#8220;It looks just like blue cheese, doesn’t it?” About 15 of my medical school classmates and I were in a group pathology discussion. The subject was lung infections. “Blue cheese” was the pathologist’s assessment of a tuberculosis lung lesion. The lesion is referred to as a caseating, or cheese-like, granuloma, and the blue cheese description was spot on. In an autopsy specimen, you see a blue-and-white marbled chunk where lung tissue should have been.
“I was planning to have blue cheese on my salad for lunch,” I whispered to the friend sitting next to me, “but now I’m not so sure.”
A few weeks before, a second-year medical student had told me that pathology would ruin food for me. I had no idea what he meant until that moment. He’d even given me specific examples, which in the spirit of medical student curiosity I decided to look up. Between his examples and the tubercular lung lesion, I go to class more equipped. I also have a menu.
Currant jelly sputum We’d already encountered this one, but I wanted to know more. This vibrant, viscous substance — compared to the jelly of red currant berries — is made up of blood, mucus, and other debris. The cause is pneumonia provoked specifically by the bacteria Klebsiella pneumoniae, which gives the coughed up sputum its less-than-appetizing look.
Popcorn cells These are a subtype of Reed-Steinberg cells seen in Hodgkin’s lymphoma. On a slide, the nucleus of this cell is larger than usual, with any number of lobes that make the cell look puffed up and fluffy, just like a kernel of popcorn.
Fried egg appearance In a bone marrow biopsy of hairy cell leukemia, you’ll see giant white oval spaces (the “fried eggs”) surrounded by purple-stained cells. The so-called “eggs” don’t have a yolk, but they’re the right shape.
Chocolate cysts This description refers to endometriomas, a kind of ovarian cyst. They’re filled with a thick, dark brown liquid that looks to me just like Hershey’s chocolate syrup. Seeing a specimen photo, I had one single, crystal clear thought: “I do not want to see one of these ruptured.”
Nutmeg liver When the liver doesn’t get the blood supply it needs, its normal reddish-brown tissue can become mottled with dark spots. This can happen in a number of conditions, including right heart failure. The result allegedly resembles the dark striations of a halved nutmeg kernel, but honestly I don’t see it.
Bunch of grapes That description can refer to a number of conditions. One of them is the appearance of bronchiectasis on a CT scan. Bronchiectasis is a condition in which the airways are permanently dilated, often after chronic lung infections. On a normal CT scan, the lungs are a gunmetal gray, almost black, laced with white, tendril-like airways. In bronchiectasis, you see cartoonish grapes — clustered, widened rings of white surrounding pitch black orbs.
Strawberry tongue Usually, strep throat is easily resolved through antibiotics. But a very small percentage of people with strep, usually between ages five and 15, can get scarlet fever, which may show itself with “strawberry tongue.” In these cases, the tongue becomes engorged and ruby red. In some of the pictures I’ve seen, the tongue is studded with bumps that look almost like seeds — maybe it’s how the taste buds appear in this condition; I’m not sure. Whatever the cause, it looks very unpleasant.
The need to use commonly understood analogies, including food, to describe not-so-common things makes sense. It’s certainly not unique to pathologists — we all do it. (Though usually, these comparisons don’t provoke such a visceral reaction.) Out of all these pathology analogies, the two that disturbed me the most — and most turned my stomach —were the caseating (cheese-like) tuberculosis lesion and the chocolate cysts. But cheese and chocolate are two of my most treasured foods. I can’t imagine letting a pathology specimen or image, no matter how disconcerting, keep me from them. So right after our pathology discussion, I returned to my apartment and made that salad for lunch — with extra blue cheese for good measure.