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

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

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

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

Cottage loaf sign (TAPVC)

The heart is one of the first organs to function; it begins to beat from about 5 weeks of pregnancy. Normally after birth, 4 pulmonary veins return oxygenated blood from the lungs to the heart’s left side. This blood is then pumped by the heart to the rest of the body.

During pregnancy, when the future baby’s heart is developing, abnormalities in the heart’s development can occur. One of these abnormalities is total anomalous pulmonary venous connection/drainage (TAPVC) where the 4 pulmonary veins do not drain into the heart’s left side.

Patients with TAPVC because of the abnormal internal anatomy may on chest X-ray have an appearance akin to a cottage loaf – cottage loaf sign.

Reference:

Somerville J, Grech V. The chest x-ray in congenital heart disease 1. Total anomalous pulmonary venous drainage and coarctation of the aorta. Images Paediatr Cardiol, 2009 11(1):7–9. Go to reference
Go to Improbabble version of this post

Panel A ‘Cottage loaf’, ‘snowman’ or ‘figure of 8’ heart shape due to total anomalous pulmonary venous drainage, image reproduced with kind permission of the Images in Pediatric Cardiology journal. Panel B Outline of cottage loaf. Panel C Cottage loaf (a rustic traditional English loaf of bread made with yeast and white flour) consisting of two parts, the upper part is smaller than the lower part, image from Wikimedia Commons the free media repository.

Omental cake

Ovarian cancer is difficult to discover because victims tend initially to have vague complaints such as feeling bloated, having urinary and bowel troubles.

Invasion of the peritoneum – a double layered membrane - that lines some of the intra-abdominal and pelvic organs by ovarian cancer cells can occur. Widespread peritoneal infiltration by these cancer cells may be seen for example on ultrasound scan and computed tomography images. In appearance, the infiltrated regions look like a cake – omental cake.
The omentum is part of the peritonuem.

Besides ovarian cancer, other cancers and conditions can cause omental cake.
Reference:

Wang KY, Lee WJ, Lin HJ. Omental cake. Int J Emerg Med, 2010 ;3(4):477-8 Go to reference

Ovarian cancer, peritoneum (red & blue)

Image from Wikimedia Commons

Image from Wikimedia Commons