Small Biopsy
Duration: One month
Rotation Director(s): Jiang Wang, MD, PhD
Faculty/ Instructor(s):
Fred Lucas, MD
Description of Rotation
The resident will become familiar with the different histologic patterns of the conditions affecting the liver, kidney and heart, including transplantation pathology, and thus arrive at a correct diagnosis in any given case.
Rotation Objective
- Become familiar with how to handle donor and transplant biopsy specimens.
- Become familiar with the different ancillary techniques for evaluation of liver, heart and kidney tissue and their interpretation.
- Become familiar with all major groups of liver diseases, including liver tumors and tumor-like conditions (FNH etc.), chronic hepatitis and cirrhosis, metabolic diseases and liver transplant pathology, as well as donor liver and kidney pathology.
- Become familiar with adult heart disease, including cardiomyopathies, myocarditis, vasculitides and cardiac transplant pathology.
- Become conversant with clinical presentation and mechanisms of tissue injury applicable to various conditions affecting the kidney.
- Be able to interpret clinical, laboratory, immunopathologic and electron microscopic findings related to most common kidney diseases and renal transplant-related conditions.
- Develop knowledge about principles of EM specimen fixation, processing, thick and thin sectioning and evaluation of ultrastructural features.
- Contrast and compare electron microscopic findings with light microscopic and immunofluorescence findings for renal biopsies.
- Develop familiarity with the physics involved in the production of an image in the electron microscope.
Overall Responsibilities
The resident is responsible to see all in-house liver, cardiac and renal biopsy specimens. The resident will review and evaluate consults as they are received. The resident will review file cases periodically with rotating faculty.
Daily Responsibilities
- To review transplant and native liver, heart and kidney biopsies. Transplant biopsies are processed and reviewed the same day they arrive to the laboratory. The resident should be in contact with the gross room, pathology technicians and histology lab to be aware of pending cases. Appropriate histories, particularly previous biopsy results for transplant patients, should be obtained and reviewed prior to review of cases with attending. The resident should attempt as much as possible to evaluate independently the biopsies and arrive at a differential diagnosis before signing the case out with the attending. Special stains will be ordered in conjunction with consultation with the attending. As the resident becomes proficient, he/she will dictate the cases.
- Be available at the time the clinicians wish to review cases. Therefore, if the resident is not performing other duties, it is important that they are physically present in the surgical pathology area for their study time so that they can be involved in these case reviews. As the resident becomes more proficient, he/she may be asked to review the cases with the clinicians after consultation with the attending pathologist, and will be evaluated as such.
- See consultation cases, determine a differential diagnosis and assist in obtaining necessary clinical information.
Evaluation
- Arrival at a correct diagnosis at the time of signing the cases out.
- Evaluation of dictations and independently generated reports.
- Evaluation of professional interactions including communication skills.
- Evaluation of presentation at conference, when appropriate.