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January 1992, Volume 42, Issue 1

Tit Bits In Medicine

SURGICAL PATHOLOGY OF A CAKE

Azhar Mubarik  ( Armed Forces Institute of Pathology, Rawalpindi. )

It was the birthday party of one of the residents of histopathology department. Everybody was happy for the break in the routine work. The junior trainees were more interested in the types of specimens which were expected to be served as refreshments, besides the cake. Some were speculating about the type of cake. They wanted it not to be a simple cake but a large specimen with attached adnexa. When the party started, the trainees completely forgot to ask about the clinical background and past history of the cake and chicken patties. As trainees in histopathology they should have asked about the age of the cake and also the site of its origin. Nobody appeared to be interested in that vital information. The second rule of the department was broken when minimum time was spent on the gross examination of the specimens. Detailed observation of gross morphology and any anatomical abnormality or pathological lesions were completely omitted. The surgical pathologists were transformed into culinary pathologists. Without any further loss of time, non representative sections of cake were taken. Again, it was forgotten that too big sections are not appropriate for processing. Sections of the cake were immediately placed in the mouth, missing many steps of routine processing. Chicken patties were orally embedded as such, leaving no remnants in the container for further study of special processing. Tea in ample quantities was consumed as rehydrating agent. Rapid frozen sections of vanilla ice cream were also taken at the same time. It was not time for an interpretation and reporting on the taste and flavour of the specimens. As expected, due to lack of back ground information and poor gross examination, some difficulty was faced in interpreting the flavour of the cake. Some were of the opinion that it was almond cake, while others suggested that it was plum cake. One trainee, who was known for having a predilec. tion for making diagnosis of rare tumours, decided that it was a variant of walnut cake known as walnut crunch cake. Finally the senior registrar decided that gross examination of the cake should be repeated and more cake should be processed. This time cake was examined more carefully. On cutting thin slices it was seen that pieces of almonds were embedded in the stroma of the cake. Appropriate size representative sections were taken and processed per orum slowly. The gross diagĀ­nosis of almond cake was immediately confirmed by the taste buds.
The moral of the story is that one should not forego the basic principles whether eating a cake or handling a surgical specimen like an ovarian cyst.

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