About Jane Bennett Munro

I've published 6 Toni Day mysteries, 4 set in Twin Falls, Idaho, where I live, one on a cruise ship, and one in Long Beach, California. My main character, Dr. Toni Day, is a pathologist in a rural hospital, much like me. Murder under the Microscope came out in 2011, Too Much blood in 2012, Grievous Bodily Harm in 2013, Death by Autopsy in 2014, and The Body on the Lido Deck in 2016, and A Deadly Homecoming in 2018. My seventh, The Twelve Murders of Christmas, is currently going through publication.

Blood Under the Microscope

normal blood smearSince my books are named Murder under the Microscope and Too Much Blood, how about we look at blood, under the microscope?
Blood is composed of plasma and cells. Plasma is pretty boring, but the cells …ah, they’re another thing entirely. Beautiful to look at, delightful to behold.
Blood cells are made in the bone marrow. In the fetus and newborn, nearly every bone in the body is involved, but after that, it’s pretty much limited to the ribs, sternum, vertebrae, and hipbones.bone marrow H&E_edited-1 That’s why, when a patient has a bone marrow aspiration, it’s done either in the sternum or hip.
The process of blood cell production is called hematopoiesis. There are three types of cells made in the bone marrow: RBC precursors in marrowerythroid precursors in marrow_edited-1nucleated RBCerythroid, or red cells; myeloid precursors in marrow_edited-1myeloid, or white cells; megakaryocyte_edited-1and megakaryocytes, which make platelets.
Red cells carry hemoglobin, which binds oxygen from the lungs and releases it to the tissues of the body.
White cells fight infection.
Platelets help blood to clot when there’s an injury, so that one doesn’t bleed to death from every little cut or scrape.
The precursors to these cells live in the bone marrow, and are not supposed to be present in the blood. However, when things go wrong, there’s no telling what may show up there. The pathologist is sometimes called upon to review blood smears, and sometimes can give clues to the patient’s doctor as to what may be going on there. It’s like a detective gathering clues to solve a crime.
Only instead of murder, the crimes here are called things like anemia, polycythemia, leukopenia, leukocytosis, thrombocytopenia, thrombocytosis, and the mother of them all, pancytopenia. Then there are myelodysplastic syndromes, and myeloproliferative syndromes, and leukemias.
There is another type of cell found in the blood, but these cells are made in the lymph nodes, or other lymphoid tissue in the body. They fight infection too, by making antibodies. But they can also cause crimes against the body, that are called lymphomas. And they can affect the bone marrow too, to cause leukemias. Or just to interfere with its function by taking up too much space.
Pathologists are often called upon to look at a blood smear to evaluate the lymphocytes in the blood, and decide whether they represent leukemia, or just reactive change, say to something like infectious mononucleosis. Here’s an example of normal and reactive lymphocytes.blood smears
There is so much to talk about when discussing blood disorders that it’s way too much for just one blog.
So stay tuned to this station. There will be more blogs on this utterly fascinating subject.

A Polyp for Your Thoughts

 

 

A friend of mine had a colonoscopy recently.

“Did they find anything?” I asked him.

“They found a couple of polyps,” he said, “but they weren’t those cancerous ones.”

“What do you mean, they weren’t those cancerous ones?” I asked, being a pathologist, after all. “Were they hyperplastic or adenomatous?”

Naturally, his eyes glazed over and he just shrugged. 

“What did your doctor tell you they were?” I persisted.

“He just said they weren’t cancerous.”

“When did he say you should have another colonoscopy?”

“Two years from now.”

OK. What we have here is a failure to communicate. The vast majority of polyps aren’t cancerous. But there are some that can become cancerous, and some that never do, no matter how big they get.

The mere fact that my friend was advised to have another colonoscopy in two years told me that his polyps were the kind that can become cancerous. Otherwise, he wouldn’t have to have another colonoscopy for ten years.

ImageImage

The majority of colon polyps fall into two categories: hyperplastic (top) and adenomatous (bottom). There are a few other kinds of polyps, but these are the most common. Hyperplastic polyps have 0% risk of cancer. Adenomatous polyps have a 10% cancer risk, and the bigger they get, the bigger the risk.

Image

The first change in an adenomatous polyp is called high-grade dysplasia (above). It’s a premalignant change. If a polyp can be removed, and the dysplastic area is completely surrounded by benign colonic mucosa, that’s all that needs to be done.

But sometimes the dysplastic mucosa covers the stalk of the polyp.

Sometimes the dysplastic changes invade into the stalk of the polyp. That’s cancer.

When that happens, the patient must have a colon resection to be sure all the malignant tissue is gone, and that none of the cancer has involved lymph nodes. Usually a cancer that early hasn’t involved anything but the area right around the polyp.

What about my friend?

Well, I guess he’ll have to wait until his next colonoscopy, two years from now.

For right now, he doesn’t have cancer, and I guess that’s all he needs to know

Big Juicy Colons

Since the name of this blog is bigjuicycolon.com, I figured we may as well start with colon cancer. That and diverticulitis are the usual reasons colons get removed. Not the entire colon, mind you, just the affected part. It may look like the surgeon took more than he needed to, but surgeons have to be mindful of the vascular supply to the remaining colon. Everything that has the same vascular supply as the affected part has to be removed, or it will become gangrenous, and that will require another surgery.

colon cancer

colon cancer

Ever since Katie Couric’s husband Jay died of colon cancer at age 42, colon cancer has been pretty much out of the closet.  Colon cancer is one of the commonest cancers in this country, after lung and breast. Most colon cancers look pretty much like this. 

The surgeon needs to know that the margin is adequate. That’s why fresh colon resections come to pathology so that the pathologist can open them and measure how far the tumor is from the ends of the specimen. Especially when there is more than one tumor, which can happen. Here’s a colon with three!

colon w 3 cancers

And one of them is right in the margin.

Some specimens are pretty striking. Patients who use certain kinds of laxatives for years get this dark brown coloration of the mucosa, called melanosis. Notice that the small bowel, the polyps, and the cancer are not colored. That’s because they grow fast and don’t have enough time to get discolored.

colon with melanosis, a cancer, and polyps

colon with melanosis, a cancer, and polyps

Colon cancers nearly always start from polyps, also called adenomas. Here is an example of an adenoma.

colon polyp

colon polyp

Ever wonder what pathologists see when they look through the microscope? This slide shows the microscopic appearance of normal colon mucosa, or lining.

normal colon mucosa

normal colon mucosa

This slide shows cancer arising in an adenoma. Adenoma on the left, cancer on the right.

adenoma-carcinoma spectrum

adenoma-carcinoma spectrum

This is cancer too.

colon cancer micro

colon cancer micro

What do you think? Grossed out? I did warn you, you know. Me, I find this stuff fascinating.

Guess I wouldn’t be a pathologist if I didn’t.

Now, what do you want to see next?

Welcome to my new blog, bigjuicycolon.com!

munjan002_4x5I can just hear you all saying what a gross name for a blog! But there is a story behind it.

Those of you who have seen my appearances on Rise & Shine Idaho with Danielle and Nick to promote my first book, Murder Under the Microscope, might remember the conversation we had about why pathologists on TV are always doing autopsies. Well, the reason is, autopsies are interesting. There’s nothing interesting about watching somebody sitting at a microscope signing out surgicals all day. Of course, if I was to go into the histology lab and if I got, say, a big juicy colon … I never got to finish that sentence because both Danielle and Nick were majorly grossed out.

“Eww, I sure hope nobody’s eating breakfast!” they said.

But that didn’t stop them from mentioning it again at intervals during the rest of their program that morning. “Big juicy colon, huh? Bet those words have never been spoken on TV until today.”

Well, I’ve been on their show two more times, to promote my second and third books, Too Much Blood and Grievous Bodily Harm, and they always bring up the big juicy colon. I always threaten to create a website called bigjuicycolon.com.

Well, here it is.

I plan to use it as a platform in which to talk about things that happen in hospitals, which are big scary places for most people. I’ll tell you my stories, you tell me yours.

How’s that?

Tell me what’s on your mind.