Anatomical pathology - AbsoluteAstronomy.com

Anatomical pathology (Commonwealth) or Anatomic pathology (U.S.) is a medical specialty that is concerned with the diagnosis of disease based on the gross

Gross examination

Gross examination or "grossing" is the process by which pathology specimens are inspected with the bare eye to obtain diagnostic information, while being processed for further microscopic examination....

, microscopic

Histopathology

Histopathology refers to the microscopic examination of tissue in order to study the manifestations of disease...

, chemical, immunologic and molecular

Molecular pathology

Molecular pathology is an emerging discipline within pathology which is focused in the study and diagnosis of disease through the examination of molecules within organs, tissues or bodily fluids....

examination of organs

Organ (anatomy)

In biology, an organ is a collection of tissues joined in structural unit to serve a common function. Usually there is a main tissue and sporadic tissues . The main tissue is the one that is unique for the specific organ. For example, main tissue in the heart is the myocardium, while sporadic are...

, tissues

Tissue (biology)

Tissue is a cellular organizational level intermediate between cells and a complete organism. A tissue is an ensemble of cells, not necessarily identical, but from the same origin, that together carry out a specific function. These are called tissues because of their identical functioning...

, and whole bodies (autopsy

Autopsy

An autopsy—also known as a post-mortem examination, necropsy , autopsia cadaverum, or obduction—is a highly specialized surgical procedure that consists of a thorough examination of a corpse to determine the cause and manner of death and to evaluate any disease or injury that may be present...

). Its modern beginner was the Italian

Italy

Italy , officially the Italian Republic languages]] under the European Charter for Regional or Minority Languages. In each of these, Italy's official name is as follows:;;;;;;;;), is a unitary parliamentary republic in South-Central Europe. To the north it borders France, Switzerland, Austria and...

scientist Giovan Battista Morgagni from Forlì

Forlì

Forlì is a comune and city in Emilia-Romagna, Italy, and is the capital of the province of Forlì-Cesena. The city is situated along the Via Emilia, to the right of the Montone river, and is an important agricultural centre...

.

Anatomical pathology is one of two branches of pathology, the other being clinical pathology

Clinical pathology

Clinical pathology , Laboratory Medicine , Clinical analysis or Clinical/Medical Biology , is a medical specialty that is concerned with the diagnosis of disease based on the laboratory analysis of bodily fluids, such as...

, the diagnosis of disease through the laboratory

Medical laboratory

A medical laboratory or clinical laboratory is a laboratory where tests are done on clinical specimens in order to get information about the health of a patient as pertaining to the diagnosis, treatment, and prevention of disease.-Departments:...

analysis of bodily fluid

Bodily fluid

Body fluid or bodily fluids are liquids originating from inside the bodies of living people. They include fluids that are excreted or secreted from the body as well as body water that normally is not.Body fluids include:-Body fluids and health:...

s and/or tissues. Often, pathologists practice both anatomical and clinical pathology, a combination known as general pathology

General pathology

General pathology, also called investigative pathology, experimental pathology or theoretical pathology, is a broad and complex scientific field which seeks to understand the mechanisms of injury to cells and tissues, as well as the body's means of responding to and repairing injury...

. The distinction between anatomic and clinical pathology is increasingly blurred by the introduction of technologies that require new expertise and the need to provide patients and referring physicians with integrated diagnostic reports. Similar specialties exist in veterinary pathology

Veterinary pathology

Veterinary pathologists are doctors of veterinary medicine who specialize in the diagnosis of diseases through the examination of animal tissue and body fluids. Like medical pathology, veterinary pathology is divided into two branches, anatomical pathology and clinical pathology. Veterinary...

.

Anatomical pathology is itself divided in subspecialties, the main ones being surgical pathology

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,...

, cytopathology

Cytopathology

Cytopathology is a branch of pathology that studies and diagnoses diseases on the cellular level. The discipline was founded by Rudolf Virchow in 1858. A common application of cytopathology is the Pap smear, used as a screening tool, to detect precancerous cervical lesions and prevent cervical...

, and forensic pathology

Forensic pathology

Forensic pathology is a branch of pathology concerned with determining the cause of death by examination of a corpse. The autopsy is performed by the pathologist at the request of a coroner or medical examiner usually during the investigation of criminal law cases and civil law cases in some...

. In many countries, to be licensed

Medical license

In most countries, only persons with a medical license bestowed either by a specified government-approved professional association or a government agency are authorized to practice medicine. Licenses are not granted automatically to all people with medical degrees...

to practice pathology, one has to complete medical school

Medical school

A medical school is a tertiary educational institution—or part of such an institution—that teaches medicine. Degree programs offered at medical schools often include Doctor of Osteopathic Medicine, Bachelor/Doctor of Medicine, Doctor of Philosophy, master's degree, or other post-secondary...

and secure a license to practice medicine. An approved residency

Residency (medicine)

Residency is a stage of graduate medical training. A resident physician or resident is a person who has received a medical degree , Podiatric degree , Dental Degree and who practices...

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.

Skills and procedures

The procedures used in anatomic pathology include:

Gross examination
Gross examination
Gross examination or "grossing" is the process by which pathology specimens are inspected with the bare eye to obtain diagnostic information, while being processed for further microscopic 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
Magnifying glass
A magnifying glass is a convex lens that is used to produce a magnified image of an object. The lens is usually mounted in a frame with a handle ....

or a stereo microscope
Optical microscope
The optical microscope, often referred to as the "light microscope", is a type of microscope which uses visible light and a system of lenses to magnify images of small samples. Optical microscopes are the oldest design of microscope and were possibly designed in their present compound form in the...

, especially when examining parasitic organisms.
Histopathology
Histopathology
Histopathology refers to the microscopic examination of tissue in order to study the manifestations of disease...

- the microscopic
Microscope
A microscope is an instrument used to see objects that are too small for the naked eye. The science of investigating small objects using such an instrument is called microscopy...

examination of stained tissue sections using histological
Histology
Histology is the study of the microscopic anatomy of cells and tissues of plants and animals. It is performed by examining cells and tissues commonly by sectioning and staining; followed by examination under a light microscope or electron microscope...

techniques. The standard stains are haematoxylin
Haematoxylin
Haematoxylin, hematoxylin, Natural Black 1, or C.I. 75290 is extracted from the heartwood of the logwood tree. When oxidized it forms haematein, a compound that forms strongly coloured complexes with certain metal ions, the most notable ones being Fe and Al salts. Metal-haematein complexes are used...

and eosin
Eosin
Eosin is a fluorescent red dye resulting from the action of bromine on fluorescein. It can be used to stain cytoplasm, collagen and muscle fibers for examination under the microscope. Structures that stain readily with eosin are termed eosinophilic....

, 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
Immunohistochemistry
Immunohistochemistry or IHC refers to the process of detecting antigens in cells of a tissue section by exploiting the principle of antibodies binding specifically to antigens in biological tissues. IHC takes its name from the roots "immuno," in reference to antibodies used in the procedure, and...

- 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
In situ hybridization
In situ hybridization is a type of hybridization that uses a labeled complementary DNA or RNA strand to localize a specific DNA or RNA sequence in a portion or section of tissue , or, if the tissue is small enough , in the entire tissue...

- Specific DNA
DNA
Deoxyribonucleic acid is a nucleic acid that contains the genetic instructions used in the development and functioning of all known living organisms . The DNA segments that carry this genetic information are called genes, but other DNA sequences have structural purposes, or are involved in...

and RNA
RNA
Ribonucleic acid , or RNA, is one of the three major macromolecules that are essential for all known forms of life....

molecules can be identified on sections using this technique. When the probe is labeled with fluorescent dye, the technique is called FISH
Fluorescent in situ hybridization
FISH is a cytogenetic technique developed by biomedical researchers in the early 1980s that is used to detect and localize the presence or absence of specific DNA sequences on chromosomes. FISH uses fluorescent probes that bind to only those parts of the chromosome with which they show a high...

.
Cytopathology
Cytopathology
Cytopathology is a branch of pathology that studies and diagnoses diseases on the cellular level. The discipline was founded by Rudolf Virchow in 1858. A common application of cytopathology is the Pap smear, used as a screening tool, to detect precancerous cervical lesions and prevent cervical...

- the examination of loose cells spread and stained on glass slides using cytology
Cell biology
Cell biology is a scientific discipline that studies cells – their physiological properties, their structure, the organelles they contain, interactions with their environment, their life cycle, division and death. This is done both on a microscopic and molecular level...

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
Immunohistochemistry
Immunohistochemistry or IHC refers to the process of detecting antigens in cells of a tissue section by exploiting the principle of antibodies binding specifically to antigens in biological tissues. IHC takes its name from the roots "immuno," in reference to antibodies used in the procedure, and...

, but it is still in common use for certain tasks, including the diagnosis of kidney
Kidney
The kidneys, organs with several functions, serve essential regulatory roles in most animals, including vertebrates and some invertebrates. They are essential in the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid–base balance, and...

disease and the identification of immotile cilia syndrome among many others.
Tissue cytogenetics
Cytogenetics
Cytogenetics is a branch of genetics that is concerned with the study of the structure and function of the cell, especially the chromosomes. It includes routine analysis of G-Banded chromosomes, other cytogenetic banding techniques, as well as molecular cytogenetics such as fluorescent in situ...

- the visualization of chromosomes to identify genetics defects such as chromosomal translocation
Chromosomal translocation
In genetics, a chromosome translocation is a chromosome abnormality caused by rearrangement of parts between nonhomologous chromosomes. A gene fusion may be created when the translocation joins two otherwise separated genes, the occurrence of which is common in cancer. It is detected on...

.
Flow immunophenotyping
Flow cytometry
Flow cytometry is a technique for counting and examining microscopic particles, such as cells and chromosomes, by suspending them in a stream of fluid and passing them by an electronic detection apparatus. It allows simultaneous multiparametric analysis of the physical and/or chemical...

- the determination of the immunophenotype of cells using flow cytometry
Flow cytometry
Flow cytometry is a technique for counting and examining microscopic particles, such as cells and chromosomes, by suspending them in a stream of fluid and passing them by an electronic detection apparatus. It allows simultaneous multiparametric analysis of the physical and/or chemical...

techniques. It is very useful to diagnose the different types of leukemia
Leukemia
Leukemia or leukaemia is a type of cancer of the blood or bone marrow characterized by an abnormal increase of immature white blood cells called "blasts". Leukemia is a broad term covering a spectrum of diseases...

and lymphoma
Lymphoma
Lymphoma is a cancer in the lymphatic cells of the immune system. Typically, lymphomas present as a solid tumor of lymphoid cells. Treatment might involve chemotherapy and in some cases radiotherapy and/or bone marrow transplantation, and can be curable depending on the histology, type, and stage...

.

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

Surgery

Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...

specimens, as well as biopsies

Biopsy

A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...

submitted by non-surgeon

Surgeon

In medicine, a surgeon is a specialist in surgery. Surgery is a broad category of invasive medical treatment that involves the cutting of a body, whether human or animal, for a specific reason such as the removal of diseased tissue or to repair a tear or breakage...

s such as general internists

Internal medicine

Internal medicine is the medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases. Physicians specializing in internal medicine are called internists. They are especially skilled in the management of patients who have undifferentiated or multi-system disease processes...

, medical subspecialists

Internal medicine

, dermatologists, and 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

Dentistry

Dentistry is the branch of medicine that is involved in the study, diagnosis, prevention, and treatment of diseases, disorders and conditions of the oral cavity, maxillofacial area and the adjacent and associated structures and their impact on the human body. Dentistry is widely considered...

, 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 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

Pap smear

The Papanicolaou test is a screening test used in to detect pre-cancerous and cancerous processes in the endocervical canal of the female reproductive system. Changes can be treated, thus preventing cervical cancer...

, 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 pathology which is focused in the study and diagnosis of disease through the examination of molecules within organs, tissues or bodily fluids....

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.

Autopsy pathology

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. In addition to pathologists, additional staff including Diener

Diener

The word Diener is German for servant. In English, it is generally used to describe the person, in the morgue, responsible for handling, moving, and cleaning the corpse...

s and Pathologists Assistants are often involved in performing autopsies.
Autopsies represent less than 10% of the workload of typical pathologists in the United States.
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.
Quincy, M.E.
Quincy, M.E., also called Quincy, is a United States television series from Universal Studios that aired from October 3, 1976, to September 5, 1983, on NBC...

and Silent Witness
Silent Witness
Silent Witness is a BBC crime thriller series focusing on a team of forensic pathology experts and their investigations into various crimes. First broadcast in February 1996, the series is still airing to the present day, with a fifteenth series expected to air in January 2012. The series was...

.

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. Because of this, it is necessary for forensic pathologists to have a strong background in anatomical pathology before becoming forensic pathologists. 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 of Anatomical Pathologists

Australia

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

Anatomical Pathology 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, then complete a minimum of 1 year of clinical medical experience (internship)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

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 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.

Anatomical pathology 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
Residency (medicine)
Residency is a stage of graduate medical training. A resident physician or resident is a person who has received a medical degree , Podiatric degree , Dental Degree and who practices...

, teaching medical students, conducting basic
Basic Research
Basic Research is an herbal supplement and cosmetics manufacturer based in Salt Lake City, Utah that distributes products through a large number of subsidiaries. In addition, their products are sold domestically and internationally through a number of high-end retailers. Dennis Gay is the...

, clinical
Clinical research
Clinical research is a branch of medical science that determines the safety and effectiveness of medications, devices, diagnostic products and treatment regimens intended for human use...

, or translational research
Translational research
Translational research is a way of thinking about and conducting scientific research to make the results of research applicable to the population under study and is practised in the natural and biological, behavioural, and social sciences...

, and/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
Histology
Histology is the study of the microscopic anatomy of cells and tissues of plants and animals. It is performed by examining cells and tissues commonly by sectioning and staining; followed by examination under a light microscope or electron microscope...

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
Clinical pathology
Clinical pathology , Laboratory Medicine , Clinical analysis or Clinical/Medical Biology , is a medical specialty that is concerned with the diagnosis of disease based on the laboratory analysis of bodily fluids, such as...

, which allows them to supervise blood banks, clinical chemistry laboratories, and medical microbiology
Medical microbiology
Medical microbiology is both a branch of medicine and microbiology which deals with the study of microorganisms including bacteria, viruses, fungi and parasites which are of medical importance and are capable of causing infectious diseases in human beings...

laboratories as well.

Large corporate providers of anatomical pathology services have emerged in recent years, the most notable one being AmeriPath 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
Economies of scale
Economies of scale, in microeconomics, refers to the cost advantages that an enterprise obtains due to expansion. There are factors that cause a producer’s average cost per unit to fall as the scale of output is increased. "Economies of scale" is a long run concept and refers to reductions in unit...

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
Radiology
Radiology is a medical specialty that employs the use of imaging to both diagnose and treat disease visualized within the human body. Radiologists use an array of imaging technologies to diagnose or treat diseases...

and pathology, are another practice model. In some case, these may be large groups controlled by an HMO or other large healthcare 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 clinican groups receiving direct insurance payments for pathology services. Proposed changes to Medicare
Medicare (United States)
Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over; to those who are under 65 and are permanently physically disabled or who have a congenital physical disability; or to those who meet other...

regulations may essentially eliminate these arrangements in the United States.

External links

"Conversations with Pathologists", a website based on a book project by Sue Armstrong, sponsored by Genentech
Genentech
Genentech Inc., or Genetic Engineering Technology, Inc., is a biotechnology corporation, founded in 1976 by venture capitalist Robert A. Swanson and biochemist Dr. Herbert Boyer. Trailing the founding of Cetus by five years, it was an important step in the evolution of the biotechnology industry...

and The Pathological Society of Great Britain and Ireland
Pathological society
The Pathological Society of Great Britain and Ireland is a professional organisation whose mission is stated as 'understanding disease'.- Membership and Profile :...
PathReports.in: Make Anatomical pathology reporting paperless and save trees.
PathMax, a collection of online Pathology resources
MyBiopsy.org, information on more than 25 of the most common cancers and cancer-related conditions
The Doctor's doctor, a very useful web site for patients and pathologists
Pathologie Online, online Pathology resources in German
Pathology Outlines, an online textbook of anatomic pathology
College of American Pathologists
American Board of Pathology
CYTOPATHNET Online Resource Center for Cytopathology
Histology Group of Victoria Incorporated
Flickr group: Pathology and Lab Medicine: numerous photos illustrating the work of pathologists.
Pathtalk.org: A multiple-author weblog by and for anatomic pathologists, with illustrative cases and specialty-related discussions.
PathologyPics.com: An interactive histology database for the Practicing Anatomic Pathologist as well as Pathology Trainees.

The source of this article is wikipedia, the free encyclopedia. The text of this article is licensed under the GFDL.

Skills and procedures

Surgical pathology

Oral and maxillofacial pathology

Cytopathology

Molecular pathology

Autopsy pathology

Forensic pathology

Training and certification of Anatomical Pathologists

Australia

Canada

USA

Anatomical pathology practice settings

See also

External links