Anatomic Pathology Rotations

Anna-Luise Katzenstein, MD, Director of Anatomic Pathology

General and Common Goals in Anatomic Pathology

While the following goals are flexible and certainly should not be considered final, the context of these goals is defined by the time and resource constraints of pathology practice and by the fundamental principle that our efforts must always serve the patient.

  1. Learn to use gross inspection, routine histology, cytopathology and special investigations to formulate differential diagnoses, arrive at diagnoses, and solve clinical problems.
  2. Learn to communicate your findings and conclusions clearly, in a manner useful to all appropriate audiences, especially clinicians. Skill in both oral and written communication is critical.
  3. Learn to constantly update and expand your knowledge of facts, terminology, and classifications of disease. Clinical correlations are often key to meaningful diagnosis, problem solving, prognostication and thus effective pathology consultation. Furthermore, understanding limits of knowledge is essential to obtaining assistance in difficult situations.
  4. Maintain enthusiasm for continued learning. Nurture your familiarity with bibliographic resources. Learn how to critically evaluate literature. Recognize and apply self-motivation in your work. Prepare yourself for assumption of major responsibility.
  5. Explore the possibility of being involved in a research project with a faculty member and/or other residents.

Autopsy/Forensic Pathology Rotation

Length of Rotation: 4 months
Faculty: Robert Stoppacher, MD, Director, Autopsy Service & Chief Medical Examiner, Robert Corona, DO, MBA, Deborah Johnson, MD, Laura Knight, MD, Julia Shields, MD

The autopsy service is run by the Medical Examiner's Office (MEO) at the Wallie Howard Jr. Center for Forensic Science. As part of University Hospital, it provides a medical service to the physicians who refer their patients, as well as to members of the patient's family. It is also an educational component of the Medical Center, providing opportunities for learning not only to pathology residents, but also to other medical and paramedical students, pathology faculty and staff physicians and residents from all specialties. The VA Hospital autopsy service is under the direction of Dr. Margaret Kowalski and staffed by VA attending pathologists.

The overall goal of the autopsy rotation at the Medical Examiner's Office is to develop a competent pathologist who can perform a complete autopsy procedure independently and has a basic skill set to understand the pathology observed in the context of the circumstances of death and the clinical history. This competency includes dissection, retrieval of specimens for specialized testing, and microscopic analysis.

Cytopathology

Length of Rotation: 2 months
Faculty: Kamal K. Khurana, MD, Director, Gustavo de la Roza, MD, Ola El-Zammar, MD, Alfredo Valente, MD

The main goal of this rotation is to provide residents with the necessary tools to deal effectively with most cytopathology cases encountered in a general pathology practice. This rotation will also serve as a basic foundation for those interested in pursuing cytopathology as a subspecialty. This rotation provides an intense and diverse exposure to gynecological and non-gynecological exfoliative cytology and fine needle aspirations (FNA). The latter includes aspirations from superficial and palpable lesion performed by the Cytopathologist Team (attending, fellow, and rotating resident) at the FNA Clinic or at the bedside and aspirations from deep-seated lesions obtained under imaging guidance (percutaneous CT or ultrasound guided or endoscopic ultrasound).

Surgical Pathology Rotation at University Hospital

Length of Rotation: 9 months
Faculty: Gustavo de la Roza, MD, Director, Anna-Luise Katzenstein, MD, Gustavo de la Roza, MD, Ola El-Zammar, MD, Joseph Fullmer, MD, PhD, Kamal K. Khurana, MD, Steve K. Landas, MD, Alfredo Valente, MD, and Shengle Zhang, MD

The goal of this rotation is for the resident to develop into an outstanding surgical pathologist with strong skills in gross and microscopic diagnosis and the knowledge and ability to utilize ancillary immunohistochemical and molecular techniques as well as current literature in formulating diagnoses. Our surgical pathology laboratory sees a great diversity of common and highly complex specimens from all specialties with a significant number of cases in the following areas: gastrointestinal pathology, neoplastic and non-neoplastic lung disease, head and neck pathology, endocrine pathology including thyroid, parathyroid, and adrenal gland, musculoskeletal pathology with great emphasis on bone and soft tissue tumors, and pediatric pathology with a significant number oncologic cases. This division houses a comprehensive immunohistochemistry laboratory with two daily runs of tests and a complete molecular diagnostic section dedicated to solid tumors. There is a general, non-specialized signout with attending pathologists with special interests in most subspecialty areas. The surgical pathology service is divided into a Biopsy Service and Routine/Frozen Section Service covered by three residents and three attending pathologists. A same-day service using a microwave-based system is available for rush biopsies. The biopsy cases are usually available from the lab at about 8:00 AM the morning after they are grossed, and the biopsy resident is expected to review them before signing out with the attending, usually starting by 10:30-11:00. The routine slides are available before noon, and the routine resident has the rest of the day (between frozen sections) to review them and prepare for signout the next day in the morning right after the morning teaching conference.

Surgical Pathology Rotation at the VA Hospital

Length of Rotation: 3 months
Faculty: Yiran Dai, MD, Henry Friedman, MD, Seena Kumar, MD, Naili Ma, MD, PhD

The rotation at the VA gives residents the opportunity to experience a general pathology practice. Residents are exposed to a variety of scenarios that integrate anatomic pathology, clinical pathology, and laboratory administration. While residents mainly concentrate on surgical pathology, they are also exposed to hematopathology and cytology, including a fine needle aspiration service. Since there is only one resident rotating at the VA at a time, residents benefit from working with three different pathologists in a short period of time and are able to participate in daily departmental consultation conferences and interdepartmental conferences. The relatively smaller and less complex case load in surgical pathology at the VA gives residents the opportunity to master their skills in routine cases and spend more time reviewing and learning from them. Residents see a fair amount of skin, lung, prostate, GI, and bladder biopsies at the VA.