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Almost four decades later, the image of Professor Dumms, standing in front of our class in medical school, still plays vividly in my mind. Perhaps it was the way she intertwined humor into her lectures or the way she introduced herself in her opening remarks: "Yes. I'm a doctor, a different kind of a doc. When people ask me, at a social reception or a party, what I do for a living, I tell them I'm a doctor, and they express interest. They say, 'Oh. Wow! Interesting. A doctor? What kind of a doctor?'
But when I tell them I'm a pathologist, they don't ask about an ache that has been haunting them for the past decade, nor for advice on their aunt who fell ill. Instead, their faces turn long and pale and they quickly find an excuse to move toward someone else, four tables away. I'm not healing the living, I learn from the dead. I study the errors of nature. From the congenital to the debilitating, to the detrimental. I ask myself, what went wrong? How does our biology betray us? I want to study the abnormal, the pathological, the disfiguring, and the deadly. The class fell silent. The only sound came from a slide projector humming in the background. We wanted to know more.
In my last column, I told you about a young woman whose armpit gave milk. I used her story to illustrate the astonishing feat of biological engineering nature uses to build a human body. It begins with a fertilized egg--a single cell created by the union of a sperm cell and an egg cell--and grows through repeated division into an adult composed of thirty trillion specialized cells.
What can go wrong?
In one of the following lectures, Professor Dumms described the different types of gonadal tumors (gonads are the name doctors give to the testes where sperm cells are formed, and ovaries where eggs are formed). She describes a case of a young woman who presented with left lower abdominal pain.
"The doctors examine her, then took images of her abdomen and found an ovarian tumor," Prof. Dumms told the class, "they surgically removed it, and we, at our lab, examined it closely. Next slide please ..." The student at the back of the class, in charge of the slide projector, gently placed the next slide in the projector and slid it gently so the image turned up clear and horrifying on the screen.
It was a round tumor of the ovary that was cut along its side with its content spilling out. Shockingly, it contained a mix of hair and teeth. "This is a classic example of a teratoma," Professor Dumms said. And to make the message unforgettable, she added a joke, a medical joke: "Do you know what's the best way to diagnose an ovarian teratoma?" She asked, waiting a bit for dramatic suspension. "Take a bag of ice, place it on the patient's abdomen, wait a bit, and listen carefully. If you hear teeth chattering, it's a teratoma."
The class burst into laughter. The truth, of course, is different: ovarian teratomas aren't a laughing matter, and they can be easily diagnosed using an ultrasound machine or a CAT scan,
How do teratomas such as this form?
Nearly every one of our thirty trillion cells inherits the same library of DNA instructions. Yet through a process called differentiation, cells learn to express entirely different chapters of that genetic code. Some become heart cells that beat. Others become brain cells that analyze signals and generate ideas. Still others form the light-detecting retina or the muscle fibers that allow us to walk.
The egg cells in the ovaries are called germ cells. They are pluripotent, meaning they have the unique ability to become anything in the human body--skin, teeth, hair, brain tissue, or bone.
Normally, an egg cell waits for fertilization and precise chemical signals before it starts dividing. In a teratoma such in the case I discussed, an unfertilized egg “wakes up” on its own inside the ovary and begins executing its developmental software.
Unlike in a normal developing embryo, where neighboring cells send out continuous chemical “GPS signals” telling each other where the top, bottom, front, and back of the body are, in the ovary, those spatial signals don’t exist.
Without spatial guidance, the germ cell multiplies and turns on random genetic instructions. It builds mature hair follicles, fully formed teeth, sebum-producing skin glands, and pieces of cartilage--all bundled together inside a cyst.
Nature works miracles and when it fails it can do so miserably. As I'm writing these lines, I feel grateful for my teachers and professors who quenched my curiosity and satisfied my desire for entertainment with their vast knowledge and sense of humor.
EDITOR'S NOTE: Shahar Madjar, MD, MBA, is a urologist and an author. He practices at Schoolcraft Memorial Hospital in Manistique and in Baraga County Memorial Hospital in L'Anse. Find his books on Amazon or contact him at smadjar@yahoo.com.