Neuropathology
Duration: One month
Rotation Director(s): Ady Kendler, MD, PhD
Faculty/ Instructor(s):
Matthew Hagen, MD
Description of Rotation
The focus of the neuropathology rotation is on general neuropathology as commonly encountered by anatomic pathologists—i.e., brain tumor biopsies and brain autopsies for dementia. Understanding of complex issues is gradually built by starting with normal neuroanatomy/histology, continued with basic patterns of pathological responses and simple descriptions of findings to arrive at diagnostic patterns of disease and understanding of principles of pathophysiology.
Rotation Objective
- To differentiate grossly and microscopically normal from pathological brain, spinal cord, peripheral nerves and skeletal muscles and to describe them accurately.
- To correctly identify common neoplastic, neurodegenerative, demyelinating, infectious, traumatic and malformative processes in the CNS and PNS and be able to describe their main features.
- To become familiar with the histological features of the common nervous system tumors and to be able to diagnose them on frozen and permanent sections.
- To know how to remove and work up brain, pituitary, spinal cord, peripheral nerve and skeletal muscle tissues.
- To be familiar with gross and microscopic neuroanatomical pathways and their main functions.
Overall Responsibilities
Guided by the neuropathology faculty, the resident on neuropathology rotation is responsible for the appropriate gross and microscopic work-up of current neuropathological specimens including clinico-pathological correlations and literature reviews as appropriate. Teaching sets of histological and power path slides, complement the ongoing surgical and autopsy material that is being worked up at the time of the rotation. Progressive responsibilities include participation in frozen section diagnoses, selection of special stains, preparation of written reports and communication with referring physicians and with technical staff; effective use of resources, safeguard of patient rights and ethical practices are discussed based on current experiences. For autopsies, the resident is responsible to carry out a case-appropriate CNS and PNS exam with the autopsy attending or with a neuropathology attending including brain cutting with clinico-pathological correlation, an up-to-date discussion and specific literature citations. Typically, the resident will start with a broad literature search and review that is then narrowed to the specific case. The resident will prepare and present cases at the autopsy conference and at clinical conferences as assigned.
Daily Responsibilities
While serving on the neuropathology rotation, the resident is involved in evaluating all current NP specimens including brain, spinal cord, peripheral nerve and muscle biopsies. Thus, the resident participates in frozen section diagnoses rendered by the attending neuropathologist and in the subsequent work-up of the permanent sections, communication with the referring physician and issue of the written reports. When there are more than one rotating residents (usually from different departments bringing different expertise—i.e., pathology, neurology, neurosurgery), they are encouraged to form a team to work up the cases according to the level of their respective experience in neuropathology. The residents are asked to review the didactic slide material in a timely manner.
Evaluation
Evaluations are based on the quality of the reports, work at the microscope/autopsy room/frozen sections and (optional) final exam. Each report created by the resident (biopsy and brain autopsy) is evaluated by the attending and rated for the ACGME competencies #1-2 (Patient Care and Medical Knowledge) #3 and #6 (Practice Based Learning and System Based Practice). Negatively weighted are gross omissions/errors such as missed specimens, wrong anatomical sites, wrong or missing diagnoses etc. The attending evaluates the basic, diagnostic and technical skills on an ongoing basis that takes the rate of progress into account and the level of training. A brief test may complete the rotation. The final score is adjusted for the year of training.