Anatomical pathology

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File:Streptococcus pneumoniae meningitis, gross pathology 33 lores.jpg

Autopsy: a brain surrounded by pus (the yellow-greyish coat around the brain, under the dura lifted by the forceps), the result of bacterial meningitis.

File:End-stage interstitial lung disease (honeycomb lung).jpg

Gross examination: appearance of the cut surface of a lung showing the honeycomb pattern of end-stage pulmonary fibrosis.

File:Villous adenoma of the sigmoid colon, gross pathology.jpg

Gross examination: appearance of a colorectal polyp (the cauliflower-shaped tumor) attached to the colon mucosa (the horizontal line at the bottom).

File:Breast invasive scirrhous carcinoma histopathology (1).jpg

Histopathology: microscopic appearance of invasive ductal carcinoma of the breast. The slide is stained with Haematoxylin & Eosin.

File:Breast invasive scirrhous carcinoma histopathology (2) HER2 expression.JPG

Histopathology: microscopic appearance of invasive ductal carcinoma of the breast. The slide is stained with an antibody (immunohistochemistry) against the ongene Her2neu. The dark brown reaction indicates that this tumor over-expresses this gene.

File:Pap test abnormal.JPG

Cytopathology: microscopic appearance of a Pap test. The pink cell a the center with a large nucleus is abnormal, compatible with low grade dysplasia.

Anatomical pathology is a medical specialty that is concerned with the diagnosis of disease based on the gross, microscopic, and molecular examination of organs, tissues, and whole bodies (autopsy). The anatomical pathologist reports to doctors; he/she does not usually see patients.

Anatomical pathology is itself divided in subspecialties, the main ones being surgical pathology, cytopathology and forensic pathology. To be licensed to practice anatomical pathology, one has to complete medical school, an approved residency program and be certified. In the U.S., the American board of Pathology certifies pathologists.

Anatomical pathology is one of two branches of Template:Spinout/link, the other being clinical pathology, the diagnosis of disease through the laboratory analysis of bodily fluids. Often, Template:Spinout/link practice both anatomical and clinical pathology, a combination known as general pathology. Similar specialties exist in veterinary pathology.

Skills and procedures[]

The procedures used in anatomic pathology include:

Gross examination - the examination of diseased tissues with the naked eye. This is important especially for large tissue fragments, because the disease can often be visually identified. It is also at this step that the pathologist selects areas that will be processed for histopathology. The eye can sometimes be aided with a magnifying glass or a stereo microscope, especially when examining parasitic organisms.
Histopathology - the microscopic examination of stained tissue sections using histological techniques. The standard stains are haematoxylin and eosin, but many others exist. The use of haematoxylin and eosin-stained slides to provide specific diagnoses based on morphology is considered to be the core skill of anatomic pathology. The science of staining tissues sections is called histochemistry.
Immunohistochemistry - the use of antibodies to detect the presence, abundance, and localization of specific proteins. This technique is critical to distinguishing between disorders with similar morphology, as well as characterizing the molecular properties of certain cancers.
In situ hybridization - Specific DNA and RNA molecules can be identified on sections using this technique. When the probe is labeled with fluorescent dye, the technique is called FISH.
Cytopathology - the examination of loose cells spread and stained on glass slides using cytology techniques.
Electron microscopy - the examination of tissue with an electron microscope, which allows much greater magnification, enabling the visualization of organelles within the cells. Its use has been largely supplanted by immunohistochemistry, but it is still in common use for certain tasks, including the diagnosis of kidney disease and the identification of immotile cilia syndrome among many others.
Tissue cytogenetics - the visualization of chromosomes to identify genetics defects such as chromosomal translocation.
Flow immunophenotyping - the determination of the immunophenotype of cells using flow cytometry techniques. It is very useful to diagnose the different types of leukemia and lymphoma.

Subspecialties[]

Surgical pathology[]

Main article: Surgical pathology

Surgical pathology is the most significant and time-consuming area of practice for most anatomical pathologists. Surgical pathology involves the gross and microscopic examination of surgical specimens, as well as biopsies submitted by non-surgeons such as general internists, medical subspecialists, dermatologists, and interventional radiologists.

Oral and maxillofacial pathology[]

In the United States, subspecialty-trained doctors of dentistry, rather than medical doctors, can be certified by a professional board to practice Oral and Maxillofacial Pathology.

Cytopathology[]

Main article: Cytopathology

Cytopathology is a sub-discipline of anatomical pathology concerned with the microscopic examination of whole, individual cells obtained from smears or fine needle aspirates. Cytopathologists are trained to perform fine-needle aspirates of superficially located organs, masses, or cysts, and are often able to render an immediate diagnosis in the presence of the patient and consulting physician. In the case of screening tests such as the Papanicolaou smear, non-physician cytotechnologists are often employed to perform initial reviews, with only positive or uncertain cases examined by the pathologist. Cytopathology is a board-certifiable subspecialty in the U.S.

Molecular pathology[]

Main article: Molecular pathology

Molecular pathology is an emerging discipline within anatomical pathology which is focused on the use of nucleic acid-based techniques such as in-situ hybridization, reverse-transcriptase polymerase chain reaction, and nucleic acid microarrays for specialized studies of disease in tissues and cells. Molecular pathology shares some aspects of practice with both anatomic and clinical pathology, and is sometimes considered a "crossover" discipline.

Autopsy pathology[]

Main article: Autopsy

General anatomical pathologists are trained in performing autopsies, which are used to determine the disease factors contributing to a person's death. Autopsies are important in the ongoing medical education of clinicians, and in efforts to improve and verify the quality of medical care. Dieners are non-physicians who assist pathologists in the gross dissection portion of the autopsy. The recently established field of Pathologists Assistant has taken over a the role of Diener and contributes a great deal to the pre-diagnosis of disease within the pathology laboratory. Autopsies represent less than 10% of the workload of typical pathologists in the United States.^[1] However, the autopsy is central to public perceptions of the field, in part due to portrayals of pathologists on television programs such as Quincy, M.E. and Silent Witness.

Forensic pathology[]

Main article: Forensic pathology

Forensic pathologists receive specialized training in determining the cause of death and other legally relevant information from the bodies of persons who died in a non-medical or potentially criminal circumstances. Autopsies make up much, but not all of the work of the practicing forensic pathologist, and forensic pathologists are occasionally consulted to examine a survivor of a criminal attack. Forensic pathology is a board-certifiable sub-specialty in the U.S.

Training and certification of Anatomical Pathologists[]

Australia[]

(Also New Zealand, Hong Kong, Singapore and Malaysia)

Anatomical Pathology one of the specialty training programs offered by the Royal College of Pathologists of Australasia (RCPA). The RCPA wikipedia article is here. To qualify as a Fellow of the RCPA in Anatomical Pathology, the candidate must complete a recognised undergraduate or postgraduate medical qualification, then complete 2 years of clinical medical experience (Internship and a general clinical residency year) as a prerequisite to selection as a training registrar. The training program is a minimum of 5 years, served in at least two laboratories, and candidates must pass a Basic Pathological Sciences examination (usually in first year), the Part 1 examination (not before 3rd year) and the Part 2 examination (not before 5th year). Fellows may then continue into subspecialty training.

Canada[]

Anatomical Pathology (AP) is one of the specialist certificates granted by the Royal College of Physicians and Surgeons of Canada. Other certificates related to pathology include general pathology (GP), forensic pathology, hematopathology, and neuropathology. Candidates for any of these must have completed four years of medical school and five years of residency training. After becoming certified in either AP or GP, it is common for pathologists to seek further fellowship training in a subspecialty of AP.

USA[]

Anatomic Pathology (AP) is one of the two primary certifications offered by the American Board of Pathology. The other is Clinical Pathology (CP). To be certified in anatomic pathology, the trainee must complete four years of medical school followed by three years of residency training. Many US pathologists are certified in both AP and CP, which requires a total of four years of residency. After completing residency, many pathologists enroll in further years of fellowship training to gain expertise in a subspecialty of AP.