Histopathology: microscopic appearance of invasive ductal carcinoma of the breast. The slide is stained with Haematoxylin & Eosin.Histopathology: microscopic appearance of invasive ductal carcinoma of the breast. The slide is stained with an antibody (immunohistochemistry) against the oncogene Her2neu. The dark-brown reaction indicates that this tumor over-expresses this gene.Cytopathology: microscopic appearance of a Pap test. The pink cell at the center with a large nucleus is abnormal, compatible with low-grade dysplasia.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.Gross examination: appearance of the cut surface of a lung showing the honeycomb pattern of end-stage pulmonary fibrosis.Gross examination: appearance of a colorectal polyp (the cauliflower-shaped tumor) attached to the colon mucosa (the horizontal line at the bottom).
Anatomical pathology (Commonwealth) or anatomic pathology (U.S.) is a medical specialty that is concerned with the diagnosis of disease based on the macroscopic, microscopic, biochemical, immunologic and molecular examination of organs and tissues. Over the 20th century, surgical pathology has evolved tremendously: from historical examination of whole bodies (autopsy) to a more modernized practice, centered on the diagnosis and prognosis of cancer to guide treatment decision-making in oncology. Its modern founder was the Italian scientist Giovanni Battista Morgagni from Forlì.[1]
Anatomic pathology relates to the processing, examination, and diagnosis of surgical specimens by a physician trained in pathological diagnosis. Clinical pathology involves the laboratory analysis of tissue samples and bodily fluids; procedures may include blood sample analysis, urinalysis, stool sample analysis, and analysis of spinal fluid. Clinical pathologists may specialize in a number of areas, including blood banking, clinical chemistry, microbiology, and hematology.[3]
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.
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. Surgical pathology increasingly requires technologies and skills traditionally associated with clinical pathology such as molecular diagnostics.
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 is a sub-discipline of anatomical pathology concerned with the microscopic examination of whole, individual cells obtained from exfoliation 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 is an emerging discipline within anatomical and clinical pathology that 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.
Forensic pathologists receive specialized training in determining the cause of death and other legally relevant information from the bodies of persons who died suddenly with no known medical condition, those who die from non-natural causes, as well as those dying as a result of homicide, or other criminally suspicious deaths. A majority of the forensic pathologists cases are due to natural causes. Often, additional tests such as toxicology, histology, and genetic testing will be used to help the pathologist determine the cause of death. Forensic pathologists will often testify in courts regarding their findings in cases of homicide and suspicious death. They also play a large role in public health, such as investigating deaths in the workplace, deaths in custody, as well as sudden and unexpected deaths in children. Forensic pathologists often have special areas of interest within their practice, such as sudden death due to cardiac pathology, deaths due to drugs, or Sudden Infant Death (SIDS), and various others.
Training and certification
Australia
(Also New Zealand, Hong Kong, Singapore, Malaysia, and Saudi Arabia)
Anatomical Pathology is one of the specialty training programs offered by the Royal College of Pathologists of Australasia (RCPA). The RCPA. To qualify as a Fellow of the RCPA in Anatomical Pathology, the candidate must complete a recognised undergraduate or postgraduate medical qualification and then complete a minimum of 2 years of clinical medical experience 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 examinations (not before 3rd year) and the Part 2 examinations (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), hematopathology, and neuropathology. Candidates for any of these must have completed four years of medical school and five years of residency training.
United States
Anatomic Pathology (AP) is one of the two primary certifications offered by the American Board of Pathology (the other is Clinical Pathology (CP))[4] and one of three primary certifications offered by the American Osteopathic Board of Pathology.[5] To be certified in anatomic pathology, the trainee must complete four years of medical school followed by three years of residency training. Many U.S. 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 or CP. Pathologists' Assistants are highly trained medical professionals with specialized training in Anatomic and Forensic pathology. To become a Pathologists' Assistant one must enter and successfully complete a NAACLS accredited program and pass the ASCP Board of Certification Exam.
Practice settings
Academic anatomical pathology is practiced at university medical centers by pathologists who are also university faculty. As such, they often have diverse responsibilities that may include training pathology residents, teaching medical students, conducting basic, clinical, or translational research, or performing administrative duties, all in addition to the practice of diagnostic anatomical pathology. Pathologists in academic settings often sub-specialize in a particular area of anatomic pathology and may serve as consultants to other pathologists regarding cases in their specific area of expertise.
Group practice is the most traditional private practice model. In this arrangement, a group of senior pathologists will control a partnership that employs junior pathologists and contracts independently with hospitals to provide diagnostic services, as well as attracting referral business from local clinicians who practice in the outpatient setting. The group often owns a laboratory for histology and ancillary testing of tissue, and may hold contracts to run hospital-owned labs. Many pathologists who practice in this setting are trained and certified in both anatomical pathology and clinical pathology, which allows them to supervise blood banks, clinical chemistry laboratories, and medical microbiology laboratories as well.
Large corporate providers of anatomical pathology services, such asAmeriPath in the United States. In this model, pathologists are employees, rather than independent partners. This model has been criticized for reducing physician independence, but defenders claim that the larger size of these practices allows for economies of scale and greater specialization, as well a sufficient volume to support more specialized testing methods.
Multispecialty groups, composed of physicians from clinical specialties as well as radiology and pathology, are another practice model. In some case, these may be large groups controlled by an HMO or other large health care organization. In others, they are in essence clinician group practices that employ pathologists to provide diagnostic services for the group. These groups may own their own laboratories, or, in some cases may make controversial arrangements with "pod labs" that allow clinician groups to lease space, with the clinician groups receiving direct insurance payments for pathology services.[6] Proposed changes to Medicare regulations may essentially eliminate these arrangements in the United States.[7]
↑ "Archived copy"(PDF). Archived from the original(PDF) on 2007-09-28. Retrieved 2007-05-20.{{cite web}}: CS1 maint: archived copy as title (link) Foster, Swift, Collins, and Smith, P.C. - Health Care Alert, August 2006.
Pathology is the study of disease and injury. The word pathology also refers to the study of disease in general, incorporating a wide range of biology research fields and medical practices. However, when used in the context of modern medical treatment, the term is often used in a narrower fashion to refer to processes and tests that fall within the contemporary medical field of "general pathology", an area that includes a number of distinct but inter-related medical specialties that diagnose disease, mostly through analysis of tissue and human cell samples. Idiomatically, "a pathology" may also refer to the predicted or actual progression of particular diseases, and the affix pathy is sometimes used to indicate a state of disease in cases of both physical ailment and psychological conditions. A physician practicing pathology is called a pathologist.
Forensic pathology is pathology that focuses on determining the cause of death by examining a corpse. A post mortem examination is performed by a medical examiner or forensic pathologist, usually during the investigation of criminal law cases and civil law cases in some jurisdictions. Coroners and medical examiners are also frequently asked to confirm the identity of remains.
Dermatology is the branch of medicine dealing with the skin. It is a speciality with both medical and surgical aspects. A dermatologist is a specialist medical doctor who manages diseases related to skin, hair, nails, and some cosmetic problems.
Cytopathology is a branch of pathology that studies and diagnoses diseases on the cellular level. The discipline was founded by George Nicolas Papanicolaou in 1928. Cytopathology is generally used on samples of free cells or tissue fragments, in contrast to histopathology, which studies whole tissues. Cytopathology is frequently, less precisely, called "cytology", which means "the study of cells".
An autopsy is a surgical procedure that consists of a thorough examination of a corpse by dissection to determine the cause, mode, and manner of death; or the exam may be performed to evaluate any disease or injury that may be present for research or educational purposes. The term necropsy is generally used for non-human animals.
Histopathology is the microscopic examination of tissue in order to study the manifestations of disease. Specifically, in clinical medicine, histopathology refers to the examination of a biopsy or surgical specimen by a pathologist, after the specimen has been processed and histological sections have been placed onto glass slides. In contrast, cytopathology examines free cells or tissue micro-fragments.
The medical examiner is an appointed official in some American jurisdictions that investigates deaths that occur under unusual or suspicious circumstances, to perform post-mortem examinations, and in some jurisdictions to initiate inquests. They are necessarily trained in pathology.
A diener is a morgue worker responsible for handling, moving, and cleaning the corpse. In the UK, the equivalent job title is 'Mortuary Assistant', whilst the preparation, evisceration and reconstruction of the deceased is performed by an Anatomical Pathology Technician. In the US, Dieners are also referred to as "mortuary assistants" or "autopsy technicians". The word is derived from the German word Leichendiener, which literally means corpse servant.
Dermatopathology is a joint subspecialty of dermatology and pathology or surgical pathology that focuses on the study of cutaneous diseases at a microscopic and molecular level. It also encompasses analyses of the potential causes of skin diseases at a basic level. Dermatopathologists work in close association with clinical dermatologists, with many possessing further clinical training in dermatology. The field was founded by German dermatologist and physician Gustav Simon, who published the first textbook on dermatopathology, 'Skin Diseases Illustrated by Anatomical Investigations', in 1848.
Neuropathology is the study of disease of nervous system tissue, usually in the form of either small surgical biopsies or whole-body autopsies. Neuropathologists usually work in a department of anatomic pathology, but work closely with the clinical disciplines of neurology, and neurosurgery, which often depend on neuropathology for a diagnosis. Neuropathology also relates to forensic pathology because brain disease or brain injury can be related to cause of death. Neuropathology should not be confused with neuropathy, which refers to disorders of the nerves themselves rather than the tissues. In neuropathology, the branches of the specializations of nervous system as well as the tissues come together into one field of study.
A medical specialty is a branch of medical practice that is focused on a defined group of patients, diseases, skills, or philosophy. Examples include those branches of medicine that deal exclusively with children (paediatrics), cancer (oncology), laboratory medicine (pathology), or primary care. After completing medical school or other basic training, physicians or surgeons and other clinicians usually further their medical education in a specific specialty of medicine by completing a multiple-year residency to become a specialist.
Clinical pathology is a medical specialty that is concerned with the diagnosis of disease based on the laboratory analysis of bodily fluids, such as blood, urine, and tissue homogenates or extracts using the tools of chemistry, microbiology, hematology, molecular pathology, and Immunohaematology. This specialty requires a medical residency.
Gynecologic pathology is the medical pathology subspecialty dealing with the study and diagnosis of disease involving the female genital tract. A physician who practices gynecologic pathology is a gynecologic pathologist. The term originates from the Greek gyno-(gynaikos) meaning "woman" and the suffix -ology, meaning "study of".
Surgical pathology is the most significant and time-consuming area of practice for most anatomical pathologists. Surgical pathology involves gross and microscopic examination of surgical specimens, as well as biopsies submitted by surgeons and non-surgeons such as general internists, medical subspecialists, dermatologists, and interventional radiologists.
Gastrointestinal pathology is the subspecialty of surgical pathology which deals with the diagnosis and characterization of neoplastic and non-neoplastic diseases of the digestive tract and accessory organs, such as the pancreas and liver.
Gross processing, "grossing" or "gross pathology" is the process by which pathology specimens undergo examination with the bare eye to obtain diagnostic information, as well as cutting and tissue sampling in order to prepare material for subsequent microscopic examination.
The history of pathology can be traced to the earliest application of the scientific method to the field of medicine, a development which occurred in the Middle East during the Islamic Golden Age and in Western Europe during the Italian Renaissance.
A pathologists’ assistant (PA) is a physician extender whose expertise lies in gross examination of surgical specimens as well as performing forensic, medicolegal, and hospital autopsies.
The American Board of Pathology (ABPath) is one of 24 member boards of the American Board of Medical Specialties. This organization was assembled in May 1936, under the approval of the Advisory Board for Medical Specialties (ABMS) and the American Medical Association (AMA) Council on Medical Education and Hospitals. It is the duty of the ABPath to grant certification in Anatomic Pathology, Clinical Pathology and/or Anatomic/Neuropathology to qualified Doctors of Medicine and Doctors of Osteopathic Medicine (M.D./D.O.).
Valerie A. Fitzhugh is an American pathologist and Associate Professor of Pathology, Immunology, and Laboratory Medicine at Rutgers New Jersey Medical School as well as an Associate Professor of Pathology and Laboratory Medicine at Rutgers Robert Wood Johnson Medical School. She is the Chair of the Department of Pathology, Immunology, and Laboratory Medicine at Rutgers and the Chair at Rutgers Robert Wood Johnson Medical School as well. Fitzhugh specializes in bone and soft tissue pathology and cytopathology and has made the Pathology Power List by The Pathologist Magazine in 2016, 2018, and 2019. She is involved in educating pathology residents and she actively uses social media as a platform for education and for improving diversity in pathology and she also studies how effective social media is at enhancing accurate communication of science and medicine.
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