Making the Link – Macro specimens and Histopathology (Group Work)Learning outcomesAt the end of this session you will be able to1. Discuss the role of the teaching medical museum in undergraduateandpostgraduate education.2. Outline the history behind, and application of, the Human Tissue Act(2004).3. Use simple examples of the language of pathology.4. Explain the relationship between your knowledge of histopathology and thecognate lesions or structural changes observed in museum specimens.IntroductionAs part of this module, we have organised sessions to be held in the Gordon Museumof Pathology, hosted by the Curator, Mr Bill Edwards.This is very much a student-centred exercise where we provide you with a learningenvironment. Here you will be able to explore selected specimens in the museum’scollection.Typically, the majority of histological specimens seen by pathologists and biomedicalscientists will arrive in specimen reception in pots full of fixative. Therefore, thedescription of these specimens will be of them in their fixed, rather than fresh, state.The specimens in the museum have also been fixed, so you will be seeing them in asimilar state to that seen at the cut-up bench.In the Histopathology department, the specimens must be “described” before theyare prepared for processing to sections on glass slides. These descriptions aredictated by the pathologist and tend to be precise and concise so that information onthe appearance of the specimens can be reviewed and understood by anypathologist interpreting the slides in the reporting tray.Here is an example:SPECIMEN(S) RECEIVEDRight breast excisionCLINICAL DATA20mm right breast microcalcification B3 on biopsyMACROSCOPIC DESCRIPTIONPot labelled [patient’s name]. Right breast excision biopsy wide local: A fibrofatty tissuefragment measuring superior to interior 23mm medial tolateral 22mm and anterior to posterior25mm. The wire is passing near the short stitch attached superiorly. Specimen is sliced intofour slices, slice 1 being lateral most guide wire is passing through slice 2.Block 1: Slice 1 lateral resection margin cruciates.Block 2: Slice 2.Block 3: Slice 3.Block 4: Medial resection margin cruciate. No tissue remains.SP3: 09 February 2018Biomedical scientists mostly assist the pathologist at cut-up and will therefore need tohave some understanding of the descriptive language used. Some biomedicalscientists progress their careers by undertaking additional formal training in dissectionso that they can take on the role of the pathologist at cut-up for simple specimens.In your groups, you should use your knowledge and understanding of anatomy,histology and pathology to help you recognise and explain the presentations of thevarious diseases on display. Every display specimen (or “pot”) has a code numberthat links to a short description to be found in the relevant folder on the gallery sills.You should also have copies of your histology and histopathology text books withinyour groups.Once you begin to study these pots, you will be faced with the challenge of describingwhat you can see. Why is this? How many different words can your group use todescribe the specimens? Is your vocabulary up to the task?Assignment for your group’s ePortfolioBy now, you will be beginning to appreciate how important the language of pathologyis for describing macroscopic and microscopic specimens. We do not expect you tobe experts at anatomical description as this takes many hours of practical experience.Nonetheless, by the end of the session you should be able to provide basicdescriptions at a macroscopic level, with the aid of drawings (photography isprohibited in the museum), of either one neoplastic or one non-neoplasticdisease of your choice. Where possible, support your descriptions with a descriptionof the underlying histology at the microscopic level. These descriptions should beuploaded to your group’s ePortfolio as a short one-page document and accompaniedby labelled histological slide images (derived from images available through WSB,your SP1/SP2 sessions or other relevant sources) describing the underlyinghistopathology. You may also consider sunstituting the written work with a two minuteExplain Everything video, not filmed in the Museum.Programme15:20 Leave the University for the Gordon Museum (please request leavingearlier if there are mobility issues)15:50 Meet in the foyer of the Hodgkin Building. Please assemble quietly andrespect other users of the building16:00 Short introduction to the museum by the museum’s curator, Mr BillEdwards. This will be followed by your pursuit of the activitiesoutlined below.17:00 “Medical Museums” by Mr Bill EdwardsThis lecture explores the purpose, history and development of HumanSpecimen Collections and Museums. Looking at the philosophical and legalchanges and the societal and educative implications of such collections,moving from pre-history to the “lawlessness” of the 18th and 19th centuries.Also looking at the move from the old Anatomy Act and Human Tissue Actto the Modern Human Tissue Bill.There will be examples of different specimen collections from around theworld, many created during the last four hundred years, and compares andcontrasts the various approaches to the preservation and use of HumanMaterial. Finally trying to divine the future, if any, of such collections.18:00 End of scheduled sessionSP3: 09 February 2018Student-Centred Activity in the Gordon MuseumWe have decided to run this session in the Gordon Museum as it presents us with afantastic and rare opportunity to show you a huge range of macroscopic pathologywith histopathological correlation in the context of the module. It will make such adifference to your understanding and appreciation of the pathologies that we cover inthe module. The guidance below suggests a focused route through the collection.This will also ensure that you are not all crowding around one area. If you cannot getto your target area, then explore what else is available to you, following your owncuriosity and interest.If you are unable to attend the session, then please use Westminster Slide Box toexplore the histological slides available to you on the day and discuss the learningoutcomes with the other members of your group when you next meet them.Exam Pots1. LiverHB68 – chronic active hepatitisHB94 – micronodular cirrhosis
ACTION FOCUS: Compare and contrast HB94 and HB682. LungR75 – Healed post-primary TBR124 – EmphysemaR201
ACTION FOCUS: Explain the gross appearance of the TB-affected lungbased on your understanding of its histopathology.3. BreastB1, B2 – Fibrocystic disease of the breastQ: What is apocrine metaplasisa?Case note: “A conservative removal was effected and recoveryfollowed.”Q: What is meant by the term ‘conservative’ mean and why itisimportant?B17 – Tuberculous mastitisCase Note: ‘Mastectomy’Q: Is this the the normal procedure for breast lumps? (Note the year,1937.)B18B28 – FibroadenomaB37 – Multiple FibroadenomataB53 – Fibrotic reaction to implant (fibrosis)B58 – Male mammary carcinomaSP3: 09 February 2018B69 – CarcinomaB71- Demonstrating peau d’orangeB75 – Fungating (exophytic) carcinomaB78 – Advanced stage breast carcinoma
ACTION FOCUS: Compare and contrast the appearance of B2 and B784. ProstateU485, U486, U486B – examples of an enlarged prostate and theconsequences to the bladder of an obstructed urethra.
ACTION FOCUS: Discuss how hyperplasia of one organ (prostate) can haveindirect compensatory effects on another (bladder).5. GutA436 – appendicitisA685 – ulcerative colitisA670 – Crohn’s disease
ACTION FOCUS: Choose one of these and relate the macroscopicappearance to the underlying histopathology.A518 – Familial adenomatous polyposisA543 – colonic adenocarcinoma
ACTION FOCUS: Choose one of these and relate the macroscopicappearance to the underlying histopathology.6. KidneyLook at the models demonstrating the organisation of the blood vessels in thekidney. It is worth also looking at the congenital disorders of the kidney.U156 – acute pyelonephritis – note the pale tan streaks, what are they?U254 – transitional cell carcinoma of the renal pelvis. Look at thecommentaryand clinical history and review your level 5 Applied Pathophysiology casestudy.
ACTION FOCUS: Relate the macroscopic appearance of U156 to theunderlying histopathology.7. CervixCG97 – squamous cell carcinoma of the cervix (do not mistake the fibroid(high and left) for the tumour.There are another of other similar examples on display of tumours affectingthe vagina, cervix, uterus and ovaries. We will only be looking at thecytologyof potentially malignant lesions in the module, so it is worth looking at theendpoint of cervical cancer in particular.
ACTION FOCUS: Describe the macroscopic appearance of a named cervicalcancer specimen.SP3: 09 February 20188. Lymphoreticular SystemLR96 – Non-Hodgkin lymphomaLR108 – Hodgkin lymphomaACTION FOCUS: These tumours look very similar macroscopically. How canthey be differentiated microscopically?
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