Youssef Farhat, MD/PhD
@yMDPhD
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Digital Pathologist 🔬 Medical Director 🔬 #GIpath fellowship-trained 🔬 Independent contractor 🔬 Available for remote pathology work
Detroit, MI
Joined March 2019
Welcome to my first #PathTweetorial! HOW TO PREPARE FOR PATHOLOGY BOARDS Now that I've finished AP and CP #PathBoards, I would like to share some tips that might make it easier for those who will be taking it in subsequent years! My tips will cover the following: #yAdvice
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@YaraBahaaMo 💯 The WHO advocates for the term SSL now… some may not like it, but I think it’s a reasonable way to distinguish them from the inherently dysplastic classic “adenomas” of the GI tract and presumably benign hyperplastic polyps… but we all know SSL/A/P are synonymous terms!
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Although SSLs occur far more frequently in the right colon than the left colon/rectum, and they tend to be >1 cm, they can and do occur in the left colon/rectum and may show classic boot shaped crypts even when they are small, like this one!
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@ParasiteGal Yes, here they are! Any thoughts?
Worms!!! The patient needs a stool and ova test to confirm which type, but I suspect it's a Strongyloides infection. What do you think?
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@CakePath @Dr_Brian_Cox @ALBoothMD You can see from the replies there are differences in opinion among experts. I believe the boot shaped crypt you show is sufficient to diagnose this as an SSL, even in the sigmoid. If you told us it was in the R colon I think we’d all agree to SSL... Clinical history matters!
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@HamamSoheir It’s a good differential diagnosis, and I thought about schistosomiasis as well. These structures do not look calcified to me. They look more like lots of dark nuclei/cellular structures, which I think could be part of adult worms like strongyloides. But I wouldn’t commit to it!
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@HamamSoheir It’s a good differential diagnosis, and I thought about schistosomiasis as well. These structures do not look calcified to me. They look more like lots of dark nuclei/cellular structures, which I think could be part of adult worms like strongyloides. But I wouldn’t commit to it!
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@HamamSoheir It’s a good differential diagnosis, and I thought about schistosomiasis as well. These structures do not look calcified to me. They look more like lots of dark nuclei/cellular structures, which I think could be part of adult worms like strongyloides. But I wouldn’t commit to it!
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Worms!!! The patient needs a stool and ova test to confirm which type, but I suspect it's a Strongyloides infection. What do you think?
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@Ba_P10 @DanGrahamMD @DrGeeONE @GiPath The fields you show demonstrate a filiform polyp with low grade dysplasia, serrations/ectopic crypts and eosinophilic cytoplasm, which fits the criteria of a TSA quite well. Rectosigmoid is a common location for them too. Nice case!
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Answer: This is a sessile serrated lesion with low-grade dysplasia, confirmed with loss of nuclear MLH-1 staining in the dysplastic crypts. I look at striking images like this every day while diagnosing patients via #DigitalPathology Reach out if you'd like to connect!
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