August 2012
Cytopathology and More

‘I was great and gorgeous’

Ann T. Moriarty, MD

“What a great case!” my pathologist exclaimed as she first reviewed all 10 of my parts under the microscope. I had been growing slowly, in a warm, subcutaneous location, until my life changed abruptly. I suddenly found myself flowing through a small caliber stainless steel tunnel as I was rapidly aspirated, smeared between two glass slides, and unceremoniously dunked into ethanol. Part of me was left out to dry. After being delivered to a well-lit, organized laboratory, I was carefully stained with a Papanicolaou stain that left me a riotous kaleidoscope of green, purple, pink, and orange, and given a matching modified Giemsa stain that gave me a general purple hue. After that, I had been covered in glass after being swathed in a permanent mounting media. I was gorgeous (if I do say so myself) and apparently worth a second look. I was passed around the department so all the cytologists could appreciate my features.

After my debut, I was carefully filed into a study set where I languished in the darkness for years. After 10 years, I was scheduled to be discarded with all my neighbors, to make room for a new generation. My pathologist was pained to see me leave, as I had managed to increase the expertise of the entire laboratory. But the time had come for me to move to glass disposal.

At the last minute, I was carefully culled from the discard stack, packaged lovingly along with my history before I became glass, and sent by mail to a wonderful world called the College of American Pathologists. It was at the CAP that I came into my true purpose as glass. First, I was given a number. Then I was reviewed by a CAP cytotechnologist who understood what a treasure I was (and I had been stored so well that I had not faded or aged at all over 10 years). The cytotechnologist took all my information and me along with about 2,000 other interesting new neighbors to something called a Cytopathology Committee meeting. Over the course of four days, at least three American-Board-of-Pathology–certified anatomic pathologists scrutinized me and my compatriots. They unanimously agreed that I was a truly great case and was going to play a role in three different programs for the CAP.

First, I was going to get some enhancements. The special stains performed on my cell block were going to be photographed and electronically stored in the computer system at the CAP. Then all my parts were going to be digitized so I could be virtual glass and immortalized as a great case, in case my parts became too faded or (heaven help me) broken. Once I was sent to virtual heaven, I would circulate as a pair to as many laboratories that subscribed to an educational interlaboratory comparison program. Any cytotechnologist or pathologist who received me could go online and see my special stains. After successfully identifying me and understanding the importance of my ancillary stains, they could answer a short scored assessment and receive educational credits to maintain their certification or fulfill their educational requirements for credentialing or licensure. I was proudly teaching in my field, once again.

The most exciting turn of events happened with my virtual reincarnation. I was released as an online challenge that could be viewed by hundreds of people simultaneously. In that life, the viewers saw me on their computer screens and got to make a general diagnosis and then to choose the special stains accompanying me. It was like being reborn with each viewing. The cytologists got to “work me up” just like my original brilliant pathologist had when she first encountered me. Once they had all the available ancillary information, the participants would make the most specific diagnosis they could. Then they have the opportunity to prove they learned from me by passing an assessment. I was a great teacher.

Not only am I now electronically immortal, but I have gone on to have an impact on the whole field of pathology, as more and more people have had a chance to view my parts. My original pathologist was brilliant to have shared me with her colleagues in the United States and internationally. My glass has been to 18 different countries and my virtual self has beamed all around the world. Who would have thought that a mere lump could have had such a great legacy? I am a truly great case.

If you have great cases to share with the world, be a brilliant pathologist and share them. Donations for the nongynecologic and fine-needle aspiration glass slide and virtual programs are being accepted (gynecologic cases welcome too). Donation forms and instructions can be obtained from the CAP Web site or by calling Larry Flennoy at 847-832-7275 or 800-323-4040 ext. 7275. Donors are reimbursed for their clerical expenses when donating slides to any CAP program.