I'm back!
Hi, I'm Anna Dhody, Curator of the Mütter Museum. And welcome to another very special Mütter unboxing!
Now, why is this one just a little bit special? Well, it's because I know what's in here,
but I don't know-know what's in here. And maybe you'll know and I'll know as soon as I unbox it.
I know that this should contain a uterus. Or maybe a partial uterus. And maybe some fibroids. But not
all the fibroids. And maybe not intact. Do you see what I mean where I'm going with this? So,
let's back up a little bit! A couple of months ago, I was contacted by a lovely individual,
and they were going to have their uterus removed because of something called
"fibroids." Now, what are fibroids? Well, they are non-cancerous growths that occur in the uterus,
oftentimes during child-bearing years. And they are composed of smooth muscle tissue and fibrous
connective tissue. Some of them, very very small. Some of them, very very big. How big? Well,
let me tell you, down in our wet specimen room, we have a fibroid that has to be at
least 100 pounds. (It's actually about 30 pounds.) Well, it's 100 pounds in the jar with the fluid. I
know that because I can't lift it. But it's huge! And these happen all the time. They're very, very
common, but getting them very big, maybe a little bit less common. And when that happens, they have
to be removed. And sometimes, the uterus has to go along with them. So, what's exciting is that we
know what happened, we know that this individual had a hysterectomy, and that the uterus came out
along with the fibroids. Apparently, there were three very big ones. And we know this because
she named them. And what were their names, you ask? Well, I hope I don't get sued for copyright
infringement or anything, because they're Cruella was one, Voldemort, and the third one: Sauron.
So, very exciting! Those were her three biggest ones. So, without further ado, let's open up
this package and see what exactly we're going to be getting. All right, here we go!
Now, before I begin, there is a lot of tape on this. I'm sure they packed this really well, so this
might take a few minutes. Maybe, through the power of post-production, we can like do a
little speed-up so it doesn't take too long. Who knows? We'll find out at the end.
It's a big purple splotchy thing here. At least this knife is sharp this time.
All right, did that work? Yes! All right.
In case I wasn't sure what it was... I love that it's:
"Uterus specimen from Albany Medical Center Pathology. Enjoy! Sarah." Thank you, Sarah!
Thank you for the uterus! Okay.
We can reuse these, let's not waste.
These are great. You put a wet specimen underneath that if you're doing some
work with it, catches the spills. It's really good. We're not going to waste these. Upcycle, people!
A lot of them... Okay. Ooh!
Oh, this is awesome! Okay, wow. All right, here's the thing, this might be pretty odorous and this
might be pretty wet, so I'm gonna go get a mask. Hopefully help a little bit with the fumes here.
Again, can we just mention that I have a Tupperware exactly like this. I proof my bread dough in it.
The more you know.
All right, more tape, more tape, more tape. I kind of wonder what this is going to smell like.
We did an unboxing of a bladder stone. And boy, howdy, that was a smell.
You do not forget that.. All right here we...
...don't go. Another piece of tape. See? Now you know it's real, we don't stage here. Oh, all right! Well,
this is big. I'm not going to tilt it too much. This is a biohazard bag with
quite a significant lump of tissue in here. And you know what I'm going to do? Time to bring out the chucks.
One. Oh, what have we here?
Just a... Wow! Smaller bit of tissue and...
...a larger bit of tissue! Now, here's what we're going to do.
I am not going to open these lovely things in our wonderful Historical Medical Library
because I'm pretty sure the librarian would kill me. So we're going to take a break.
And we're going to meet back in our wet specimen lab that has ventilation and some more equipment.
And maybe we'll also bring Lowell in, and he can help me do the actual unwrapping so we
can kind of immediately move these into the type of container and fluid that they need to be in.
So, please hold!
Hi! And we're back, this time in a much better room that is much more suited for this
type of work. And of course we have Lowell here, who is much better suited to handling this
material with me. So, all right Lowell, like I said, we started opening this in Gross and then immediately
figured out, probably not a good idea. So let's continue the process. -Yeah, we got three bags in here.
One is a smaller fibroid that looks like some decay may have happened when they packed it,
we're not sure yet. -We're not sure. -It's wrapped in paper towels. We'll have to unpack and see exactly what
we got there. -Yeah, but let's go to the big ones. Yeah, so I might need some help with this.
Let's do this one first. -All right. -Now remember, we don't know exactly
what we got. We got a lovely letter just saying, "Uterus specimen." Okay. But we know this individual
had fibroids, so what's the situa--Oh my God, okay. So here's the situation that's going on here.
Wow! Oh, Lowell look at this. Okay, so what we're looking at here, it looks to me--remember,
I am not a medical doctor, I am an osteologist, biological anthropologist. I deal in bones.
This is not bony, but to me what it looks like is they took out the entire uterus with the fibroids in situ,
meaning the fibroids and the uterus came out together at the same time. They did not remove the fibroids and then
remove the uterus. I believe the scientific term is "the whole kit and caboodle."
-Yes, the whole shebang. -The whole shebang. And so you can see the differences in the tissue type.
Look at this, look how the density, the fibrousness of this uterus is amazing. And then you see the
totally different type of tissue, which is the fibroid, again, I would assume. But like just
looking at the texture differences and everything. -Yeah, some muscle tissue, probably myothelium, I'd guess.
-Yes, so this is only part of the uterus and about one fibroid. And it looks like they probably
took a small... Ah! Here, I see cuts. So they probably took some biopsies of the fibroids here, but
they gave us almost all of it. -Almost all of it. -And what I really think is exciting here is when
you think about what a uterus does, when it's not full of fibroids or it's not full of a baby, then it's
relatively small. But it has this capacity to greatly increase in size. And you can see
the striations and the... Just, it's meant to do that, and how... This is so thick! Oh my goodness,
I mean, so we're talking years and years, probably dealing with this. That's interesting, look!
You see here, it's got like a... i don't know if that's something embedded into there. Again, I have no--
That's really interesting. -Yeah, you can also say there's a lot of blood supply on the exterior.
-And I saw something interesting, which is some green markings here. So they
labeled it. I mean, that to me looks like writing. -I think it's possibly marked for surgery
or residual from how they preserved it. -Yeah, I'm not entirely sure. I don't think that's
part of it. That's pretty, pretty green. -Not a green color you see in a human body... usually.
-Usually, because it doesn't look to me to be infected or decomposing, necrotic, you know, where you could
see some decomposition, but no, this looks really interesting. So the patient said they
had three, at least three. So this is definitely one. I'm not sure if that counts. Maybe they weren't
counting the small ones, but can we see if we can get out the other ones and maybe piece together...
-Essentially the whole uterus? -Yeah! Because I want to see how big
it was when all is said and done. -Okay. -Oh, this one's leaking. -That's all right that's why we
have an absorbent pad under it. -Yeah, I don't know what the real word for this is. I call them "chucks." I don't know if they're...
-I feel like most people call them "chucks." -Oh, wow, now this is-- Wow! Okay.
That is amazing. So, again, same situation here. We've got, what I believe is: uterus, fibroid,
and just all cut into thin sections. And here, look. -Clear biopsy mark. -Definitely where
they took a piece of it. So that's something that was really interesting is when we were talking to
the hospital, up until the point that we unwrapped this, we didn't know what we were going to get.
At some point, we thought we were just going to get maybe the uterus and then some of these slides.
Maybe a thin section. So we were never promised to get all of the fibroids. And this is just super
exciting, but Lowell, I can already see a conservation challenge and a display challenge, which is: I'm
really interested in seeing if it's possible, when we put them on display, if we could reassemble
the uterus and the fibroids to kind of get an idea of how big it is. So wait, let's see, look for this.
This is like a really, really interesting jigsaw puzzle because we have to look for the cut lines.
-This was clearly fixed after they had sliced it because it's really tough to put it back together.
-Without breaking it apart, can you get to the... Okay, so that's the outside area here, this is
the outside area here. Can they come together? -I suspect, like... Oh, well no, the slices would
line up like that. So not perfectly anymore. -Not perfectly, but
that gives you a good idea of the size. -Of the scale. -And the weight
that this patient was carrying around. This portion probably weighed about the same amount that my
son did when he was born. He was over nine pounds. I would say this section here is definitely over
nine pounds, so over the size of one robust newborn. And what do you think about that one? How much do
you think that side weighs? -This side gets about eight pounds, I think, if I'm picking up.
This part matched up to here, which is how we were doing it. -Yeah, so these are the two larger
of the fibroids, and then that may be the third one or that could just be tissue because this be...
-Yeah, we'll explore this tomorrow. -Yeah, what I'm interested in is, are these distinct fibroids? Are they nodules
that are extending out of the original fibroid? I don't know, but all I know is I'm really excited
that we got this. And I'm really excited to share it with everybody and to talk about this because,
granted this is a pretty extreme case, but research indicates anywhere between 40-80%
of individuals who have a uterus will develop a fibroid of some size. The vast majority, we're not
looking at a fibroid this size, but it can happen! And I think that's important to know from a public
health standpoint, from a medical standpoint. -We often show extremes, right? But that doesn't mean
that the same issue doesn't occur in higher frequencies, but less extreme, so smaller. So I
think that's a very important thing to note. And what I'm really looking forward to is, you know,
this individual--her name is Flo--who donated these wonderful fibroids and her uterus to us, and she's
agreed to be interviewed and to tell her story. So I'm really excited to kind of be able to talk
to her about that and her journey and everything. She had the surgery a couple months ago and
she's doing well. -Back in November, I think. -Back in November. So there are definitely different ways
surgically to remove these fibroids, as well. When they're very small, they can be done minimally
invasively. You can go and go up through the vagina, I believe, and take away the small ones. When you
get to this size, as I mentioned the uterus is also here, so this was a complete hysterectomy
or complete uterine hysterectomy, I should say, with the fibroids in situ. And this, if you think about it,
was probably a very, very invasive surgery. That the incision that had to be made, the healing that had
to be done. You're talking about a pretty long healing process. But I talked to her over the internet
recently, so she's very excited to... -Participate. -Yeah! She also, I believe, worked in
healthcare, too, so I think it's important to her. -Good perspective on it. -Yeah. Some more fun fibroid facts.
Now we talked about the fact that this is a growth, however, they're almost always benign.
I think it's about 1 in 350 cases of fibroids where there will be malignancy, so the vast majority of them are
non-cancerous. However, you know, I think "benign" is a misnomer. I mean, just because it's not cancerous
obviously does not mean it's not detrimental to your health. So aside from the heavy bleedings,
you get pelvic pain, frequent urination, there's a lot of associated issues with these. And that's why,
of course, when they get to this size, they really do have to come out. So, speaking of size, we talked
about what we think are weights of this, but do you want to take a guess as what the largest
fibroid ever recorded? The weight removed. -Uh, 85 pounds. -144 pounds! -Ooff! Okay. -But, to be fair,
that was removed during a postmortem so the individual had died. So the largest fibroid
removed from a living individual: 100 pounds. -Wow. -Yes, so I don't think these are quite as large
as that. We do have some pretty large ones back there, but they weren't anywhere near 100 pounds either. -No.
-So I can't even fathom 100 pounds of fibroids. But I will say that I think they're very
dense, the tissue is very dense, so they are pretty heavy for their size. So I think that's something
to keep in mind. But what do you think are going to be some of the challenges when we... We have to
do two things. We have to get them into a jar that fits, get the fluid to cover it, but also we want
to present it in a way that people can see things. -Yeah, the real challenges with these will be, first,
preserving them because this is very dense sort of tissue. Usually, I would soak specimen for about 48
hours in formalin to arrest decay activity, but due to the density here, I will do injections in the
flesh all over the place and then let them soak for about 24 hours later. After they're all fixed,
and that process is usually two days in formalin, then a day in water to let formalin gases escape,
and then a step through a series of ethanol concentrations ending at 70% ethanol. And then it'll
go in the jar. And in this case, so it's not just resting at the bottom of the jar, we'll probably
use a glass plate again to sort of elevate it in a way that looks more or less invisible. Though these
may look perfectly fine resting on the bottom. I'll just test it out and see what it looks like.
-Because they are so big. -But, yeah, the real challenge will be fixing them well considering the density.
-Now, normally we talk about not wanting to artificially put holes, like sew them and string them up, however,
you know I noticed this one is pretty intact. They didn't slice through all the way. This is kind of
falling apart. I'm interested in how we can maybe keep the pieces relatively in situ, so there might
have to be maybe a little sewing project going on here, I'm not sure. But I'm also thinking about how
I might want to have them look as they're in the jar, and I think... Part of me was like, it'd be
interesting to kind of see the uterus as a whole, but then you won't be able to see the fibroids.
So maybe we kind of put it back-to-back, like that. I think that would be really cool, but again,
we're just going to have to see what works. -Yeah, and there will be some sewing difficulties because,
as I mentioned earlier, the fact that it was split open and then put in a fixative has sort of firmed up
the tissue a lot, so it's hard to rejoin without potentially breaking some of the flesh. -Oh yeah, that's true.
-So we'll see how that plays. We'll give it some time after it's soaked in water, probably, to see if I
can limber it up some. -Yeah, every time we get a new specimen or if we're conserving a specimen, they
all have their own unique issues and things to deal with, whether it's, you know, the density of the
tissue, how old it is, the time for preserving. But I'm really excited to see where this will bring us.
-Yeah. -So yeah. All right, well I'm going to say, definitely good luck on this and we'll see
what happens. But until next time, I'm Anna Dhody, encouraging you to stay disturbingly informed!
-Did you just drop just some fibroid juice on my knee? -No, I think it missed you. -Oh, great.
-Oh no, there's a little bit. -See, this is why we can't have nice things in the lab.
You know, these are my one nice pair of dress pants