Anatomical pathology

Source: Wikipedia, the free encyclopedia.
Histopathology: microscopic appearance of invasive ductal carcinoma of the breast. The slide is stained with Haematoxylin & Eosin.
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.
dura lifted by the forceps), the result of bacterial meningitis
.
lung showing the honeycomb pattern of end-stage pulmonary fibrosis
.
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

Anatomical pathology is one of two branches of

general pathology.[2] Similar specialties exist in veterinary pathology
.

Differences with clinical pathology

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]

Anatomical pathology is itself divided in subspecialties, the main ones being surgical pathology (breast, gynecological, endocrine, gastrointestinal, genitourinary, soft tissue, head and neck, dermatopathology), neuropathology, hematopathology cytopathology, and forensic pathology. To be licensed to practice pathology, one has to complete medical school and secure a license to practice medicine. An approved residency program and certification (in the U.S., the American Board of Pathology or the American Osteopathic Board of Pathology) is usually required to obtain employment or hospital privileges.[citation needed]

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.
  • 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.
  • FISH
    .
  • Cytopathology – the examination of loose cells spread and stained on glass slides using cytology techniques
  • immotile cilia syndrome
    .
  • Tissue cytogenetics – the visualization of chromosomes to identify genetic defects such as chromosomal translocation
  • immunophenotype of cells using flow cytometry techniques. It is very useful to diagnose the different types of leukemia and lymphoma
    .

Subspecialties

Surgical pathology

interventional radiologists
. Surgical pathology increasingly requires technologies and skills traditionally associated with clinical pathology such as molecular diagnostics.

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

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

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 pathology

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

See also

Notes and references

  1. PMID 18340813
    .
  2. ^ "Pathology Specialty Description". American Medical Association. Retrieved 5 October 2020.
  3. ^ "Clinical Pathology Overview - Health Encyclopedia - University of Rochester Medical Center". www.urmc.rochester.edu. Retrieved 2024-01-23.
  4. ^ "ABP Home". Archived from the original on 2007-06-30. Retrieved 2006-01-11.
  5. ^ "Specialties & Subspecialties". AOA. Archived from the original on 2015-08-13. Retrieved 2 October 2012.
  6. ^ "Out of joint?OIG takes dim view of pod lab setup - College of American Pathologists". Archived from the original on 2005-03-08. Retrieved 2007-05-20. Congress of American Pathologists Feature story - "Out of joint OIG takes dim view of pod lab setup" January 2005 (Accessed May 19, 2007)
  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.

External links