THE FIELD OF DIAGNOSTIC ANATOMIC PATHOLOGY
Anatomic pathology is that field of study which describes gross and microscopic anatomic abnormalities in organisms, tissues, and cells, with the goal of diagnosing individual diseases. The field encompasses autopsy pathology, surgical pathology, and cytopathology.
WHAT WE DO
Autopsy pathologists make a set of gross and microscopic diagnoses on a dead patient, and then define the causal relationship between these different diagnoses. For example, if a patient dies in septic shock with renal failure, acute pyelonephritis, lung failure, and mental status changes, then the logical progression of these multiple diseases is “acute pyelonephritis, leading to septic shock and multiorgan (renal, pulmonary, and CNS) failure.” The logical ordering of diagnoses requires understanding of the body’s normal structure/function, knowledge of the antemortem events, and an ability to integrate these facts with morphologic observations made at the time of autopsy examination. When done correctly, it creates closure for both the family and the treating clinical team, because it coherently explains the disease processes leading to death. TV has made a detective of the autopsy pathologists involved in criminal cases; these forensic pathologists do double duty as physicians and expert witnesses when they get drawn into the legal drama of assignment of blame and guilt. Thanks to these portrayals, noncognoscenti in the lay public think that all pathologists are autopsy pathologists. Although the majority of pathologists have had training in the area of autopsy pathology, most of their anatomic pathology effort involves surgical pathology and cytopathology. WHAT WE DO
Surgical pathologists use the same understanding of the body’s normal structure/function, knowledge of concurrent clinical and laboratory abnormalities, and ability to integrate these facts with morphologic observations to make gross and microscopic diagnoses on living patients who undergo surgical biopsies or resections of abnormal individual organs. These diagnoses also inform the patient, family, and treating clinical team, and do so at a time when the patient can hopefully be treated to slow or eliminate the disease process.
TV pays no attention to surgical pathologists, even though most pathologists practice surgical pathology. Lawyers, on the other hand, pay close attention to surgical pathologists because of the potentially lucrative monetary awards tied to missed or delayed diagnoses. Surgical pathology is an umbrella field, with specialists for each of the organ systems. Some of these organ systems are sufficiently complex and subtle that they merit case diagnosis by subspecialty-boarded pathologists, for example, neuropathology, hematopathology, and dermatopathology. Hematopathology is a unique subgroup, in that it integrates data from a variety of other sources (flow cytometry, cytogenetics, and molecular pathology) with standard microscopic examination of lymph node, spleen, and marrow.
WHAT WE DO
Cytopathologists diagnose diseases based on scant samples that typically show only cellular features, that is, samples lacking elements of tissue architecture. These specimens include fine needle aspirates (FNAs), scrape smears (think PAP smears), paraffin-embedded cell blocks, and needle cores.