Abstract
Social media has become a powerful tool within the field of pathology. Many pathologists, trainees, and pathology-interested medical students worldwide utilize social media platforms like Twitter to connect, collaborate, and engage in high-quality education. Although virtual journal clubs and case unknown discussions are well-documented utilities of social media within pathology, pathologists and other physicians rarely post their own surgical cases on social media for others to learn from. This case report represents a novel presentation of a pathologist who took to social media (#PathTwitter) to share her gross and histopathologic findings from a mass removed from her neck. Her example demonstrates how physicians, albeit at their own discretion, may be able to leverage social media to provide teaching points to medical students and trainees while using themselves as medical examples.
Introduction
Pathology’s presence in social media has grown in the past decade [1]. From Facebook to YouTube, social media has become a proven ground for pathologists, trainees, and medical students of all ages [2] to connect, collaborate, and engage in free, fellowship-level education worldwide [3]. A common way that this engagement occurs is through hashtags, where users add a “#” in front of a word or phrase to help characterize their content (such as “#PathTwitter” for pathology-related posts) [4]. Twitter has become a stapled platform for pathologists due to its user-friendly interface, widespread audience, and ease of integrating multimedia in posts (such as images, videos, and links). Although many pathologists may still be weary of social media use in the field due to medicolegal concerns, the Health Insurance Portability and Accountability Act (HIPAA) of 1996 permits the public sharing of deidentified pathology images without patient consent on these platforms [5]. However, what does HIPAA say regarding pathologists sharing identifiable pathology images from themselves as patients on social media? We present a novel case of a pathologist who courageously took to social media to present her pathology images after undergoing surgery for a cystic neck mass.
Pathology’s presence in social media has grown in the past decade [1]. From Facebook to YouTube, social media has become a proven ground for pathologists, trainees, and medical students of all ages [2] to connect, collaborate, and engage in free, fellowship-level education worldwide [3]. A common way that this engagement occurs is through hashtags, where users add a “#” in front of a word or phrase to help characterize their content (such as “#PathTwitter” for pathology-related posts) [4]. Twitter has become a stapled platform for pathologists due to its user-friendly interface, widespread audience, and ease of integrating multimedia in posts (such as images, videos, and links). Although many pathologists may still be weary of social media use in the field due to medicolegal concerns, the Health Insurance Portability and Accountability Act (HIPAA) of 1996 permits the public sharing of deidentified pathology images without patient consent on these platforms [5]. However, what does HIPAA say regarding pathologists sharing identifiable pathology images from themselves as patients on social media? We present a novel case of a pathologist who courageously took to social media to present her pathology images after undergoing surgery for a cystic neck mass.
Case
(As told by PO)
(As told by PO)
I first noticed swelling in the right lateral neck of my neck 4 years ago when I was under intense stress (see Figure 1). I was in my mid-40s at the time. The neck mass was initially evaluated by ultrasonography which showed a 3-centimeter-long nodular lesion with smooth borders in front of the carotid artery. It appeared to be dense and cystic, but septa were present and demonstrated vascularization, and this lesion was evaluated soon after on magnetic resonance imaging (MRI, see Figure 2). A preliminary diagnosis of branchial cyst was made, but a fine-needle aspiration of the neck mass was performed to exclude a metastatic malignancy. In cytology samples obtained, abundant histiocytes, keratinous oily material, and keratinocytes were observed, but carcinoma or malignancy was not apparent (see Figure 3).
I waited 3 years but developed tinnitus during this timespan, as well as increased pressure in my neck and discomfort while sleeping. In May 2022, the cyst reached a length of 4.5 centimeters on ultrasonography. The decision to pursue surgery was made. The nodular cystic lesion, which was present around the third branchial arch, was successfully removed without complications and sent to the pathology laboratory for further evaluation. Gross examination revealed a cystic lesion with a thin wall and yellow cheesy material (see Figure 4). Histopathologically, the inner surface of the cystic lesion was surrounded by dense lymphoid tissue and stratified squamous epithelium at a rate of 96-97%. Few bronchial epithelia were seen, and the cyst was septated (see Figure 5). Pathology confirmed the diagnosis of a branchial cyst, and I have not had a recurrence of the mass since its removal.
I posted my case with pathology images and discussion on PathTwitter on December 2, 2022, which can be found at the link here (see Figures 6-9): https://twitter.com/pembeoltulu/status/1598776100540121090.
Discussion
This case report has two discussion points that are important to highlight. The first is that the senior author (PO) of this report, who is a board-certified pathologist, is also the patient described in the “Case” section. Very few case reports discuss the physician as the patient, but they do exist in the current literature [6-9]. As stated previously, this pathologist's diagnosis was not uncommon. Branchial cysts (or branchial cleft cysts) are congenital anomalies of branchial arches derived from persistent cervical sinuses [10]. They can be classified in multiple ways, including by the arch of origin (Work Classification, 1972) and topography (Bailey, 1929). Although these cysts are congenital, they may not appear until the second or third decades of life, often during times of stress or inflammation.
Clinically, they often present as well-circumscribed, cystic masses anterior to the sternocleidomastoid muscle. They may be tender if acutely inflamed, such as in the setting of acute upper airway infections, and are typically not life-threatening. However, complications such as carotid sinus syndrome [11] and airway compromise [12] have been documented. Ultrasonography tends to show a well-defined cystic lesion with posterior acoustic enhancement and thin walls. Since the fluid content of these cysts includes protein, they appear hypersignalled on T1 and T2 MRI sequences. Histologically, squamous multilayered epithelium with much surrounding lymphoid tissue and germinal centers or respiratory epithelium may be present. Inflammatory infiltrates, keratosis, and necrotic content may also be visualized. Surgery is often curative, and cysts may develop malignant transformation over time if left untreated [13]. Of note, approximately 3-24% of lateral cystic neck masses are malignant, but Yehuda et al. [14] found this percentage to increase to up to 80% in adults over age 40.
The second, and novel of the two discussion points, is that the pathologist (and patient), took to Twitter to share her story and pathology images from her case (as seen in the figures included). Twitter is a free social media platform widely used within the pathology community due to its ease of user interface, accessibility for sharing multimedia, and its ability for global collaboration/information sharing [4]. Cima et al. [15] have found that reporting cases on social media-based platforms such as Twitter serves as an appropriate alternative to traditional journal-based case reporting, which has steadily decreased over the past decade. Furthermore, Ho et al. [16] have effectively demonstrated how case reporting on Knowledge In Knowledge Out, or "KiKo", is a novel approach to intersecting social media and peer review in a format that efficiently promotes scholarly contribution by both authors and reviewers.
Although her diagnosis is not uncommon, PO’s bravery in disclosing her condition, surgery findings, and histologic evaluation in this manner is inspirational, especially as she used her case as an example for younger colleagues to learn from and refine their histopathologic differentials of head and neck cystic lesions. She even tagged fellow Twitter users (denoted by “@” symbols in Figures 6-9) using pathology content-related hashtags, such as “#PathTwitter” and “#HeadandNeckPath” (see Figures 7-9). Yes, at the core of pathology (and medicine) lies science: understanding biomolecular interactions, pathophysiologic mechanisms of disease manifestations, evidence-based decision-making regarding the most appropriate diagnostic guidelines and therapies for varying diagnoses, etc. While medicine/science is meant to be objective and non-emotional, however, physicians (including pathologists) work in emotional environments as they make clinical decisions daily for the betterment of patient safety.
Even though little is known about how positive or negative emotions may influence physician decision-making, Heyhoe et al. [17] argue that "the tendency to view clinical practice as a purely rational [non-emotional] process hinders consideration of the potential impact of emotion on healthcare safety". At the end of the day, physicians are also humans, and their work (albeit, based on "rational and considered thought" per Heyhoe et al. [17]) is emotional as they deal with feelings of pain, joy, anxiety, etc., on a day-to-day basis. While further empirical studies are needed to show the exact impact of emotion on medical decision-making [17], we cannot neglect the importance of how PO's decision, as the physician patient, to share her story and experiences on social media allowed her to demonstrate her emotion and vulnerability as a human living with a medical condition.
Having said all this, are there negatives to this style of patient-initiated case reporting? Potentially. Physicians undergo years of rigorous training to become objective observers of medical diagnostics, management, and clinical judgment. Thus, physician patients are more likely to elicit accurate histories and are better able to decipher clinical information to come to correct (or best) interpretations of medical findings regarding their conditions (such as PO in this case). On the other hand, non-physician patients may be less accurate regarding the medical interpretation of their clinical findings because they simply do not have the same or similar amount of rigorous, objective training that physician patients may have. This can lead to misleading information. Subsequently, large volumes of non-physician patient-initiated case reporting on social media or in peer-reviewed journals could lead to ethical dilemmas as reported data may be inaccurate and jeopardize clinical interpretation in everyday practice [18].
This case report has two discussion points that are important to highlight. The first is that the senior author (PO) of this report, who is a board-certified pathologist, is also the patient described in the “Case” section. Very few case reports discuss the physician as the patient, but they do exist in the current literature [6-9]. As stated previously, this pathologist's diagnosis was not uncommon. Branchial cysts (or branchial cleft cysts) are congenital anomalies of branchial arches derived from persistent cervical sinuses [10]. They can be classified in multiple ways, including by the arch of origin (Work Classification, 1972) and topography (Bailey, 1929). Although these cysts are congenital, they may not appear until the second or third decades of life, often during times of stress or inflammation.
Clinically, they often present as well-circumscribed, cystic masses anterior to the sternocleidomastoid muscle. They may be tender if acutely inflamed, such as in the setting of acute upper airway infections, and are typically not life-threatening. However, complications such as carotid sinus syndrome [11] and airway compromise [12] have been documented. Ultrasonography tends to show a well-defined cystic lesion with posterior acoustic enhancement and thin walls. Since the fluid content of these cysts includes protein, they appear hypersignalled on T1 and T2 MRI sequences. Histologically, squamous multilayered epithelium with much surrounding lymphoid tissue and germinal centers or respiratory epithelium may be present. Inflammatory infiltrates, keratosis, and necrotic content may also be visualized. Surgery is often curative, and cysts may develop malignant transformation over time if left untreated [13]. Of note, approximately 3-24% of lateral cystic neck masses are malignant, but Yehuda et al. [14] found this percentage to increase to up to 80% in adults over age 40.
The second, and novel of the two discussion points, is that the pathologist (and patient), took to Twitter to share her story and pathology images from her case (as seen in the figures included). Twitter is a free social media platform widely used within the pathology community due to its ease of user interface, accessibility for sharing multimedia, and its ability for global collaboration/information sharing [4]. Cima et al. [15] have found that reporting cases on social media-based platforms such as Twitter serves as an appropriate alternative to traditional journal-based case reporting, which has steadily decreased over the past decade. Furthermore, Ho et al. [16] have effectively demonstrated how case reporting on Knowledge In Knowledge Out, or "KiKo", is a novel approach to intersecting social media and peer review in a format that efficiently promotes scholarly contribution by both authors and reviewers.
Although her diagnosis is not uncommon, PO’s bravery in disclosing her condition, surgery findings, and histologic evaluation in this manner is inspirational, especially as she used her case as an example for younger colleagues to learn from and refine their histopathologic differentials of head and neck cystic lesions. She even tagged fellow Twitter users (denoted by “@” symbols in Figures 6-9) using pathology content-related hashtags, such as “#PathTwitter” and “#HeadandNeckPath” (see Figures 7-9). Yes, at the core of pathology (and medicine) lies science: understanding biomolecular interactions, pathophysiologic mechanisms of disease manifestations, evidence-based decision-making regarding the most appropriate diagnostic guidelines and therapies for varying diagnoses, etc. While medicine/science is meant to be objective and non-emotional, however, physicians (including pathologists) work in emotional environments as they make clinical decisions daily for the betterment of patient safety.
Even though little is known about how positive or negative emotions may influence physician decision-making, Heyhoe et al. [17] argue that "the tendency to view clinical practice as a purely rational [non-emotional] process hinders consideration of the potential impact of emotion on healthcare safety". At the end of the day, physicians are also humans, and their work (albeit, based on "rational and considered thought" per Heyhoe et al. [17]) is emotional as they deal with feelings of pain, joy, anxiety, etc., on a day-to-day basis. While further empirical studies are needed to show the exact impact of emotion on medical decision-making [17], we cannot neglect the importance of how PO's decision, as the physician patient, to share her story and experiences on social media allowed her to demonstrate her emotion and vulnerability as a human living with a medical condition.
Having said all this, are there negatives to this style of patient-initiated case reporting? Potentially. Physicians undergo years of rigorous training to become objective observers of medical diagnostics, management, and clinical judgment. Thus, physician patients are more likely to elicit accurate histories and are better able to decipher clinical information to come to correct (or best) interpretations of medical findings regarding their conditions (such as PO in this case). On the other hand, non-physician patients may be less accurate regarding the medical interpretation of their clinical findings because they simply do not have the same or similar amount of rigorous, objective training that physician patients may have. This can lead to misleading information. Subsequently, large volumes of non-physician patient-initiated case reporting on social media or in peer-reviewed journals could lead to ethical dilemmas as reported data may be inaccurate and jeopardize clinical interpretation in everyday practice [18].
Conclusion
We believe this is the first case report where an author/physician is the patient described, while also utilizing social media as an educational tool for sharing his or her story (with appropriate images). This case report demonstrates how social media may be positively used by physicians and patients to share their stories (as long as they feel comfortable doing so) for the purpose of helping others learn.
Conflicts of Interest
We believe this is the first case report where an author/physician is the patient described, while also utilizing social media as an educational tool for sharing his or her story (with appropriate images). This case report demonstrates how social media may be positively used by physicians and patients to share their stories (as long as they feel comfortable doing so) for the purpose of helping others learn.
Conflicts of Interest
Casey Schukow is an Ambassador for KiKo but he does not receive financial compensation for this position.
References
1. Isom J, Walsh M, Gardner JM. Social Media and Pathology: Where Are We Now and Why Does it Matter? Adv Anat Pathol. 2017 Sep;24(5):294-303. doi: 10.1097/PAP.0000000000000159. PMID: 28719442.
2. Gardner JM, McKee PH. Social Media Use for Pathologists of All Ages. Arch Pathol Lab Med. 2019 Mar;143(3):282-286. doi: 10.5858/arpa.2018-0431-ED. PMID: 30816833.
3. Folaranmi OO, Ibiyeye KM, Odetunde OA, Kerr DA. The Influence of Social Media in Promoting Knowledge Acquisition and Pathology Excellence in Nigeria. Front Med (Lausanne). 2022 Jun 3;9:906950. doi: 10.3389/fmed.2022.906950. PMID: 35721068; PMCID: PMC9203859.
4. Schukow CP, Booth AL, Mirza KM, Jajosky RP. #PathTwitter: A Positive Platform Where Medical Students Can Engage the Pathology Community. Arch Pathol Lab Med. 2023 Feb 1;147(2):135-136. doi: 10.5858/arpa.2022-0282-ED. PMID: 36453869.
5. Gardner JM, Allen TC. Keep Calm and Tweet On: Legal and Ethical Considerations for Pathologists Using Social Media. Arch Pathol Lab Med. 2019 Jan;143(1):75-80. doi: 10.5858/arpa.2018-0313-SA. Epub 2018 Aug 22. PMID: 30132683.
6. Haver B. When a doctor becomes a patient with a mystery illness: a case report. Case Rep Med. 2010;2010:565980. doi: 10.1155/2010/565980. Epub 2010 Jul 4. PMID: 20671956; PMCID: PMC2910477.
7. Brown SL. When the Doctor Becomes the Patient. JACC Heart Fail. 2019 Jun;7(6):527-530. doi: 10.1016/j.jchf.2019.03.006. PMID: 31146876.
8. Knuti KA, Wharton RH, Wharton KL, Chabner BA, Lynch TJ Jr, Penson RT. Living as a cancer surpriser: a doctor tells his story. Oncologist. 2003;8(1):108-22. doi: 10.1634/theoncologist.8-1-108. PMID: 12604737.
9. Tierney WM, McKinley ED. When the physician-researcher gets cancer: understanding cancer, its treatment, and quality of life from the patient's perspective. Med Care. 2002 Jun;40(6 Suppl):III20-7. PMID: 12064753.
10. Vrînceanu D, Sajin M, Dumitru M, Mogoantă CA, Cergan R, Georgescu MG. Current approach to branchial remnants in the neck. Rom J Morphol Embryol. 2022 Jul-Sep;63(3):485-490. doi: 10.47162/RJME.63.3.02. PMID: 36588486; PMCID: PMC9926148.
11. Yam SDF, Fung TLD, Tang LCD. Life-threatening Cardiac Failure: A Rare Complication of Branchial
Cleft Cyst. Int J Head Neck Surg. 2014;5(3):158-160. doi: 10.5005/jp-journals-10001-1205.
12. Schmidt K, Leal A, McGill T, Jacob R. Rapidly enlarging neck mass in a neonate causing airway compromise. Proc (Bayl Univ Med Cent). 2016 Apr;29(2):183-4. doi: 10.1080/08998280.2016.11929409. PMID: 27034563; PMCID: PMC4790565.
13. Colella G, Boschetti CE, Spuntarelli C, De Cicco D, Cozzolino I, Montella M, Tartaro G. Primary branchiogenic carcinoma: malignant degeneration of a branchial cyst, a case report. Cancer Rep (Hoboken). 2021 Apr;4(2):e1315. doi: 10.1002/cnr2.1315. Epub 2020 Dec 9. PMID: 33295154; PMCID: PMC8451376.
14. Yehuda M, Schechter ME, Abu-Ghanem N, Golan G, Horowitz G, Fliss DM, Abu-Ghanem S. The incidence of malignancy in clinically benign cystic lesions of the lateral neck: our experience and proposed diagnostic algorithm. Eur Arch Otorhinolaryngol. 2018 Mar;275(3):767-773. doi: 10.1007/s00405-017-4855-6. Epub 2017 Dec 27. PMID: 29282522.
15. Cima L, Pagliuca F, Torresani E, Polonia A, Eloy C, Dhanasekeran V, Mannan R, Gamba Torrez S, Mirabassi N, Cassisa A, Palicelli A, Barbareschi M. Decline of case reports in pathology and their renewal in the digital age: an analysis of publication trends over four decades. J Clin Pathol. 2023 Feb;76(2):76-81. doi: 10.1136/jcp-2022-208626. Epub 2022 Dec 16. PMID: 36526332.
16. Ho J, Lapham D, Gardner J. The KiKo Case Report Platform - What if we re-imagined the entire scholarly communications industry? KiKo Case Reports [Internet]. 2023 February; Available from: https://kikoxp.com/posts/21259.
17. Heyhoe J, Birks Y, Harrison R, O'Hara JK, Cracknell A, Lawton R. The role of emotion in patient safety: Are we brave enough to scratch beneath the surface? J R Soc Med. 2016 Feb;109(2):52-8. doi: 10.1177/0141076815620614. Epub 2015 Dec 18. PMID: 26682568; PMCID: PMC4793767.
18. Denecke K, Bamidis P, Bond C, Gabarron E, Househ M, Lau AY, Mayer MA, Merolli M, Hansen M. Ethical Issues of Social Media Usage in Healthcare. Yearb Med Inform. 2015 Aug 13;10(1):137-47. doi: 10.15265/IY-2015-001. PMID: 26293861; PMCID: PMC4587037.
1. Isom J, Walsh M, Gardner JM. Social Media and Pathology: Where Are We Now and Why Does it Matter? Adv Anat Pathol. 2017 Sep;24(5):294-303. doi: 10.1097/PAP.0000000000000159. PMID: 28719442.
2. Gardner JM, McKee PH. Social Media Use for Pathologists of All Ages. Arch Pathol Lab Med. 2019 Mar;143(3):282-286. doi: 10.5858/arpa.2018-0431-ED. PMID: 30816833.
3. Folaranmi OO, Ibiyeye KM, Odetunde OA, Kerr DA. The Influence of Social Media in Promoting Knowledge Acquisition and Pathology Excellence in Nigeria. Front Med (Lausanne). 2022 Jun 3;9:906950. doi: 10.3389/fmed.2022.906950. PMID: 35721068; PMCID: PMC9203859.
4. Schukow CP, Booth AL, Mirza KM, Jajosky RP. #PathTwitter: A Positive Platform Where Medical Students Can Engage the Pathology Community. Arch Pathol Lab Med. 2023 Feb 1;147(2):135-136. doi: 10.5858/arpa.2022-0282-ED. PMID: 36453869.
5. Gardner JM, Allen TC. Keep Calm and Tweet On: Legal and Ethical Considerations for Pathologists Using Social Media. Arch Pathol Lab Med. 2019 Jan;143(1):75-80. doi: 10.5858/arpa.2018-0313-SA. Epub 2018 Aug 22. PMID: 30132683.
6. Haver B. When a doctor becomes a patient with a mystery illness: a case report. Case Rep Med. 2010;2010:565980. doi: 10.1155/2010/565980. Epub 2010 Jul 4. PMID: 20671956; PMCID: PMC2910477.
7. Brown SL. When the Doctor Becomes the Patient. JACC Heart Fail. 2019 Jun;7(6):527-530. doi: 10.1016/j.jchf.2019.03.006. PMID: 31146876.
8. Knuti KA, Wharton RH, Wharton KL, Chabner BA, Lynch TJ Jr, Penson RT. Living as a cancer surpriser: a doctor tells his story. Oncologist. 2003;8(1):108-22. doi: 10.1634/theoncologist.8-1-108. PMID: 12604737.
9. Tierney WM, McKinley ED. When the physician-researcher gets cancer: understanding cancer, its treatment, and quality of life from the patient's perspective. Med Care. 2002 Jun;40(6 Suppl):III20-7. PMID: 12064753.
10. Vrînceanu D, Sajin M, Dumitru M, Mogoantă CA, Cergan R, Georgescu MG. Current approach to branchial remnants in the neck. Rom J Morphol Embryol. 2022 Jul-Sep;63(3):485-490. doi: 10.47162/RJME.63.3.02. PMID: 36588486; PMCID: PMC9926148.
11. Yam SDF, Fung TLD, Tang LCD. Life-threatening Cardiac Failure: A Rare Complication of Branchial
Cleft Cyst. Int J Head Neck Surg. 2014;5(3):158-160. doi: 10.5005/jp-journals-10001-1205.
12. Schmidt K, Leal A, McGill T, Jacob R. Rapidly enlarging neck mass in a neonate causing airway compromise. Proc (Bayl Univ Med Cent). 2016 Apr;29(2):183-4. doi: 10.1080/08998280.2016.11929409. PMID: 27034563; PMCID: PMC4790565.
13. Colella G, Boschetti CE, Spuntarelli C, De Cicco D, Cozzolino I, Montella M, Tartaro G. Primary branchiogenic carcinoma: malignant degeneration of a branchial cyst, a case report. Cancer Rep (Hoboken). 2021 Apr;4(2):e1315. doi: 10.1002/cnr2.1315. Epub 2020 Dec 9. PMID: 33295154; PMCID: PMC8451376.
14. Yehuda M, Schechter ME, Abu-Ghanem N, Golan G, Horowitz G, Fliss DM, Abu-Ghanem S. The incidence of malignancy in clinically benign cystic lesions of the lateral neck: our experience and proposed diagnostic algorithm. Eur Arch Otorhinolaryngol. 2018 Mar;275(3):767-773. doi: 10.1007/s00405-017-4855-6. Epub 2017 Dec 27. PMID: 29282522.
15. Cima L, Pagliuca F, Torresani E, Polonia A, Eloy C, Dhanasekeran V, Mannan R, Gamba Torrez S, Mirabassi N, Cassisa A, Palicelli A, Barbareschi M. Decline of case reports in pathology and their renewal in the digital age: an analysis of publication trends over four decades. J Clin Pathol. 2023 Feb;76(2):76-81. doi: 10.1136/jcp-2022-208626. Epub 2022 Dec 16. PMID: 36526332.
16. Ho J, Lapham D, Gardner J. The KiKo Case Report Platform - What if we re-imagined the entire scholarly communications industry? KiKo Case Reports [Internet]. 2023 February; Available from: https://kikoxp.com/posts/21259.
17. Heyhoe J, Birks Y, Harrison R, O'Hara JK, Cracknell A, Lawton R. The role of emotion in patient safety: Are we brave enough to scratch beneath the surface? J R Soc Med. 2016 Feb;109(2):52-8. doi: 10.1177/0141076815620614. Epub 2015 Dec 18. PMID: 26682568; PMCID: PMC4793767.
18. Denecke K, Bamidis P, Bond C, Gabarron E, Househ M, Lau AY, Mayer MA, Merolli M, Hansen M. Ethical Issues of Social Media Usage in Healthcare. Yearb Med Inform. 2015 Aug 13;10(1):137-47. doi: 10.15265/IY-2015-001. PMID: 26293861; PMCID: PMC4587037.
Figures
Figure 1. Cystic neck mass on PO, clinical image.
Figure 2. From left to right: sagittal, coronal, and axial MRI views of PO cystic neck mass.
Figure 3. Cytology of PO cystic neck mass (hematoxylin and eosin staining).
Figure 4. Cystic neck mass on PO, gross images.
Figure 5. Cystic neck mass on PO, histopathology images (hematoxylin and eosin staining).
Figure 6. Twitter post by PO, part 1.
Figure 7. Twitter post by PO, part 2.
Figure 8. Twitter post by PO, part 3.
Figure 9. Twitter post by PO, part 4.
Submitted 2/15/2023
Submitted 2/15/2023
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