쉐도잉 연습: 2025 Pathology Review: Practical Updates in Breast, Gastrointestinal and Genitourinary Pathology - YouTube로 영어 말하기 배우기

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I have the opportunity to talk about renal cell tumors,
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I have the opportunity to talk about renal cell tumors,
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which is one of my favorite topics.
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Feel free to reach out afterwards if you have any questions or anything like that.
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And of course, live, I'll be happy to answer any questions here. So first,
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let's just start off with sort of an introduction about renal
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cell tumors kind of go through in a pattern-based approach by some of the more common patterns,
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clear cell, papillary, and eosinophilic,
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and then talk about some other tumors.
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What's important about renal tumor pathology?
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Well, I think nowadays we might be asked to do more with less.
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That is, we might be asked to diagnose renal mass biopsies more regularly or perhaps biopsies from metastatic sites of renal cancer.
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And it may be tricky with just a very small visualization of the tumor.
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is a trend toward less aggressive management of renal tumors.
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So if you have a very small renal mass,
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there may be consideration for surveillance.
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And so the diagnosis that we make in a biopsy could be relevant for surveillance.
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And then there's increasing recognition that renal cell cancer is more than one disease.
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And trying to divide them into clear cell or non-clear cell types may be important for management purposes,
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especially when you have metastatic renal cancer.
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Clinicians would like to know ideally if we have a clear cell or non-clear cell tumor.
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So here's just an example of what might happen based on a renal mass biopsy.
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So say a renal mass biopsy is performed,
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this is from a publication in the Journal of Urology several years ago.
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If the histology is benign,
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like for example angiomyelipoma, then nothing further needs to be done.
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But if you have a very low-risk tumor like a chromophobe renal cell carcinoma or a low-grade papillary renal cell carcinoma,
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this algorithm suggests that active surveillance would be reasonable.
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As you have kind of intermediate risk tumors,
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like a clear cell of grade 1 to 2 or a higher grade papillary tumor,
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the algorithm kind of figures that depending on tumor size,
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if you have a very small size,
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that may be amenable to active surveillance.
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But as the size is larger,
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that may be a candidate for surgery.
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And then very high-risk tumors are kind of automatically a candidate for surgery,
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such as tumors that are grade three or urothelial carcinomas or comatoid or unclassified renal cell carcinomas.
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So just an example of what might happen based on renal mass biopsy.
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The way I kind of approach it is that if a renal mass biopsy is being done,
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it probably means that the clinicians are thinking of doing something different other than the routine resection of the renal mass.
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And so I should think about sort of the risk of the tumor
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and try to do my best to classify it into a specific box,
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whether it's a high or low risk tumor.
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So if you have a patient that perhaps is elderly with multiple comorbidities,
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that may be an indication for surveillance.
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So a biopsy might be done considering that surveillance would be undertaken for a patient who has perhaps not an extreme...
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We're going to do some sneaky cancers in gastric biopsies.
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Everyone's favorite topic.
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Puts hair on your chest.
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I have no conflicts to report and so today in this discussion we're going to focus on like two broad categories.
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Benign mimics of gastric cancer in biopsy samples.
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Talking about macrophages and epithelial mimics.
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And then carcinomas that simulate benign conditions both diffuse type and tubular type carcinomas.
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So let's start off with benign mimics of carcinoma.
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The major situation in which you're going to come up against benign repair type changes
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that simulate neoplasia are in the context of chemical gastropathy with ulcers.
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What happens is you'll, and there are a lot of different scenarios,
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the epithelial cell atypia related to repair,
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gastric xanthomas or macrophage responses to ruptured epithelial cells,
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sloughed mucus neck cells that simulate signet ring cell carcinoma,
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tissue processing artifacts, and mucosal ischemia.
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So you'll remember from a few days ago,
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chemical gastropathy, we see a diffuse alteration in the epithelial cell morphology
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and architecture without much inflammation to explain those So the pits are elongated
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and they're lined by cells that are cytoplasmically depleted with a nuclear enlargement and scattered mitotic activity.
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Most of the time what you can appreciate is
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that there's maturation of this epithelial cell atypia as you move to the surface of the mucosa.
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You can get into trouble when there are erosions in areas of extreme repair because that induces even more cytologic abnormalities,
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as you can see here.
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A few clues that you're dealing with a benign process.
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You see superficial fragments that do show maturation,
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and the overall proliferation respects the boundaries within the mucosa,
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so you'll see that there is a lobular architecture overall with preserved bundles of smooth muscle cells and vessels permeating the mucosa.
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Higher power, you can see some of that cytologic atypia over here.
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In general, I would say don't make a diagnosis of low-grade dysplasia
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and be very careful about a carcinoma diagnosis in the setting of chemical gastropathy with an erosion.
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My colleague Liz Montgomery some time ago published a paper talking about repair type atypia in Barrett esophagus
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and in the gastric mucosa and described what she calls the four lines of maturation in benign epithelium or non-neoplastic epithelium.
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And I think it's a helpful thing to keep in mind
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when you're approaching repair-type changes in the stomach and in the distal esophagus.
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And what she was talking about is when you have In this presentation,
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I will talk about breast pathology in the area of genomics.
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Molecular testing has been increasingly used in breast cancer diagnosis and treatment.
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In this presentation, I will use some case examples to illustrate how we use molecular testing to help us with tumor classification,
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diagnosis, and treatment.
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As a surgical pedologist, we don't have to personally do molecular testing,
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but it's important to know using it as a tool to help us interpreting difficult cases.
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So for two more classification,
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we talk about this in our triple negative breast cancer presentation.
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Certain special histological subtypes of carcinoma,
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breast carcinomas, have characteristic somatic genomic alterations.
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In difficult cases, we could use these alterations to help us to confirm the diagnosis.
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For example, I know cystic carcinoma has maybe NFIB rearrangement or maybe L1 rearrangement, maybe amplification.
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I don't always do this testing.
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If histologically is consistent, I'll go ahead and make the diagnosis.
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But in difficult cases, we can do in situ hybridization,
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sequencing analysis, or recently We have been using immunoskeministry as a surrogate to detect the genomic alteration.
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Another tumor is this one,
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secretory carcinoma, has characteristic ETV6 N-TRAC fusion.
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Again, we can use FISH or sequencing analysis or immunoskeministry for PANTRAC to confirm the diagnosis if histologically it's not classic,
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it's not definitive.
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This is another tumor with unique mutation profile we talk about.
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Tall cell carcinoma with reverse polarity has unique IDH2 R172 hotspot mutation.
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This can be detected by sequencing analysis or immunosupportism chemistry using mutation specific immunosupportism chemistry assay.
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So I don't want to repeat too much.
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I'll move on to case examples to show how we use molecular testing,
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helping us in diagnosis in difficult cases.
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So this case, a patient was a 40-year-old woman with rapidly growing mass in the breast,
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almost 5 centimeters at presentation.
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had a core biopsy diagnosis, proceeded with mastectomy.
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I'll show you some images from her mastectomy specimen.
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This is the...

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단계별 섀도잉 가이드

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  1. 비디오를 한 번 시청하세요: 전체 내용을 이해하는 것이 중요합니다.
  2. 일부분을 선택하세요: 주요 문구나 관심 있는 부분을 중심으로 합니다.
  3. 소리 내어 따라하세요: 연사와 함께 발음하고 억양을 배우세요. 'shadowspeaks'를 활용하여 연사의 발음을 따라가는 것도 좋습니다.
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쉐도잉이란? 영어 실력을 빠르게 키우는 과학적 방법

쉐도잉(Shadowing)은 원래 전문 통역사 훈련을 위해 개발된 언어 학습 기법으로, 다언어 학자인 Dr. Alexander Arguelles에 의해 대중화된 방법입니다. 핵심 원리는 간단하지만 매우 강력합니다: 원어민의 영어를 들으면서 1~2초의 짧은 지연으로 즉시 소리 내어 따라 말하는 것——마치 '그림자(shadow)'처럼 화자를 따라가는 것입니다. 문법 공부나 수동적인 청취와 달리, 쉐도잉은 뇌와 입 근육이 동시에 실시간으로 영어를 처리하고 재현하도록 훈련합니다. 연구에 따르면 이 방법은 발음 정확도, 억양, 리듬, 연음, 청취력, 말하기 유창성을 크게 향상시킵니다. IELTS 스피킹 준비와 자연스러운 영어 소통을 원하는 분들에게 특히 효과적입니다.

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