🔬 A Cytology Lesson: One Marker • Two Histories • Three Primaries !!! 👩‍⚕️ Patient • 72-year-old female with pleural effusion • Initial history provided: Previous h/o anal squamous cell carcinoma and breast carcinoma 🔍 Cytology Findings • Highly cellular specimen • Malignant epithelial cells in clusters and 3D groups • Marked nuclear atypia • Occasional vacuolated cytoplasm 🧪 Initial Cell Block IHC ✅ BerEP4 positive ❌ Calretinin negative ✅ CK7 positive ❌ CK20 negative 🎯 Diagnostic Approach Based on Available History • TTF1 → to exclude primary lung adenocarcinoma • p63 → to assess squamous differentiation • TRPS1 → to evaluate possible breast origin 📋 Results ❌ TTF1 negative ❌ p63 negative ✅ TRPS1 patchy positive ⚠️ The Pitfall With a history of breast carcinoma and a CK7 /TRPS1 profile, metastatic breast carcinoma seemed highly likely. 🔄 The Turning Point • TRPS1 positivity was only patchy • Additional clinical information was obtained • Histologic correlation was performed 🧩 The Missing History The patient also had a recently diagnosed endometrial malignancy with frozen pelvis and extensive local spread, a crucial piece of information that was not initially available. 🧬 Further Workup ✅ PAX8 positive - favor mullerian ❌ GATA3 negative - point against breast cancer 📌 Final Interpretation Metastatic Müllerian carcinoma, with correlation favoring high-grade serous carcinoma. 💡 Take-Home Messages ✔️ TRPS1 is a useful marker, but not entirely specific for breast carcinoma. ✔️ Patchy TRPS1 positivity can be seen in Müllerian serous carcinomas and other non-mammary tumors. ✔️ Never interpret immunostains in isolation. ✔️ Morphology Clinical History Imaging Histology Correlation = Accurate Diagnosis. ✔️ Always question a result that does not perfectly fit the overall picture. 🏆 Lesson Learned 💎 The most important diagnostic tool in this case was not TRPS1—it was the missing clinical history. #Cytopathology #PleuralFluid #DiagnosticPitfall #TRPS1 #BreastPathology #PathologyPearls #Cytology #ClinicopathologicCorrelation #PathTwitter #MedEd #LearningFromCases

Dr. Anna Bortnick ♥️ delivering an eloquent case based presentation to fellows about importance of Intra coronary imaging and IVL usage during complex coronary cases. #LearningFromCases #SCAIScientificFellowsSummit #FIT #SCAI2026 @SCAI @MyJSCAI

A 23-year-old male patient, with a history of X-linked pseudo-obstruction requiring lifelong parenteral nutrition (PN), was referred to hepatology for evaluation of abnormal liver blood tests... Do you know what the CT findings show? Test your knowledge here! 👇 👇 👇 bit.ly/455qlUB With thanks to the authors - Imran Iqbal, Clare Donellan and Oliver Tavabie. @PhilSmithIsBack @OTavabie @dr_aditi_kumar @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman @DrLChina @acv69cardenas @GeriKeane @jamesbmaurice @drobeirne #ClinicalCase #CaseReport #RareCase #RareDisease #MedicalCase #CasesInMedicine #LearningFromCases #MedEd #ClinicalLearning #DiagnosticChallenge #TeachingCase #InterestingCase #AcademicMedicine #MedTwitter #FOAMed

"A previously healthy 58-year-old woman presented to the emergency department with epigastric pain and dizziness. She reported recurrent episodes of epistaxis, and her elder sister also had a similar condition..." With thanks to Dr Karen Cheuk-Ying Ho and Dr Loey Lung-Yi Mak for this fantastic case! fg.bmj.com/content/early/202… @PhilSmithIsBack @OTavabie @dr_aditi_kumar @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman #ClinicalCase #CaseReport #RareCase #RareDisease #MedicalCase #CasesInMedicine #LearningFromCases #MedEd #ClinicalLearning #DiagnosticChallenge #TeachingCase #InterestingCase #AcademicMedicine #MedTwitter #FOAMed

📷 🤔 KNOWLEDGE CHECK ⚠️ ⚠️ ⚠️ A woman in her late twenties presents upper quadrant pain 1 week after laparoscopic cholecystectomy, with the following CT appearances. What is the diagnosis? With thanks to Dr Daniel Gero and co-authors. @PhilSmithIsBack @OTavabie @dr_aditi_kumar @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman @Nendoscopy @GeriKeane @sheiybani #ClinicalCase #CaseReport #ImageReport #MedicalImaging #Radiology #Pathology #LearningFromCases #MedEd #Gastroenterology #GI #AcademicMedicine #MedTwitter

🏥 Gastric fundus necrosis in a patient after stem cell transplantation, culminating in partial gastrectomy and splenectomy 🏥 What caused for the necrosis? FIND OUT HERE 👇 👇 👇 doi.org/10.1136/flgastro-202… With thanks to Dr Patricia Mester and co-authors for sharing this insightful case. @PhilSmithIsBack @OTavabie @dr_aditi_kumar @TrevorTabone @eathar_s @IrenePerezMD @KGananandan @zare_benjamin @medicalreg @dtleiberman #ClinicalCase #CaseReport #ImageReport #MedicalImaging #EndoscopyImages #Radiology #Pathology #LearningFromCases #MedEd #Gastroenterology #GI #AcademicMedicine #MedTwitter

Key learning points from @MPSdoctorsIRE analysis of #learningfromcases #GPConference

10% of claims came from procedures and minor surgery #learningfromcases #GPConference @MPSdoctorsIRE

Delayed cancer diagnosis #learningfromcases @jamesthorpe1979 #GPConference @MPSdoctorsIRE

Key learning points from @diane_baylis Doctors are human. Robust practice systems need to be in place. #learningfromcases

Should a patient follow up their own test results with their GP. Dr Ellen Walshe @MPSdoctorsIRE points out the onus is on the requesting Dr and that the information is passed on. #learningfromcases

Positive and negative reasons why you didn’t think it was a specific issue Should be documented #learningfromcases @MPSdoctorsIRE

I’ve had mine have you? @MPSdoctorsIRE #learningfromcases webinar reminder tomorrow night 7pm

Thank you @Lornabi52318062 for an excellent #learningfromcases. Extra benefit of working from home I get all this along with cat and crochet! @NorthumbriaNHS

Learning From Cases today with @NorthumbriaNHS always good to reflect and openly discuss learning opportunities and more meaning is applied when they’re real cases. @nikimsanders @Faye_Dixon19 @EmmaD_72 #learningfromcases