Updates:
I’ve returned to Morgantown!
For 6 weeks anyway, as I rotate through the Ruby Memorial Autopsy suite.
Morgantown is a thoroughly enjoyable place to spend the summer months. In my off-time I’ve been hiking in Coopers Rock State Park, the Morgantown Botanic Garden, going to live music in Pittsburgh, and walking along the rail-trail to enjoy some peace and quiet.
I’ve had opportunities to gross new specimens (Larynx and partial maxillectomy) here during some visits to the hospital lab when there hasn’t been any autopsies. I’ve been surprised at how confident I’ve gotten in my decision-making while grossing. The most important principles of surgical pathology have been effectively solidified in my brain to the point that I can use them to guide any decisions I have to make, and so even the more complex specimens aren’t so scary any more!
I finished my last big project of the program: a presentation of a case that I worked on this year. I did my presentation on an invasive hydatidiform mole following a partial molar pregnancy. As a presenter, I hate reading off slides, so my presentations are more like one-sided conversations with my audience. I know I picked the right profession, because I like explaining pathology, and I like talking about the cases I’ve worked on, and the presentation was a nice reminder of this.
Since I’ve been here, I’ve also been planning for what comes after graduation. Job searching, of course, but also deciding how I’m going to move myself back across the country. I’ve cleaned out my storage unit, sold and donated half the things I’ve accumulated since I’ve been here, and shipped or packed up all non-essentials for the last 3.5 months. My job search has been going well. I’ve interviewed with two labs, one in Washington and one in Oregon. I’ve had an offer from one, and I’m scheduling a second interview with the other. They are fairly different positions, so I’m in the process of deciding what sort of duties I am most interested in and what would be the best fit for me.
Reflections:
Something I’ve been thinking about is the platitude “where there’s a will, there’s a way”, a somewhat obvious statement, but when you are able to demonstrate it with your own Will and Way, it becomes more resonant. Some things this year have not gone as planned, and many things have not gone as smoothly as I’d hoped. Among that, there was always the Will to finish what I started, even on the toughest days.
In these last few months, I’d like to set an intention to continue to do the very best I can in my own Way, because it’s astounding how far I’ve come this year, and I can only hope to continue building off that progress.
Disease of the Day: Basal Cell Carcinoma
Basal cell carcinoma is known for being the most common invasive cancer in humans! It is locally aggressive, but rarely metastasizes. It mainly occurs in light-skinned elderly adults in areas of sun exposure.
Etiology: Usually a two-hit process, a specific gene is mutated, and then an environmental stimulus creates the conditions for tumor cells to occur.
Pathogenesis:
A loss-of-function mutation in PTCH impacts the sonic hedgehog signaling pathway, which causes downstream constitutive activation, and conditions to support tumor growth. 2nd hit is UV radiation damage from sun exposure.
Syndromic form: Gorlin Syndrome (nevoid basal cell carcinoma syndrome)
Morphology:
Gross: A pearly papule with telangietasis.
Superficial variant can be erythematous
In very advanced cases, the lesion can ulcerate and have a “rodent ulcer” appearance.
Microscopic: tumor cells appear as normal basaloid cells in 2 patterns
Multifocal pattern: Laterally extends in the epidermis
Nodular pattern: Downward growth as cords and islands with palisading cells at the periphery.
Artifactual clefting separation of the tumor cells from the surrounding tissue is not pathognomonic, but can be a helpful clue!
Image courtesy of Robbins and Contran's Pathologic Basis of Disease
The Underlook Trail at Cooper's Rock State Park