Apple-core lesion

An apple-core lesion refers to a short segment where the large bowel becomes narrowed all the way around, with abrupt edges seen on imaging, producing an appearance reminiscent of the remains of an eaten apple – an apple core lesion.

This appearance is most commonly associated with colonic adenocarcinoma, a cancer of the large bowel. It arises because the tumour grows circumferentially within the bowel wall, gradually narrowing the hollow centre (lumen) rather than forming a single lump. When a contrast liquid is used to outline the bowel, only a thin column can pass through the narrowed segment, and it is this narrow column that outlines the characteristic apple-core shape. The finding is therefore an important radiological clue that often leads to further investigation, such as colonoscopy and biopsy.

Reference 

Alzaraa A, Krzysztof K, Uwechue R, Tee M, Selvasekar C. Apple-core lesion of the colon: a case report. Cases J. 2009;2:7275. Go to reference

                                                        Apple-core lesion, Apple core

Image from Alzaraa et al.

Tea-coloured urine

Urine is usually pale yellow. Tea-coloured urine refers to urine that appears dark brown, resembling strong tea. This change in colour can occur for several reasons, ranging from dehydration to medical conditions.

Tea-coloured urine can occur because substances in the urine alter its colour. These include blood-related pigments such as haemoglobin (from red blood cell breakdown) and myoglobin (from muscle injury). Tea-coloured urine can also be seen with some urinary tract infections and with some medications. Liver and bile duct problems may cause dark urine when bilirubin is excreted into the urine.

Reference 

Barsanti-Innes B, Koda Y, Hsia CC, Chin-Yee B. A 34-year-old man with tea-coloured urine. CMAJ. 2025;197(41). Go to reference

See also Coca-cola colored urine

Tea-coloured urine, Tea with mint

Image from Wikimedia Commons

Image from Wikimedia Commons

Oreo cookie sign in pericardial effusion

Pericardial effusion occurs when fluid builds up in the pericardium, the double-layered membrane that surrounds and protects the heart. This abnormal fluid buildup can be caused by infections, trauma, cancer, autoimmune diseases and other conditions.

The Oreo cookie sign describes a distinct pattern seen on medical imaging. On chest X-rays or more detailed scans, like a computed tomography (CT) scan (which uses special X-ray technology), the fluid in the pericardium forms the "cream" layer in the middle, with the outer layers of the “cookie” made up of the pericardial and epicardial membranes. Echocardiography, which uses sound waves to create real-time images of the heart, can also reveal this pattern.

The Oreo cookie sign is an important clue for diagnosing pericardial effusion, which can be serious. If the fluid buildup is large enough, it can lead to cardiac tamponade, a condition where the heart is compressed and cannot pump blood properly. Early detection and treatment are crucial to prevent complications.

Reference

Chiarenza A, Esposto Ultimo L, Falsaperla D, Travali M, Foti PV, Torrisi SE, Schisano M, Mauro LA, Sambataro G, Basile A, Vancheri C, Palmucci S. Chest imaging using signs, symbols, and naturalistic images: a practical guide for radiologists and non-radiologists. Insights Imaging. 2019;10(1):114. Go to reference

Oreo cookie sign, Oreo cookie

Image from Chiarenza A et al. Insights Imaging. 2019.

Fried egg appearance of Best disease

Best disease, or Best vitelliform macular dystrophy, is an inherited eye condition affecting the macula, the central region vital for clear vision. Typically appearing in childhood or adolescence and progressing over time, it results in central vision loss. Named after German ophthalmologist Dr. Friedrich Best, who observed a family with various stages of the disease in 1905. Best disease can reveal a distinctive fried egg appearance in the macula. This look, resembling a yellowish egg yolk, is caused by the buildup of lipofuscin, a fatty substance, in the retinal pigment epithelium cells. These cells support the retina, the light-sensitive layer of tissue in the eye. Imaging techniques, like fundoscopy, allow us to see this fried egg appearance.

Reference

Tripathy K, Salini B. Best Disease. [Updated 2023 Aug 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Go to reference

Fried egg appearance, Fried egg

Image from Nentwich MM, Rudolph G. Hereditary retinal eye diseases in childhood and youth affecting the central retina. Oman J Ophthalmol. 2013.

Candy cane aorta

The largest and main artery in the human body, the aorta, emerges from the heart. The aorta distributes oxygenated blood to all parts of the body. The aorta gives off various branches as it travels through the thorax and abdomen. The aorta's arch, which is curved and located in the thorax, joins the ascending and descending aortas. When examined from a side angle using X-rays or magnetic resonance imaging, the configuration of the ascending aorta, aortic arch and descending aorta resembles a candy cane or hockey stick in appearance – candy cane aorta.

In the abdomen, the aorta ends by splitting into the median sacral artery, a small midline vessel and the common iliac arteries, two major blood vessels. 

Reference:

Eikendal AL, Bots ML, Haaring C, Saam T, van der Geest RJ, Westenberg JJ, den Ruijter HM, Hoefer IE, Leiner T. Reference values for cardiac and aortic magnetic resonance imaging in healthy, young caucasian adults. PLoS One. 2016;11(10):e0164480. Go to reference.

Candy cane aorta, candy cane

Image from Eikendal AL et al. PLoS One. 2016.

   

Pear-shaped appearance of Babesia

Babesiosis is a rare disease caused by single-celled parasites which infect red blood cells. Babesia mainly infect animals with humans only being occasionally infected. These parasites are transmitted to humans primarily by tick bites. Their name originates from Victor Babeș (1854-1926), a Romanian physician who first described them.
Some infected people are asymptomatic. Certain groups of people are vulnerable to severe infection like those without a spleen and those with an impaired immune system. Under the microscope, these parasites are oval shaped within the red blood cells, a pear-shaped appearance.
Reference:

Zimmer AJ, Simonsen KA. Babesiosis. [Updated 2020 Aug 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Go to reference. 

Pear-shaped forms, pears

Image from Wikimedia Commons

Candy cane esophagus

Consuming very hot food and drink can injure the inside of the food pipe, the esophagus, which extends from the throat to the stomach. Normally the inside of the esophagus is pink. But when burnt by hot liquids or solids, alternating bands of red and white regions emerge, when examined by optical devices. These regions resemble candy cane in appearance – candy cane esophagus. Candy cane is a type of boiled sweet often found in alternating red and white stripes.

The outcome depends on the extent of esophageal thermal injury, with most reported cases having favorable outcomes.

Reference:

Lim CH, Yen H-H, Su W-W, Lim C-J, Tsai H-C, Chen S-T. Extensive Causative Esophagitis Caused by Thermal Injury: A Case Report and Review of the Literature. Case Reports in Gastrointestinal Medicine. 2017;2017:8243567. Go to reference

Candy cane esophagus, candy cane

Image from Lim. Case Reports in Gastrointestinal Medicine, 2017

Image from Wikimedia Commons

Caviar appendix

In a rare usually non life-threatening condition myxoglobulosis of the appendix, multiple small spherical mucin globules develop in the appendix's lumen. These pearl colored globules resemble caviar in look - caviar appendix. Most people with appendiceal myxoglobulosis have no symptoms. Discovery of the condition is often incidental during surgery or at postmortem. The cause of this condition is currently unknown.

The appendix is a blind ending tubular protrusion from the main alimentary tract. It can act as a store of healthy bacteria which re-populates the gut when diarrhea, for instance, distorts the balance of healthy micro-organisms within the main gut. It is also packed with many immune cells which assists with immune responses.

Reference:

Gosavi MS. Myxoglobulosis Of The Appendix: A Rare Cause Of Pelvic Pain. Current Educational Research. 2018 1(03). Go to reference

Caviar appendix, caviar

Image from Gosavi. Current Educational Research, 2018

Image from Wikimedia Commons

Strawberry scrotum

The scrotum ‘houses’ the testes and helps to keep them at a lower temperature than that of the rest of the body because sperm production takes place best at cooler temperatures.

In a rare disease affecting the scrotum’s skin, nodules of calcium accumulate within it - scrotal calcinosis - and because of their raised mottled look the nodules give the scrotum an appearance not unlike a strawberry in some cases – strawberry scrotum.

Scrotal calcinosis is not life threatening, its underlying cause is unknown. Affected men usually between 20 and 40 years have normal measurements of calcium in their blood. Treatment for scrotal calcinosis often for cosmetic reasons is by surgical removal of the affected scrotal region.

Reference:

Singh I, Singh N, Sharma N, Agarwal S, Tandon R. Strawberry scrotum (Idiopathic nodular scrotal calcinosis): Image in surgery. Indian J Surg, 2005;67:159. Go to reference
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Normal scrotum, Strawberry scrotum, Strawberry

Image from Wikimedia Commons

Image from Alone A, Wanjari MB. Pan Afr Med J. 2022.

Image from Wikimedia Commons

Doughnut cells

Under the light microscope in some cells of anaplastic large-cell lymphoma (ALCL) the nucleus is ring-shaped with a ‘central opening’ thus resembling a doughnut in look – doughnut cell.

ALCL is a rare cancer of the lymphocytes (the T-lymphocyte more precisely), a kind of white blood cell, thus the designation lymphoma. Anaplastic refers to cells that are abnormal in shape and function and large-cell pertains to the relatively big cells of this cancer.

Depending on individual circumstances treatment for ALCL can include, radiotherapy, chemotherapy, surgery, etc.

Reference:

Singh S, Gupta N, Tekta GR. Imprint cytology facilitating the diagnosis of primary cutaneous anaplastic large cell lymphoma of iliac fossa. J Cytol, 2012 29(4):267-9. Go to reference

Doughnut cell, doughnut

Image from Singh et al. J Cytol, 2012

Image from Wikimedia Commons

Herringbone pattern

Under the light microscope in classic cases of the soft tissue cancerous tumor fibrosarcoma, the cells are arranged like the way the branching spines of a herring skeleton are arranged – herringbone architecture.

An architecture in which a column of cells resembling one herring skeleton is oriented one way and another separate cell column again resembling the skeleton is disposed in a different direction. Under the microscope there can be several such columns.

Fibrosarcoma is a rare cancer typically afflicting adults and can be treated with surgery, radiation or chemotherapy. The soft tissues are those which support, connect or surround the body’s other structures.

Reference:

Folpe AL. Fibrosarcoma: a review and update. Histopathology. 2014 64(1):12-25. Go to reference

Herring, sarcoma

Image from Wikimedia Commons

Image from Wikimedia Commons

Image from Wikimedia Commons

Chocolate colored blood

Hemoglobin, the oxygen carrying molecule, normally exists predominantly in the ferrous state (Fe2+), which is its functional form. Hemoglobin can also exist in the ferric state (Fe3+), known as methemoglobin.

High concentrations of methemoglobin (methemoglobinemia) cause blood to appear brown and ‘chocolaty’ in color - chocolate colored blood.

Methemoglobin can occur because of heredity, exposure to drugs and chemicals.

Reference:

Ramanamurty SV. Methemoglobinemia: A Reappraisal with an Indian Perspective. Medicine Update 2013. Chapter 77. Available http://www.apiindia.org/medicine_update_2013/chap77.pdf Accessed 13 December 2014.

Blood, chocolate

Image from Wikimedia Commons

Image from Wikimedia Commons

Coffee bean nuclei

Brenner tumor (named after the German physician Fritz Brenner 1877 – 1969) is a rare ovarian tumor apparently derived from the surface epithelium – outer lining - of the ovary. The tumor is usually benign (not cancerous), but can occasionally be malignant (cancerous). Under the light microscope, the nuclei of Brenner tumor cells may have a longitudinal groove similar in look to the longitudinal groove of coffee beans – coffee bean nuclei.

Reference:

Borah T, Mahanta RK, Bora BD, Saikia S. Brenner tumor of ovary: An incidental finding. J Midlife Health. 2011 2(1):40-1. Go to reference

Brenner tumor, Coffee beans

 

Image from Wikimedia Commons

Image from Wikimedia Commons

Raisin-like nucleus

Scrapping cells off the cervix (neck of the womb) and analyzing them under the light microscope for changes that may point to the start of cancer of the cervix – Pap smear/test – has greatly reduced deaths from this cancer because treatment can be offered before the pre-cancerous changes worsen.

An abnormality that may be seen under the microscope is a cell nucleus that looks like a raisin (dried grape) – raisinoid nucleus.

The Pap smear - a screening method - is named after its inventor, the Greek doctor Georgios Papanikolaou (1883 – 1962). Most cases or cervical cancer are caused by sexually transmitted human papilloma viruses.

Reference:

Histology blog (HistoQuarterly). “Koilocytes have a clear halo around the nuclei, and the nuclei are raisinoid (literally look like raisins) [arrows] http://twitpic.com/cgp9ef” 3 Apr 2013, 8:37 a.m. Tweet. Go to reference

Pap smear/test and Raisins

Image from Wikimedia Commons

Image from Wikimedia Commons

Watered-down, fat-free milk

Ejecting fluid during sexual activity and orgasm is not usual for females. However, two physiologic (normal processes) have been described, squirting/gushing and female ejaculation. Squirting/gushing refers to the expulsion of a relativity large volume of clear fluid through the urethra (the tube that carries urine out of the body); this fluid originates from the urinary bladder and resembles diluted urine biochemically.

Female ejaculation refers to the passage of a white scanty fluid originating from the female prostate that resembles watered-down, fat-free milk; biochemically female ejaculate resembles semen except that it does not contain sperms.

The female prostate - previously called Skene’s paraurethral gland – surrounds the female urethra and empties into it or just beside it; about half to two thirds of women have a female prostate.

Reference

Rubio-Casillas A, Jannini EA. New insights from one case of female ejaculation. J Sex Med, 2011 8(12):3500-4. Go to reference

Milk, female prostate gland opening

Image from Wikimedia Commons

Image from Wikimedia Commons

Pancake brain

The front part of the brain, the forebrain also known as the prosencephalon normally separates into two halves (cerebral hemispheres) during the development of the unborn baby. Failure of the prosencephalon to separate leads to the rare disease, holoprosencephaly (HPE). The prosencephalon may fail to separate to different extents; where failure to separate is complete, alobar HPE results, which is the most severe form of HPE. The brain in alobar HPE resembles a pancake – pancake brain.
Instead of the normal two fluid-filled cavities in the front of the brain, in alobar HPE there is a single abnormal fluid-filled cavity; facial malformation frequently complicates HLE.

Cyclopia, arhinencephaly and DeMyer sequence are some of HPE’s synonyms.

Reference

Situ D, Reifel CW, Smith R, Lyons GW, Temkin R, Harper-Little C, Pang SC. Investigation of a cyclopic, human, term fetus by use of magnetic resonance imaging (MRI). J Anat, 2002 200(5):431-8. Go to reference
 

Pancakes, developing brain

 

Image from Wikimedia Commons

Image from Wikimedia Commons

Cherry red epiglottis

In the neck region the airway (larynx) and the passage (esophagus) for food, drink and so on  are near each other. If food and other material accidentally go into the airway death from airway obstruction can result.

The epiglottis is a flexible flap of tissue that prevents food and other material from going into the airway during swallowing. Due to for example, bacterial infection, the epiglottis and adjacent tissues can become (inflamed) swollen and red – cherry red epiglottis.

When inflamed, the epiglottis itself can obstruct the airway with fatal consequences; consequently visualizing the cherry red epiglottis should only be done for instance in an operating theatre with airway management specialists in attendance.

Vaccination with the Haemophilus influenzae type b (Hib) vaccine helps prevent epiglottitis (inflammation of the epiglottis) and other diseases caused by the bacterium Haemophilus influenzae.

Reference

Hung TY  et al. Bedside ultrasonography as a safe and effective tool to diagnose acute epiglottitis. Am J Emerg Med, 2011, 29(3):359.e1-3. Go to reference
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Epiglottis, Cherry

Image from Wikimedia Commons

Image from Wikimedia Commons

Salt and pepper retinopathy

Salt and pepper retinopathy refers to tiny light specks (hypopigmentation) interspersed among tiny dark specks (hyperpigmentation) that may be seen in those affected by the rubella virus when the eye’s back (retina) is viewed using special equipment.

These specks resemble salt and pepper in appearance – salt and pepper retinopathy. Besides rubella virus infection, syphilis and the toxic effects of some drugs can produce salt and pepper retinopathy. Salt and pepper retinopathy normally does not affect vision.

Vaccination of both males and females against the rubella virus helps prevent harmful effects of the rubella virus on the baby such as blindness, deafness, heart defects and other dreadful manifestations of the congenital rubella syndrome.

Please see also the celery-stick sign (click here).

Reference:

Damasceno N, Damasceno E, Souza E. Acquired unilateral rubella retinopathy in adult. Clin Ophthalmol, 2011 5:3-4. Go to reference
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Salt and pepper shakers, salt and paper retinopathy

Image from Wikimedia Commons

Image from the University of Michigan Kellogg Eye Centre

Carrot-shaped nuclei

Headache, vomiting and weakness can be the initial manifestations of medulloblastoma, the most common malignant brain tumor of childhood. The nuclei of some medulloblastomas when seen under the microscope can in shape remind you of carrots – carrot-shaped nuclei.

Medulloblastomas affect the cerebellum, a part of the brain concerned with fine-tuning movements but not initiating movements. At times medulloblastoma cells may spread to other regions via the cerebrospinal fluid, which is a clear colorless fluid surrounding the brain and spinal cord.

Surgery, radiotherapy and chemotherapy are forms of treatment for medulloblastoma.

Reference:

Kroh H, Bidziński J . Glial differentiation in medulloblastoma. Case report. Neuropatol Pol, 1993 31(1-2):75-82. Go to reference
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Carrots, Medulloblastoma (white blob)

Image from Wikimedia Commons

Image from Wikimedia Commons

Peaches and cream complexion

Located in the neck’s front region is the thyroid, a gland which produces and releases thyroid hormones that regulate the body’s metabolic rate.

A deficiency of thyroid hormones (hypothyroidism) can come about because of several reasons such as iodine deficiency (iodine is a component of thyroid hormones), destruction of the thyroid gland by disease or radiation, dysfunction of the structures which control the thyroid.

Individuals with hypothyroidism can gain weight, tolerate the cold poorly, be depressed, feel fatigued, have slow speech, menstrual cycle abnormalities, dry skin and in those with fair skin a complexion likened to peaches and cream – peaches and cream complexion.

Reference:

O'Callaghan JM, Bewick J, Paice A, Ng P. Stabbing? Cause. BMJ Case Rep, 2009;2009. pii: bcr12.2008.1312. Go to reference
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Peaches and cream

Image from Wikimedia Commons

Image from Wikimedia Commons