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Example 1

Prompt

Identify and enumerate all the anatomic nouns in the following text. For each noun provide a brief definition in layman terms.

Text to summarize:PATHOLOGIC DIAGNOSIS

SCAN IMPRESSION: Negative, essentially normal bone scan, with nonspecific increased activity in right ankle and foot; markedly enlarged right kidney.

GROSS:

BONE SCAN

DOSE: 8.0 Millicuries diphosphonate.

ADMISSION DIAGNOSIS: Right kidney mass.

BRIEF CLINICAL HISTORY:

Patient had selective renal arteriogram, 4/5/76, which demonstrated a large vascular tumor of the right kidney suggestive of a Wilm’s tumor.

SCAN DESCRIPTION:

This is a technetium polyphosphate bone scan. The study includes standard anterior and posterior views of major skeletal structures with lateral views of the skull and cervical spine. The scan appears entirely normal except that the right kidney is greatly enlarged, perhaps, 2.5 to 3 times the size of the left kidney. Also, in the region of the right ankle and foot there is increased diffuse activity, perhaps in soft tissue. The epiphyses are prominent in both ankles as well as in other long bones. The activity in the right foot and ankle does not appear to represent metastatic disease. The etiology of this is uncertain.

Response

  1. bone: The hard, rigid connective tissue that forms the framework of the body and provides support and protection for the organs.
  2. scan: A medical imaging technique that creates pictures of the inside of the body to diagnose or monitor a condition.
  3. impression:The initial observation or interpretation made by a healthcare professional based on a medical test or examination.
  4. activity: The level of functioning or movement of a body part or system.
  5. ankle: The joint connecting the lower leg and the foot.
  6. foot: The terminal part of the leg where weight is placed and the body is supported during standing and walking.
  7. kidney: An organ in the abdominal cavity responsible for filtering waste products and excess fluids from the blood to form urine.
  8. diphosphonate: A type of medication that helps to strengthen bones and reduce bone loss.
  9. diagnosis: The identification of a disease or condition based on signs, symptoms, and medical tests.
  10. mass: An abnormally large growth or tumor located in the body.
  11. arteriogram: A medical procedure that uses X-rays and a contrast dye to visualize the blood vessels.
  12. tumor: An abnormal growth of cells that can be benign (non-cancerous) or malignant (cancerous).
  13. technetium: A radioactive substance used in medical imaging procedures.
  14. polyphosphate: A type of compound that is used in certain medical procedures or treatments.
  15. soft tissue: The non-bony parts of the body, including muscles, tendons, ligaments, and organs.
  16. epiphyses: The ends of long bones where growth occurs.
  17. metastatic disease: The spread of cancer from its original site to other parts of the body.

Example 2

Prompt

Identify and enumerate all the possible diagnoses in the following text. For each diagnosis provide a brief definition in layman terms.

Text to summarize:PATHOLOGIC DIAGNOSIS

SCAN IMPRESSION: Negative, essentially normal bone scan, with nonspecific increased activity in right ankle and foot; markedly enlarged right kidney.

GROSS:

BONE SCAN

DOSE: 8.0 Millicuries diphosphonate.

ADMISSION DIAGNOSIS: Right kidney mass.

BRIEF CLINICAL HISTORY:

Patient had selective renal arteriogram, 4/5/76, which demonstrated a large vascular tumor of the right kidney suggestive of a Wilm’s tumor.

SCAN DESCRIPTION:

This is a technetium polyphosphate bone scan. The study includes standard anterior and posterior views of major skeletal structures with lateral views of the skull and cervical spine. The scan appears entirely normal except that the right kidney is greatly enlarged, perhaps, 2.5 to 3 times the size of the left kidney. Also, in the region of the right ankle and foot there is increased diffuse activity, perhaps in soft tissue. The epiphyses are prominent in both ankles as well as in other long bones. The activity in the right foot and ankle does not appear to represent metastatic disease. The etiology of this is uncertain.

Response

Possible diagnoses:

  1. Right kidney mass: The patient has a mass in their right kidney, which is a tumor that has formed in the kidney.

  2. Wilm’s tumor: The arteriogram suggested a tumor in the right kidney that may be indicative of Wilm’s tumor, a rare kidney cancer that primarily affects children.

  3. Enlarged right kidney: The right kidney is significantly larger in size compared to the left kidney.

  4. Non-specific increased activity in right ankle and foot: There is increased diffuse activity in the soft tissue of the right ankle and foot, but it is not clear what is causing it.

  5. Uncertain etiology: The cause of the increased activity in the right ankle and foot is unknown.

Example 3

Identify and enumerate all the possible diagnoses in the following text. For each diagnosis provide a brief definition in layman terms.

Text to summarize:Operations: Radical right nephrectomy with lymp- adenectomy; exploration of the left kidney.

Surgeon: Dr. A. W. M.

Preop. Diagnosis: Right Wilms’ tumor with (?) spread to the vena cava.

Postop. Diagnosis: Right Wilms’ tumor with no spread to the cava.

PROCEDURE:

The patient was taken to the operating room where general anesthesia was administered. He was placed flat on his back and was prepped and draped in the standard manner. A chevron incision was used carrying the right limb farther across than the left. This was carried through all layers. We then very carefully visually inspected the liver and palpated it and found that there was nothing to suggest metastatic spread into the liver. Palpating along the great vessels failed to reveal anything suggestive of nodal spread, and we then proceeded to mobilize the hepatic flexure of the colon. We divided the peritoneum lateral to the colon and mobilized the entire thing off the tumor. We found that this came very easily with nothing to suggest spread directly from the kidney into the adjacent colon. We then carried the dissection plane over to the vena cava, kocherizing the duodenum in the process. We then very carefully dissected down the right lateral margin of the vena cava until we found the right renal vein. By means of very careful dissection we were then able to mobilize the right renal artery. Each of these in turn starting with the artery was tied with a #2-0 silk. We then carried the dissection on down to vena cava, extending it beneath the cava and over the top of the cava over as far as the aorta. As we carried the resection down onto the iliac artery and vein, we found that there was a very vascular plexus surrounding the right ureter and we ligated each of the component parts in turn and ligated the ureter after dividing this mass. We then carried the resection up the back of the right kidney, clipping or tying bleeding points when encountered. It was possible to control the blood supply on this tumor before we palpated or mobilized the kidney in any fashion. We took pains to carefully clip the lymphatics as we did our dissection down the great vessels. We then accomplished the resection by coming around the upper portion of the kidney. We used clips and cut between the clips, coming around the adrenal and the adrenal was delivered with the tumor. We doubly clamped the artery and vein and then cut between-the-clamps and put a suture ligature of #2-0 silk on the stump of both the vein and the artery. The tumor was then delivered from the wound. It was taken to a back table where it was cut and found to be a typical Wilms’ tumor which had almost totally replaced the kidney. Bleeding was completely controlled. It was necessary to place a suture of #6-0 Prolene on one bleeding point on the cava, but this controlled it nicely.

When satisfied that there was no further bleeding, we placed the colon back into its appropriate place and tacked it in place with some interrupted #4-0 silk. We then mobilized the left colon and completely stripped Gerota’s fascia away form the left kidney. We were able to visualize and palpate the entire kidney and found that there was nothing to suggest tumor there.

We then placed the Georta’s fascia back around the kidney and placed the left colon back in place. A nasogastric tube was passed and the position was checked in the kidney. We then closed the wound with the inner two layers of muscles closed as a single layer with interrupted #0 Ethiflex placed in a figure-of-eight fashion. The outer muscular layer was closed with a running #0 ccg. suture. The wound was irrigated with Neomycin Bacitracin following which the subcutaneous tissue was closed with running #3-0 plain and skin clips were used to close the wound. No drains were used.

The patient tolerated the procedure well and was returned to the recovery room in good condition.

Response

Possible diagnoses:

  1. Wilms’ tumor
  2. Metastatic spread to the vena cava

Prompt

Repeat of previous prompt

Response

Possible diagnoses in the text:

  1. Right Wilms’ tumor: A type of kidney cancer that primarily affects children. It typically starts in one kidney but can spread to other parts of the body.

  2. Spread to the vena cava: The large vein that carries deoxygenated blood from the lower body back to the heart. Spread of the tumor to the vena cava means that the cancer cells have migrated to or invaded this major blood vessel.

  3. Metastatic spread: The spread of malignant cancer cells from the primary tumor to other parts of the body, often through the bloodstream or lymphatic system.

  4. Nodal spread: The spread of cancer cells to nearby lymph nodes, which are part of the immune system’s filtering system.

  5. Radical right nephrectomy: The surgical removal of the entire right kidney, along with adjacent lymph nodes and surrounding tissues, to treat the tumor.

  6. Lympadenectomy: The surgical removal of lymph nodes to check for the presence of cancer cells and prevent further spread.

  7. Exploration of the left kidney: A thorough examination of the left kidney to check for the presence of the tumor or any signs of cancer.

Note: The postoperative diagnosis confirms that the right Wilms’ tumor was present but did not spread to the vena cava.

Prompt

Repeat of previous prompt

Response

Possible diagnoses:

  1. Right Wilms’ tumor with no spread to the vena cava - This is the postoperative diagnosis, meaning that the initial suspicion of the tumor spreading into the vena cava was not confirmed during the surgery.

Definitions:

  • Wilms’ tumor: A type of kidney cancer that primarily affects children. It is characterized by the formation of a tumor in one or both kidneys.
  • Vena cava: A large vein that carries deoxygenated blood from the lower body to the heart.

No further diagnoses can be identified from the given text.

Prompt

Repeat of previous prompt

Response

Possible diagnoses:

  1. Right Wilms’ tumor with (?) spread to the vena cava

Definition: A type of kidney cancer that primarily affects children. It is characterized by the presence of a tumor in the kidney. In this case, there is suspicion of the tumor spreading to the vena cava, a large vein that carries blood to the heart.

  1. No spread of the tumor to the vena cava

Definition: The tumor has been removed successfully and there is no evidence of it spreading to the vena cava.

Note: The postoperative diagnosis confirms that the tumor was present in the right kidney, but further spread to the vena cava was not found during the surgery.

Example 4

Prompt

What anatomic locations were the tumor located in?

Text to consider:CLINICAL DIAGNOSIS

Right Renal Tumor

TISSUE SITE AND LOCATION

Rt Kidney

PATHOLOGIC DIAGNOSIS

Wilms’s tumor of right kidney(see micro for margins).

GROSS:

The specimen labelled “right kidney,” consists of a kidney and subcutaneous tissues weighing 285 grams. The kidney has been opened and reveals a large yellow centrally necrotic tumor measuring 6 cm. in diameter. There is a maximum of 12 mm. of renal tissue surrounding this lesion. The tumor, itself, is yellow-tan and appears to have cystic areas within it. There is a central area of hemorrhage and necrosis. The tumor appears to be well surrounded by renal tissues. The ureter is identified and no gross evidence of tumor seen within it although the tumor almost totally fills the renal pelvis. A representative section of the distal end will be submitted and labelled #1. When opened from the ureteral surface the lesion is seen to sit within the calyceal and pelvic structures causing a dilatation in some of the calyceal areas. The artery and vein are also identified and are found to be free of tumor grossly. There are occasional small lymph nodes within the hilar adipose tissue. None of these contain tumor grossly. Also with the adipose tissue on the capsule is the right adrenal measuring 4 x 2.4 x 1.0 cm.

MICROSCOPIC:

Microscopically the sections of tumor reveal essentially two cellular types. The majority of the cells are large spindle shaped cells with vesicular nuclei. The other cell type is mainly around the small vascular structures and is composed of smaller cells with more densely hyperchromatic nuclei. Definite embryonic glomeruli or tubular structures are not identified although multiple sections of the lesion are taken. In many areas there are small pseudotubular type formations and some linear pattern of cell nuclei suggestive an attempt at tubular formation. The majority of the lesion reveals the immature spindle cell stroma. There are large areas of necrotic tissues and prominent vascular structures throughout the lesion. On the microscopic sections the tumor appears to be definitely enclosed within the kideny. The narrowest margin is in the renal pelvis where the tumor extends to within an estimated 2 mm. or the thickness of the pelvis wall to separate it from the surrounding perirenal fat. Sections of the ureter are free of malignancy. Benign transitional cells are seen to line the fibromuscular structure. The sections of the renal artery and vein also are free of tumor as are the surrounding adipose and fibrous tissues. The sections of the lymph nodes found within the hilar area reveal hyperplastic lymph nodes with no evidence of any malignancy. The section of the adrenal reveals unremarkable adrenal tissue with no evidence of malignancy within the adrenal or within the surrounding adipose tissues.

COMMENT:

The sections are shown at the weekly pathologist’s conference because of the failure of the tumor to form the embryonic glomeruli and tubular structures. The department is in agreement that although these features are missing the attempt at forming the structures seen within the stroma and the characteristic appearance of the stroma, that this is, indeed, a Wilms’s tumor.

Response

The tumor was located in the right kidney.

Example 5

Prompt

What anatomic locations were the tumor located in? Were there locations that were examined and found to be tumor-free?

Text to consider:CLINICAL DIAGNOSIS

Right Renal Tumor

TISSUE SITE AND LOCATION

Rt Kidney

PATHOLOGIC DIAGNOSIS

Wilms’s tumor of right kidney(see micro for margins).

GROSS:

The specimen labelled “right kidney,” consists of a kidney and subcutaneous tissues weighing 285 grams. The kidney has been opened and reveals a large yellow centrally necrotic tumor measuring 6 cm. in diameter. There is a maximum of 12 mm. of renal tissue surrounding this lesion. The tumor, itself, is yellow-tan and appears to have cystic areas within it. There is a central area of hemorrhage and necrosis. The tumor appears to be well surrounded by renal tissues. The ureter is identified and no gross evidence of tumor seen within it although the tumor almost totally fills the renal pelvis. A representative section of the distal end will be submitted and labelled #1. When opened from the ureteral surface the lesion is seen to sit within the calyceal and pelvic structures causing a dilatation in some of the calyceal areas. The artery and vein are also identified and are found to be free of tumor grossly. There are occasional small lymph nodes within the hilar adipose tissue. None of these contain tumor grossly. Also with the adipose tissue on the capsule is the right adrenal measuring 4 x 2.4 x 1.0 cm.

MICROSCOPIC:

Microscopically the sections of tumor reveal essentially two cellular types. The majority of the cells are large spindle shaped cells with vesicular nuclei. The other cell type is mainly around the small vascular structures and is composed of smaller cells with more densely hyperchromatic nuclei. Definite embryonic glomeruli or tubular structures are not identified although multiple sections of the lesion are taken. In many areas there are small pseudotubular type formations and some linear pattern of cell nuclei suggestive an attempt at tubular formation. The majority of the lesion reveals the immature spindle cell stroma. There are large areas of necrotic tissues and prominent vascular structures throughout the lesion. On the microscopic sections the tumor appears to be definitely enclosed within the kideny. The narrowest margin is in the renal pelvis where the tumor extends to within an estimated 2 mm. or the thickness of the pelvis wall to separate it from the surrounding perirenal fat. Sections of the ureter are free of malignancy. Benign transitional cells are seen to line the fibromuscular structure. The sections of the renal artery and vein also are free of tumor as are the surrounding adipose and fibrous tissues. The sections of the lymph nodes found within the hilar area reveal hyperplastic lymph nodes with no evidence of any malignancy. The section of the adrenal reveals unremarkable adrenal tissue with no evidence of malignancy within the adrenal or within the surrounding adipose tissues.

COMMENT:

The sections are shown at the weekly pathologist’s conference because of the failure of the tumor to form the embryonic glomeruli and tubular structures. The department is in agreement that although these features are missing the attempt at forming the structures seen within the stroma and the characteristic appearance of the stroma, that this is, indeed, a Wilms’s tumor.

Response

The tumor was located in the right kidney. The surrounding renal tissues, including the renal artery and vein, were examined and found to be tumor-free. The ureter was also examined and found to be free of tumor, although the tumor almost completely filled the renal pelvis. Small lymph nodes within the hilar adipose tissue were examined and found to be tumor-free. The right adrenal, located in the adipose tissue on the capsule, was also examined and found to be tumor-free.

Example 6

Prompt

What anatomic locations were the tumor located in? Were there locations that were examined and found to be tumor-free? Create a list, sorted by anatomic location.

Text to consider: CLINICAL DIAGNOSIS

Right Renal Tumor

TISSUE SITE AND LOCATION

Rt Kidney

PATHOLOGIC DIAGNOSIS

Wilms’s tumor of right kidney(see micro for margins).

GROSS:

The specimen labelled “right kidney,” consists of a kidney and subcutaneous tissues weighing 285 grams. The kidney has been opened and reveals a large yellow centrally necrotic tumor measuring 6 cm. in diameter. There is a maximum of 12 mm. of renal tissue surrounding this lesion. The tumor, itself, is yellow-tan and appears to have cystic areas within it. There is a central area of hemorrhage and necrosis. The tumor appears to be well surrounded by renal tissues. The ureter is identified and no gross evidence of tumor seen within it although the tumor almost totally fills the renal pelvis. A representative section of the distal end will be submitted and labelled #1. When opened from the ureteral surface the lesion is seen to sit within the calyceal and pelvic structures causing a dilatation in some of the calyceal areas. The artery and vein are also identified and are found to be free of tumor grossly. There are occasional small lymph nodes within the hilar adipose tissue. None of these contain tumor grossly. Also with the adipose tissue on the capsule is the right adrenal measuring 4 x 2.4 x 1.0 cm.

MICROSCOPIC:

Microscopically the sections of tumor reveal essentially two cellular types. The majority of the cells are large spindle shaped cells with vesicular nuclei. The other cell type is mainly around the small vascular structures and is composed of smaller cells with more densely hyperchromatic nuclei. Definite embryonic glomeruli or tubular structures are not identified although multiple sections of the lesion are taken. In many areas there are small pseudotubular type formations and some linear pattern of cell nuclei suggestive an attempt at tubular formation. The majority of the lesion reveals the immature spindle cell stroma. There are large areas of necrotic tissues and prominent vascular structures throughout the lesion. On the microscopic sections the tumor appears to be definitely enclosed within the kideny. The narrowest margin is in the renal pelvis where the tumor extends to within an estimated 2 mm. or the thickness of the pelvis wall to separate it from the surrounding perirenal fat. Sections of the ureter are free of malignancy. Benign transitional cells are seen to line the fibromuscular structure. The sections of the renal artery and vein also are free of tumor as are the surrounding adipose and fibrous tissues. The sections of the lymph nodes found within the hilar area reveal hyperplastic lymph nodes with no evidence of any malignancy. The section of the adrenal reveals unremarkable adrenal tissue with no evidence of malignancy within the adrenal or within the surrounding adipose tissues.

COMMENT:

The sections are shown at the weekly pathologist’s conference because of the failure of the tumor to form the embryonic glomeruli and tubular structures. The department is in agreement that although these features are missing the attempt at forming the structures seen within the stroma and the characteristic appearance of the stroma, that this is, indeed, a Wilms’s tumor.

Response

The tumor was located in the right kidney. Locations that were examined and found to be tumor-free include:

  1. Renal artery
  2. Renal vein
  3. Surrounding renal tissue
  4. Ureter
  5. Lymph nodes within the hilar adipose tissue
  6. Adrenal gland and surrounding adipose tissues.