Blondes and Brunettes

I've been called a lot of things, but a pathologist is not one of them. So far in my medical career, I can think of very few things that have evoked an extreme, visceral reaction, but Thursday's pathology presentation got to me. Now, the first time I saw the face of my anatomy body I was a little uneasy. The smell during the disembowelment at my first autopsy was unpleasant, but nothing I couldn't push through. These things don't compare to the way the "teratoma" made me feel. How our professor went on about her "favorites" made me a little sick. I think I might have thrown up in my mouth a little bit. I have said before that the microscopic side of medicine is not nearly as interesting as gross pathology. Well, I'd probably like to ignore this part of the macroscopic as well.

A teratoma is the most common neoplasm of the ovary. It is usually benign, but only in terms of its possibility for cancer. Its morphology is by no means "benign." Not at all. It is called a teratoma because its growth is derived from multiple tissue types. Normally we define a neoplasm as either "benign" or "malignant," pertaining to its ability to metastasize and spread to other parts of the body. These tumors generally stem from an abnormal growth in tissue. Many times, if a neoplasm begins in a certain part of the body, the cells multiply from that single origin. If the tissue was of a glandular genesis, we use the term "adenocarcinoma." If it was derived from the melanocytes of the skin, it's call "melanoma." The teratoma, however, is derived from multiple tissue types. A mature teratoma is pictured above (but look at your own risk). It can grow gut tissue, respiratory tissue, teeth, hair, neuronal tissue... you name it, it's got it. Frankly, it's kind of gross.

Now from a professional standpoint, these feelings are irrelevant. I would never break poker face in the clinic, lab, or in front of a patient. The old EMS adage applies: no matter how gross it is, pretend that you've already seen it a thousand times. But sitting in the back of the MBRB lecture hall, I'm allowed to grimace a little. It looks painful, and it's hard to imagine teeth and colon growing in my ovaries (fortunately, I don't have ovaries). I also think it has something to do with the way it was described. Pathologists should avoid using food metaphors all together. Saying that a hydatidiform mole looks like a "cluster of grapes," or that endometriosis resembles little cysts of "chocolate" is not appealing, especially before lunch. I just want to eat in peace. Personifying teratomas should be banned as well.

This here is a brunette teratoma. You can see her molars and incisors, but it looks like she lost her front two teeth... Oh! Here's a blonde. She's obviously not as mature as her brunette sister. Pun intended!


No no no no no NO NO!  You know what?  Let's just ban medical metaphors in their entirely.  Thank you.  Genital warts don't look like cauliflower, and your birth mark doesn't look like Jesus!

Like I said, fortunately I don't have ovaries. This has been an important revelation over the past week (if you haven't figured it out yet, we're studying the female reproductive system). Men are simple. Your testes either descended or they didn't. There are only a few types of testicular tumors, and the most common has a good prognosis. In a women, everything can go wrong. You can have ovarian cancer, endometrial cancer, cervical cancer, vulvar cancer, ectopic cysts in your neck or stomach that menstruate each month (!!!!!), endometrium in the myometrium, and all this crazy stuff. And don't get me started on the menstrual cycle with all the hormones that are being secreted and fluctuated. In fact, "Dear Girlfriends of Past, Present, and Future... you win." Jamie Foxx can blame it on the alcohol, but sweetheart, just blame it on your period. I don't understand what's going on inside of you, but it's nuts and I want no part of it. So, women, you can have all the babies you want and enjoy that "special bond," because I don't want it. I don't need an estrogen/LH surge or menopause.

Kendall Marshall, if you're out there, then I'm sorry. I retract last week's blog post. Find your own baby daddy.