for this
#FNAFriday
CT-guided biopsy.
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"Look at those nucleoli - that must be adenocarcinoma!" in this mediastinal lymph node FNA for
#FNAFriday
(It's not adenocarcinoma)
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