A one-month neuropathology rotation is completed in the third or fourth year of the program; this is in addition to the experience in neuropathology gained as part of the autopsy rotations. There are many frozen sections and a wide variety of cases and specimens emanating from the active Maxine Dunitz Neurosurgical Institute at Cedars-Sinai. The main goal of the rotation is to recognize the neoplastic, non-tumorous and low grade neuropathologic lesions, and practice a defensive approach to tissue handling and to frozen section interpretation. In addition to Neuro-Oncology, this rotation provides an overview of diseases of muscle, nerve and neurodegenerative conditions. In these cases, even greater emphasis is placed on proper case management, and correct collection/preservation of the tissue for subsequent expert evaluation.
During the neuropathology month, the resident signs-out neuropathology and muscle cases with one of the two neuropathologists every morning, with follow-up review of all special stains. The resident participates in all aspects of neuropathology frozen section evaluation as the frozen section cases occur during the work day. Attendance also is expected at the neuropathology specialty conferences, including the Wednesday morning neuro-oncology tumor board, and the Tuesday afternoon autopsy brain cutting and sign-out sessions. Toward the end of the rotation, the resident is expected to present at the neuro-oncology tumor board. An extensive study set is available for review of a wide range of neuropathology entities.
Specific Neuropathology Goals and Objectives:
- Describe common brain tumors and lesions, and the main patterns of muscle and nerve pathology.
- Correctly process muscle and nerve biopsies.
- Apply basic diagnostic skills in common brain neoplasms/infections/demyelinating and inflammatory processes, with grading of tumors use of relevant prognostic markers.
- Identify the clinical presentations and diagnostic implications of various entities.
- Describe the appropriate use and interpretation of histochemical and immunohistochemical stains in working up Neuropathology lesions.
- Define the role of molecular pathology in diagnosis of brain tumors.
Interpersonal and Communication Skills:
- Construct a clear, cogent, accurate and properly formatted pathology report, including gross and microscopic descriptions that reflect salient diagnostic points and special studies.
- Access and interpret most Neuroradiology findings in the context of histopathologic findings.
- Interact with physician or clinical support staff to obtain more information and to report a preliminary or final diagnosis in a clear manner that inspires confidence and fosters collegiality.
- Self-identify as the case physician. Assigned cases are the resident's cases.
- Reliably follow instructions for obtaining additional studies or information.
- Keep close track of pending cases and know when to notify Attending of unexpected problems or delays.
- Take the initiative in a proactive manner to advance cases through stages of evaluation, compatible with level of competency/training.
Systems-Based Practice and Practice Based Learning:
- Consistently maintain reading on cases and on general topics in Neuropathology.
- Utilize the information provided by the clinician and/or seek additional information to aid diagnosis.
- Continuously ask questions.
- Synthesize skills learned and apply them to other areas of diagnostic pathology.