Today we went for a walk along the hills, which were filled with fragrant flowers and lush foliage. We saw eagles, and ibises and even monkeys! After that it was time to finally get to work: we entered Kijabe hospital and surveyed our workload. There was a nice collection of thyroid, gyn, and BST cases, some large cases, some small biopsies. Unfortunately the dictation software stopped working so we had to slow down a bit. We did end up finishing all the specimens though.
Afterward it was time to preview. There was a nice mix of GU, HNL, and GYN cases to look at. Afterward I went back to the house and we all ate dinner; Rochelle had made lentil soup, yum!
We had to send a couple consult cases to UW, which we do via a camera attached to the microscope. the first one was a brain tumor:
a 21 year old male status post surgery for left frontal pilocystic astrocytoma in Feb 2022. MRI 11/28/2023 showed recurrence of cyst with recurrent tumor, with patient undergoing subsequent surgery. We believed this represented a recurrence of the pilocytic astrocytoma, but were worried that there may be a higher grade process present.
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| Worrisome atypia |
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| A worrisome hypercellular area |
Our neuropathology colleagues advised that in order to rule out diffuse glioma (more invasive than pilocytic astrocytoma) we should look for high mitotic activity and other high grade features such as microvascular proliferation and necrosis. We did not end up finding these things, so we signed out the case as "worrisome" for a higher grade process.
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