The world of pathology encompasses a broad spectrum of diseases beyond the boundaries of specialties, with each disease having specific and interesting gross and microscopic features. Some of these features are pattern-based, while others are eponyms that compare them to objects, food, animals, etc., due to their striking resemblance and quick recall. Medical nomenclature is of vital importance, and it has significantly evolved historically, with etymological roots from Latin, Greek, and Roman languages of ancient times to the current internationally uniform codes of English and other modern languages. Eponyms are valuable medical literary epithets that have been used across specialties and include animal names, food names, discoverer names, geographic references, and more. The subject of pathology, in particular, has immense use of eponyms as they are valuable tools for assisting in adult learning, or andragogy. The specialty of pathology is unique in its complex patterns and diagnostic algorithm, always in need of alternate systems to arrive at quick and accurate diagnosis. Also known as intuitive thinking or reflex thinking, pattern viewing and eponyms trigger a reflex recognition system, reducing recall time and aiding in precise diagnosis. The present article aimed to review the terminological phenomenon of animal eponym usage in the context of pathological diagnosis.
Background of Study
An eponym, by definition, is a place, person, or thing after which something is named or thought to be named. It holds a privilege of its own in various specialties, including pathology. Eponyms are valuable tools for initiating pattern recognition and reflex/intuitive thinking to aid in adult learning, as well as facilitating easy recall and precise diagnosis [1]. An attempt has been made to incorporate known eponyms into the world of pathology after an extensive literature search.
Antler horn pattern in skin-Delicate digitate downgrowth of the epidermal layer with melanocytic hyperplasia at the tip, giving the resemblance of an antler-like pattern seen in Dowling-Degos disease [2].
Antler horn pattern in breast cytology-Sheets and branching clusters of cohesive ductal epithelial cells with an antler horn pattern seen in fine-needle aspiration cytology of fibroadenoma [Table/Fig-1] [3].
Fine needle aspirate cytology showing benign ductal epithelial cell clusters branching in antler horn pattern in a case of fibroadenoma (H&E stain 40x).
(Swarm of) Bees-Perifollicular inflammation predominantly, peribulbar infiltrates of lymphocytes seen around the anagen hair follicles in alopecia areata [4].
Bull’s eye inclusions-Central Periodic Schiiff’s Reagent (PAS)-positive round inclusions in the cells seen in malignant effusions, giving a target or bull’s eye appearance [5].
Butterfly sitting on a fence appearance-Arrangement of neoplastic cells on either side of the alveolar septa resembling a butterfly sitting on a fence, seen in adenocarcinoma lung; lepidic variant (earlier called bronchoalveolar carcinoma) [Table/Fig-2] [6].
Neoplastic cells in lung adenocarcinoma arranged along the alveolar septa giving a "Butterfly sitting on a fence" appearance (H&E stain 40x).
Camel foot-In chronic plaque psoriasis, rete pegs elongate into the dermis and take a plunge to accommodate the increasing basal cell population, giving rise to a camel foot appearance to dermal rete ridges [Table/Fig-3] [7].
Skin showing rete pegs elongate into the dermis and take a plunge to accommodate the increasing basal cell population giving rise to camel foot appearance in chronic plaque psoriasis (H&E stain 40x).
Caterpillar chromatin-Macrophage with an ovoid nucleus and chromatin condensed toward the center of the nucleus in a wavy rod-like pattern that resembles a caterpillar, seen in rheumatic heart disease [8].
Chicken fat clot-The yellowish part of the postmortem clot which is cell-free [9].
Chicken wire calcification-Thin lacy chicken wire-like calcification seen in chondroblastoma [10].
Chicken wire vasculature-Thin chicken wire-like arrangement of small-sized thin-walled vessels in oligodendroglioma [11].
CLAM-Clustering- constrained- attention multiple- instance learning (CLAM) uses attention-based learning to identify subregions of high diagnostic value to accurately classify whole slides in Whole Slide Imaging (WSI) [12].
Claw clutching ball-Well-circumscribed granulomatous infiltrate composed of lymphocytes, epithelioid cells, and occasional Langhans’ giant cells that are clutched by surrounding claw-shaped hyperplastic rete ridges, seen in Lichen Nitidus [Table/Fig-4] [13].
Hyperplastic rete ridges clutching the superficial dermal infiltrate of lymphocytes and epithelioid cells (H&E stain,40x) resembling a Claw clutching a ball.
CRAB criteria-Multiple myeloma defining events comprising Hypercalcemia, Renal insufficiency, Anaemia, and Bone lytic lesions (CRAB).
Crab-Crab-like streaks of chalky white elastic stroma penetrating surrounding stroma seen in the breast in cases of Infiltrating ductal carcinoma of no special type [Table/Fig-5] [14].
Crab-like white streaks of infiltrating duct carcinoma, invading into the surrounding elastotic stroma of the breast.
Cor bovinum-Heart with massive left ventricular hypertrophy seen in tertiary syphilis, chronic aortic regurgitation, and ischemic heart disease [15].
DOG1-Discovered on GIST 1-It is a sensitive and specific marker for gastrointestinal stromal tumour [16].
Feathery growth-Spindle stellate cells arranged in a loose fascicular to storiform pattern in nodular fasciitis [17].
Feline oesophagus-Trachealisation of the oesophagus on gross examination, characterised by concentric rings on the mucosal side of the oesophagus. It is seen in association with gastroesophageal reflux disease and hiatus hernia [18].
Fishnet appearance-Intercellular Immunoglobulin (Ig)G and C3 deposits in the epidermis seen in direct immunofluorescence in cases of pemphigus vulgaris [19].
Fish flesh appearance-Smooth, slightly bulging, pale tan to grey-white colour on the cut surface in lymphomas and soft-tissue sarcomas [Table/Fig-6] [20].
Cut surface of the lymphnode showing homogenous, bulging fish flesh appearance, in a case of lymphoma.
(School of) Fish-Spindle cell proliferation of endothelial cells in a fascicular pattern in Kaposi sarcoma has been likened to a school of fish. The spindle cells infiltrate through the collagen, forming slit-like spaces, especially towards the periphery of the lesions [21].
(School of) Fish-Enlarged cohesive sheets of cells with a “school of fish” architecture in reactive/regenerative changes in cervical cytology [22].
Fish mouth appearance-Narrowing of the mitral valve in rheumatic heart disease seen as a fish mouth deformity when viewed from the ventricular aspect into the atrium [23].
Flea-bitten kidney-Pinpoint haemorrhages on the external surface of the kidney in malignant nephrosclerosis and hyperacute rejection [24].
Hedgehog signaling pathway-First identified in Drosophila, the common fruit fly, represents a highly conserved evolutionary pathway of signal transmission from the cell membrane to the nucleus, playing a major role in carcinogenesis [25].
Herringbone pattern-Arrangement of neoplastic spindle cells in long sweeping fascicles forming a fish skeleton pattern in fibrosarcoma [26].
Hippo signaling-Is an evolutionarily conserved network that plays a central role in regulating cell proliferation and cell fate to control organ growth and regeneration [27].
Horseshoe kidney-A common renal fusion anomaly characterised by the fusion of two kidneys at one of the poles due to abnormal migration of nephrogenic rests [Table/Fig-7] [28].
Specimen of bilateral kidneys showing abnormal fusion in the lower pole with horseshoe appearance.
Horseshoe nucleus-Langhans type multinucleate giant cell showing nuclei arranged peripherally in a horseshoe shape, seen in tuberculosis [Table/Fig-8] [29].
Langhan type of multinucleate giant cell with nuclei arranged along the periphery in a horseshoe shape (H&E stain 40x).
LAMB syndrome-Includes Lentigines, Atrial myxoma, Mucocutaneous myxoma, and Blue nevi (LAMB) [30].
Leopard skin-Like colonic mucosa- Gross appearance of colonic mucosa in chronic granulomatous disease due to pigment-laden macrophages giving rise to brown dots across oedematous yellow colonic mucosa [31].
Moth-eaten appearance-Destruction of soft tissue or bone giving rise to a moth-eaten appearance in alopecia (secondary syphilis) and lytic lesions of bone [32].
Octopus sign-Fibrosis in pulmonary Langerhans cell histiocytosis histologically comprises a central scar with septal strands and associated airspace enlargement that give rise to an octopus-like appearance [33].
Owl eye inclusions-Large ovoid or pleomorphic nucleus with basophilic intranuclear inclusions (Cowdry bodies) surrounded by a clear halo [34].
Owl eye nuclei-Reed-Sternberg cell showing a bilobed nucleus with a prominent eosinophilic nucleolus and perinucleolar halo giving it an owl-eye appearance [Table/Fig-9] [35].
Reed-Sternberg cells of Hodgkin’s Lymphoma showing mirror image binucleation with prominent eosinphilic nucleoli and perinucleolar halo, giving a striking resemblance to owl eye (H&E stain 40x).
Pachydermia (elephant skin)-Abnormal thickening of the skin like that of a pachyderm (a tough-skinned animal like an elephant), seen in pachydermatoperiostosis and elephantiasis [36].
Phrynoderma (Toad skin)-Follicular hyperkeratosis with keratin plugs accompanied by sebaceous atrophy due to nutritional deficiency giving rise to toad-like skin [36].
Pulmonary Interstitial Glycogenosis (PIG) syndrome-A form of pulmonary interstitial disease characterised by diffuse expansion of the alveolar interstitium by glycogenated mesenchymal cells, seen in babies [37].
Salmon pink-Salmon-pink coloured amorphous acellular deposits of amyloid in Congo red stain in amyloidosis [38].
Snail expression-Zinc finger protein SNAI1, a family of transcription factors that promote the repression of the adhesion molecule E-cadherin to regulate Epithelial to Mesenchymal Transition (EMT) during embryonic development [39].
Snail track ulcer-Painless or painful erythematous lesions, greyish-white mucous patches, or irregular linear erosions coalescing to form snail track ulcers in syphilis [15].
Snake-like fashion-Renal cell carcinoma invading the renal vein and ascending up the inferior vena cava in a snake-like pattern [40].
Spider angioma-A vascular lesion characterised by anomalous dilatation of end vasculature found just beneath the skin surface. The lesion contains a central red spot and reddish extensions that radiate outward like a spider’s web, seen due to the vasodilatory effects of alcohol and hyperestrogenism in cirrhosis [41].
Staghorn nucleus- Megakaryocytes in essential thrombocythemia with dysplastic staghorn-like branching nuclei [42].
Staghorn vasculature-Capillaries or small-sized thin-walled vessels branching in a staghorn pattern in solitary fibrous tumours and hemangiopericytoma [42].
Staghorn calculus-Staghorn renal stones are large kidney stones that fill the renal pelvis and atleast one renal calyx. They are also called triple phosphate stones and are composed of struvite (magnesium ammonium phosphate) [Table/Fig-10].
A large stone in the renal pelvis which is hard and creamy white in color branching along the renal pelvicalyceal architecture giving a stag horn appearance.
Tadpole cells-Neoplastic squamous cells with a tadpole shape seen in cervical cytology in squamous cell carcinoma of the cervix [43].
Tadpole pattern-In syringoma, neoplastic strands of eccrine glands arranged in tadpole-shaped strands are best appreciated at low power [44].
Tigered effect-Describes the fatty change seen in the liver and myocardium. Microscopically and grossly, the lipid accumulation leads to normal-appearing tissue parenchyma interspersed with yellowish areas showing intracellular lipid. It is known to be seen in the liver in steatosis and in the myocardium due to hypoxia [45].
Tigroid background-Seen in cytology smears of seminoma characterised by the presence of a relatively granular, reticulated material in the background, giving it a foamy, lazy tiger-striped appearance [46].
Ugly duckling sign-Nevi in an individual generally tend to share a similar appearance, so one that does not share the same characteristics should be considered for biopsy [30].
Wolf-like/butterfly rash-Facial symmetric erythematous rash seen in systemic lupus erythematosus resembling a wolf bite/butterfly wings [47].
Zebra bodies-Deposits of lamellate, lipid-like, electron-dense material forming concentric bodies in the cytoplasm of podocytes and endothelial cells in glomerular and peritubular capillaries-in Fabry disease [48].
Conclusion(s)
Constant training of one’s neural networks in recognising pathways and patterns in pathology can be an uphill task. Employing the use of literary tools like eponym usage can prove to be an interesting methodology in acquiring reflexive thinking in adult learning. The present article integrates and highlights the role of pattern recognition using animal eponyms. Students and young consultants alike will benefit from the usage of these eponyms during routine reporting and medical education.
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