Pathology for medical students
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This article is an introduction to pathology for medical students.
Compentencies
Describing injuries
Pre-autopsy
- Filling in a death certificate.
- Difference between manner of death, cause of death and mechanism of death.
- World Health Organization standard for death certificates.
Autopsy
- Identifying medical examiner cases/coroner's cases.
- Getting an autopsy consent.
- Understanding the hierarchy and knowing it must be followed strictly.
- Knowing the difference between executer of the estate and power of attorney for health care decisions (not valid after death).
- Providing important clinical information.
- Clinical history - past medical history.
- Events leading-up to death.
- Provisional/suspected cause of death.
- Value of doing an autopsy.
- Interpretation of autopsy reports.
- Negative autopsy.
- Inherited diseases, e.g. MEN 2A, ARVC.
Surgical pathology
- Ordering biopsies and laboratory tests.
- Infectious cases - role of culture.
- Interpreting pathology reports.
- Importance of providing clinical information.
- Consultant for a specialist should have a reason for referral - pathology is not different.
Cancer diagnoses
Definitions:
- Cancer.
- Pathologic definitions of cancer.
- Tumour.
- Not necessarily cancer.
- Locally aggressive tumours, e.g. desmoid tumour.
- Benign tumours.
Pitfalls:
- The -oma endings -- some are malignant:
Implication of not otherwise specified:
Prognostic factors:
- Stage & grade.
- Lymphovascular invasion.
- Perineural invasion.
- Margin status.
- Tumour size - understanding the rationale for diagnostic size cutoffs.
Techniques
- Immunohistochemical stains.
- Targeted therapies/molecular testing:
- Receptors in breast cancer (ER, PR, HER2).
- Lung cancer biomarkers (EGFR, ALK, PD-L1, ROS1).
- BRAF testing in malignant melanoma.
- MSI testing in colorectal cancer.