S3Ep5: Sometimes It’s a Zebra: Unusual Cases in Surgical Pathology—with Dr. Cesar Moran

In medicine, we’re taught to recognize hoofbeats as horses rather than zebras. But what happens when a surgical pathology diagnosis really is a zebra? 

What is the best way to approach a challenging case? And how do you know when to ask for help? 

On this episode of Inside the Lab, our hosts, Ms. Kelly Swails, MT(ASCP), and Dr. Ali Brown, MD, FASCP, are joined by Dr. Cesar Moran, MD, Tenured Professor of Pathology at the University of Texas MD Anderson Cancer Center, to share some of the most challenging surgical pathology cases he’s faced. 

Dr. Moran describes three different types of difficult cases and discusses what to do when a tumor appears to be a new entity. Listen in for Dr. Moran’s insight on fighting against the bias of your default diagnosis and get his advice on how to know when you don’t know and ask your colleagues for help.  

Topics Covered 
· Dr. Moran’s take on the 3 different types of challenging surgical pathology cases
· How the expectations for surgical pathologists to provide a diagnosis have risen exponentially
· The volume of tissue issue in thoracic pathology
· Dr. Moran’s approach to a challenging surgical pathology case
· What to do when a tumor appears to be a new entity
· Why pathologists are unlikely to be replaced by technology
· How the diagnostic tools for surgical pathologists have evolved from electron microscopy to immunohistochemistry to molecular studies
· Examples of the most challenging cases Dr. Moran has faced in his career
· Why it’s challenging to consider unusual possibilities when you come in with a default diagnosis
· How to fight against the bias of default diagnosis
· Why Dr. Moran considers benign diagnoses to be the most difficult ones
· Dr. Moran’s advice for practicing pathologists on when to ask colleagues for help

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Connect with Dr. Moran
Dr. Moran at MD Anderson
Dr. Moran on LinkedIn 

Connect with Ms. Swails & Dr. Brown
 Ms. Swails on Twitter
Dr. Brown on Twitter 

Resources
Become a Member of ASCP
‘Xanthomatous Thymoma: A Clinicopathologic and Immunohistochemical Study of 10 Cases’ in the American Journal of Clinical Pathology
Inside the Lab in the ASCP Store