Week 1: Basics of Surgical Pathology

Before Monday, I had no idea what pathology really was. I googled it and found that they diagnose things. What things? I didn’t know…. But I had a feeling I would find out soon!

I have, in fact, learned a few things about pathology this week. I met Dr. Brian Robinson, my clinical mentor, and he explained the basic operation of the pathology department. I learned that pathologists look at tissue samples (muscle, fat, tumors, etc.) to identify a disease. They also look at where the disease came from and describe how the disease has progressed.

One of the residents I spoke with described pathology as a puzzle. They gather clues by observing the color, texture, size, and shape of the sample when it is received, dissecting to learn more. Then they prepare the specimen to be examined under a microscope to learn even more and fit it all together to form a diagnosis.

Pathologists are specially trained to see differences in morphology and architecture of the tissues on the cellular level. I had the chance to observe this during daily sign-out sessions. This is where the residents look at the slides and explain what they observed. The trained pathologist uses this as an opportunity to teach the residents what to look for and to correct any mistakes in the diagnosis. All I can make out are purple dots (the nuclei) with a lot of pink (all the cytoplasmic proteins). Maybe I’ll get better eventually. Nonetheless, I find this whole process amazing. For me, the most amazing part of pathology is the fact that solving this puzzle leads to better treatment and better outcomes for the patient. I learned that pathologists have very little, if any, direct interaction with patients, but the decisions made here significantly impact a patient’s course of treatment.

But my real concern was how does it get from the inside of a patient to the point where we can look at it under the microscope? I spent this week finding out! Samples are brought directly from the operating rooms to the pathology department to be processed. One of the first procedures I saw was what they refer to as ‘frozens’. During this process, a sample is placed in a medium called OCT, frozen into a block in a -22°C machine, cut into super-thin (5µm or less) sections, and then placed on a microscope slide. I learned that this technique is used so slides can be prepared very quickly and decisions can be made while a surgery is in progress.

For the rest of the tissue, I found out that it goes through a longer process. This includes fixing the tissue in formalin, grossing it (making large-scale observations then cutting it up into relevant representative pieces), embedding the pieces in paraffin, cutting, staining, and then finally you get to look at it with the microscope. I enjoyed learning more about each of these steps, and I really liked seeing the types of instruments and devices used for these processes; there are definitely some interesting tools here in pathology!

The most well-used tool in pathology is, of course, the microscope:

  
This microscope isn’t very happy, but at least the tissue is!

  
This week, I got to see first-hand what pathology is and how it works, and I can’t wait to learn even more! I have really enjoyed my time at the hospital and in New York City so far, and I am looking forward to the next few weeks of immersion!

Rose Buchmann

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