Jeffrey L. Myers, M.D.
A. James French Professor and Director,
Division of Anatomic Pathology

VOL 7(18)
May 26, 2010

Co-workers, teammates and colleagues,

Today's delayed edition of AP Updates comes to you from Pepin, WI, an idyllic village situated on the banks of Lake Pepin, a 30 mile aneurysm in the Upper Mississippi River that is the birthplace of Laura Ingall's Wilder (http://www.pepinwisconsin.com/).  As is always the case, please send me a note if today's Updates failed to include something that you would like to share with other members of our anatomic pathology (AP) team.

Cytology Visiting Professor next week
On Wednesday, June 2nd, Dr. Miguel Sanchez of Englewood Hospital in New Jersey and Associated Professor of Pathology at the Mount Sinai School of Medicine, will be here as a Visiting Professor as part of our ongoing cytopathology series.  He will be speaking from 12-1 PM in the Breast Cancer Clinic Education Forum in 3330 MSI, focusing on integration of fine needle aspiration (FNA) into a robust multidisciplinary breast cancer practice (The Englewood Model of Breast Care:  20 years, 10,000 cancers and 100,000 FNA's later).  His lecture will be followed at 1:30 by a case based slide conference focusing on FNA of breast lesions (One day in the life of a Community Pathologist), in the Cancer Center, room B1-286.  Make plans to take advantage of this very important educational opportunity!

Neuropathology faculty candidate, also here next week
Our busy recruitment activities continue in high gear as next week we host Dr Mary Fowkes from Mount Sinai Hospital in New York, a candidate for our open position in neuropathology.  She too will be lecturing on Wednesday, June 2nd, at 8:00 AM in 4234 MSI.  The title of her talk is CNS Development.  Don't miss this opportunity to meet another very impressive candidate for this important position.  Dr. Andy Lieberman and the members of his search committee need your help in identifying the person best suited to join our team, a team that others can only envy when it comes to excellence in not only neuropathology but all of academic anatomic pathology!

Jason's Pic-of-the-Week
Today is a sad one in that it marks the end of a section of Updates that has proven educational, fun, and enriching in ways that no other place can rival.  For over a year our ever talented Jason Carvalho has faithfully sent emails, usually in the middle of the night or early morning, with attachments comprising spectacular specimen photographs intended to illustrate art in the midst of medicine.  Whatever the medium or subject, artists help us see in the world things that might otherwise escape our attention.  Last week's photographs were an example of how talents like Jason's can impact our ability to see (JCpic_19MAY10.pdf).  Both Priya Kunju and Rohit Mehra nailed the diagnosis and are proud recipients of their very own individual $5 gift certificates good at any UMHS food service.  Please join me in CONGRATULATING Priya and Rohit on their diagnoses, and perhaps more importantly in THANKING Jason for all that he has contributed to making Wednesday mornings a little more nourishing for all of us!  Here is what he has to say about last week's entry.

   "Last week's pic of the week is of a classic in pathology and is a Warthin's tumor named after Dr. Alfred S. Warthin who was the second chairman of our department and the first to describe this tumor in 1929. Warthin tumor is the second most common benign salivary gland tumor after pleomorphic adenoma and the most common tumor to present synchronously with other salivary gland tumors (section these tumors carefully to look for a possible second tumor!).  Most Warthin tumors occur in the parotid gland ranging in size from 1-10 cm, are encapsulated, have cystic spaces with clear to yellow-brown viscous fluid with/without papillary structures which the photos show this particular tumor has most of those features.  The other name for a Warthin tumor is papillary cystadenoma lymphomatosum. Other differential diagnoses include:

   - Abscess - appear encapsulated, filled with thick yellow fluid, can have a foul odor, rim of vascular congestion, no papillary structures
   - Mucoepidermoid carcinoma - 2/3 of tumors occur in the parotid, well circumscribed but unencapsulated, 2-3 cm in size, low grade tumors can contain cysts filled with clear to blood tinged mucus, high grade tumors are more likely to be solid gray-white, can have hemorrhage and necrosis
   - Acinic cell carcinoma - rare tumor with most occurring in the parotid, encapsulated, can be solid or partially cystic, soft with white-yellow to red or gray color
   - Salivary duct carcinoma- rare, infiltrative borders, firm, gray-white,can have comedonecrosis like DCIS in the breast and/or cystic necrosis
   - Pleomorphic adenoma - more common to occur in major salivary glands, well circumscribed, encapsulate to non-encapsulated (minor salivary glands), smooth to bosselated surface, white-gray-blue, chondroid to mucinous, typically no gross cysts
   - Adenoid cystic carcinoma- can be seen in major and minor salivary glands, poorly circumscribed with infiltrative borders, firm gray-white, no cyst formation grossly
   - Polymorphous low grade adenocarcinoma- most occur in the minor salivary glands, non-encapsulate, well circumscribed, soft, solid, white-tan in color."

Attached is the final installment of Jason's Pic-of-the-Week (JCpic_26MAY10.pdf).  Don't miss your LAST CHANCE to enter a diagnosis that just might earn you a $5 gift certificate good at any UMHS food service.  Send you answers directly to Beth Minors and you'll learn next week how you did.

Ul's Word-of-the-Week
Today brings another contribution from Ul Balis, a word sure to expand your vocabulary in a way that impresses family and friends while offering you the opportunity to engage in dialogue with Dr. Balis himself.  See if you can't find a way to work this one into your lunch time conversation today!

   oikofugic (adj.)
   1. Exhibiting excessive wandering.
   2. Marked by an urge to leave home.
   3. In psychiatry, a reference to or swayed by the impulse to wander or travel away from home.

   Usage (general):
   Hoping for the attainment of full obstipation, BP's petroleum engineers hope to stem the tide of the Gulf of Mexico's oikofugic crude oil with the much lauded-but untested "top-kill" procedure today.

    Usage (IT):
   Dude, your confidential HR correspondence is showing up in the most prominent of public directories.  I think we have a mole in the department, imparting oikofugic properties to our most sensitive data.  I think it's time to call Bill Murray before the scaramouch strikes again.


That's the news to the moment from anatomic pathology, a place that remains top-of-mind when others imagine excellence in service, quality, safety and satisfaction in the fast paced world of academic anatomic pathology.  Send me a note if you have something that you would like to include next week.


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