Sunday, July 21, 2013

30 - Herring Bone Pattern

*We will start from basics :

*Question No.1: What is Herring?
-Answer: It is the name given to a type of fish which looks something like the figure shown below and is usually found in the shallow waters of north pacific and north atlantic.

*Question No.2: What is Herring Bone?
-Answer: The Herring Bone is nothing but the name given to the skeleton of the Herring fish, that looks something like the image shown below.

*Question No.3: What is so unique about the pattern of bones in the Herring fish skeleton, that it got the name Herring bone pattern?
-Answer: As is obvious from the image of the Herring Bone/Skeleton above, the skeleton of the herring fish has a beautiful pattern that is exploited in various industries like Cloth making and Tile making or it could just be a coincidence that the bone pattern matches the design.Have a look at the Herring Bone pattern on a cloth and on a pavement in the images below.

*Question No.4: Ok Ok Ok, But what the hell does this have to do with Medicine?
-Answer: Suppose you are the surgical oncologist/radiologist/General Surgeon/Paediatrician/Physician in a hospital and you came across a patient with a soft tissue tumor in some part of the body. The patient was operated upon and the soft tissue tumor was removed. The next step in the process is usually that the Specimen of tumor tissue is sent to the pathology department for confirmation of the diagnosis. The pathologist does all the preliminary things and finally colours it with dyes and watches the slide made from the specimen under the microscope.
                                                  If the pathologist sees the same HERRING BONE PATTERN, i was talking about previously in the slide, then the resected tumor is probably FIBROSARCOMA(congenital/infantile type or adult type). The slide will look something like the image shown below because of arrangement of cells{fibroblasts} in columns of short parallel lines with all the lines in one column sloping one way and lines in adjacent columns sloping the other way.

*It has to be remembered this same pattern can appear in a case of MONOPHASIC SYNOVIAL SARCOMA, which is another type of soft tissue tumor.

*To keep things simple - Herring Bone pattern on histology is seen in soft tissue tumors like fibrosarcoma(congenital/infantile or adult) or Monophasic synovial sarcoma.

-I would like to thank Wikipedia for the images.

Thursday, March 4, 2010

29 - Differential diagnosis of Nephritic syndromes based on Complement levels

*Nephritic syndromes with low complement levels :
   (Immune complex glomerulonephritis)
- Idiopathic proliferative glomerulonephritis
- Crescentric glomerulonephritis
- Membranoproliferative glomerulonephritis
- Lupus nephritis
- Cryoglobulinemia
- Bacterial endocarditis
- Shunt nephritis
- Post infectious glomerulonephritis (post streptococcal)

*Nephritic syndromes with Normal complement levels :
- Anti GBM disease : Good pasture syndrome
- Pauci immune glomerulonephritis : Wegener's granulomatosus and Microscopic PAN.
- Immune complex mediated : Henoch schonlein purpura, IgA nephropathy and Fibrillary glomerulonephritis.

*An important point to be noted is that, in Post streptococcal glomerulonephritis : Serum C3 levels are depressed within 2 weeks, however these usually return to normal levels within 6 to 8 weeks. Persistent depressed levels after this period should suggest another cause such as presence of C3 nephritic factor (Membranoproliferative glomerulonephritis).


Given below are two MCQs which appeared in the AIPGME 2004 paper related to the above topic.

1Q: Serum C3 is persistently low in all of the following except :
a. Post streptococcal glomerulonephritis
b. Membranoproliferative glomerulonephritis
c. Lupus nephritis
d. Glomerulonephritis related to bacterial endocarditis

2Q: All of the following are associated with low complement levels except
a. Lupus nephritis
b. Mesangio capillary glomerulonephritis
c. Diarrhea-associated HUS
d. Post-infectious glomerulonephritis


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