Week 2: Surgical Pathology

Over the last two weeks, I have been trying to build a surface-level understanding of pathology and the techniques used to diagnose. One of my professors in undergrad would always tell us that in order to really understand a technique, we have to understand how and why it came to be. So this week, I read a little bit about the history of pathology. Here’s what I found out:

Pathology started as simply an observation of the body. Early physicians would keep track of symptoms and relate them to what they saw on (or in) the patient’s body. They could get a rough idea of the causes and effects of a disease. This was the easiest way for them to get the information they wanted.

The microscope is extremely prevalent in this field, and this invention allowed the study of pathology to expand to a cellular (and with newer technology, atomic) level. In the late 19th century, scientists were just beginning to understand how biology worked on this small scale, and, through many different kinds of research, our present understanding of pathology was developed.

One example is this: in the early-1900s, Dr. George Papanicolaou was studying the uterus and cervix and changes seen cellularly. He developed a technique, the Pap Smear Test, which is still used today to detect cervical cancer. Fun fact about this: Dr. Papanicolaou was a Professor of Anatomy right here at Weill Cornell. They even have a little exhibit just past the lobby in the medical school building:
  
There is (supposedly) a secret elevator that leads to Dr. Papanicolaou’s archives. I have yet to confirm.

 I learned that pathology was developed to simply learn more by observing patterns that give clues to how a disease will develop. Now, scientist use many different forms of 'looking at things' to gain information from human bodies.

This week, Dr. Prince, a radiologist at Weill Cornell, taught us a little bit about interpreting images. I learned that I am unable to differentiate x-ray images of arms and legs. In my defense, they are pretty similar. Look:
  
Leg? Arm? They’re both long. They both have similar joints. They look pretty much the same to me. I did finally figure it out. For your information, the one on the left is an arm [1] and the one on the right is a leg [2].

Knowing my complete lack of observation skills, now imagine my dismay when a pathologist can look at something like this:
And provide this diagnosis: “high grade infiltrating papillary urothelial carcinoma with fused papillae lined by dysplastic transitional epithelium” [3]

I still have no clue how they do this. I asked the pathologists, and each one laughs a little bit and tells me ‘experience’. Basically, I have no hope. So I took to something I know a little bit better: software. This week, I had the chance explore some image processing software from Indica Labs. It allows the user to analyze an image digitally. Even though this is a pretty awesome piece of technology, my conclusion is that pathologists are much faster and better at analyzing these samples for diagnostic purposes. For quantitative analysis, the software excels but still takes a while.

This makes me wonder about the future direction of pathology. What advances will help answer the questions that pathologist ask every day? I have listened to physicians debate about the utility of new developments in software, surgical instruments, medical devices, and imaging techniques. I don't know what's best, but I do know that it is a very exciting time to be a biomedical engineer!

After my second week, I feel like I have learned a lot. Pathology is a new experience for me, and it has led to questions that I never would have asked otherwise. I have gotten to see a very different side of medicine and research, and I am very excited to continue to learn more!

[1] Periasamy, K., Meek, D., & Crossman, P. (2008). Posterior dislocation of the elbow as an unusual presentation after a total hip replacement: a case report. Journal of Medical Case Reports, 2, 38. http://doi.org/10.1186/1752-1947-2-38
[2] Kundu, Z. S., Gupta, V., Sangwan, S. S., & Rana, P. (2013). Curettage of benign bone tumors and tumor like lesions: A retrospective analysis. Indian Journal of Orthopaedics, 47(3), 295–301. http://doi.org/10.4103/0019-5413.111507
[3] Mondal D, Rastogi N, Chaudhuri T, Jain M. Synchronous papillary urothelial carcinoma of urinary bladder and adenocarcinoma of stomach in a middle-aged man: An extremely rare association with therapeutic dilemma. Clin Cancer Investig J [serial online] 2013 [cited 2017 Jun 30];2:156-9.

Rose Buchmann

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