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Anatomic Pathology

The scope of anatomic pathology includes primarily the examination of tissues for disease processes. The main branches of anatomic pathology include surgical pathology, cytopathology, and autopsy pathology.

Surgical pathology encompasses virtually all outpatient and inpatient biopsy and resection procedures that are performed. Most often, the scenario involves a lump or mass prompting a question of whether something is benign or malignant. Pathologists determine whether malignancy is present or absent by examining microscopic sections of the removed tissue and issue a report to the doctor who removed the tissue and other doctors who are involved in the patient’s care. If, in the middle of surgery, a surgeon comes across something that looks abnormal, he or she may request an intraoperative consultation with the pathologist. The pathologist’s intraoperative examination may involve only examining the tissue with the naked eye, but it often includes a frozen section, a procedure that allows a microscopic section of tissue to be prepared and examined for the presence of malignancy within 20 minutes. The surgeon may then modify the procedure to take into account the new information. Radical surgeries for cancer require evaluation of various prognostic parameters such as the type and extent of the tumor, the completeness of resection, and the involvement of lymph nodes. These data are used by oncologists to make decisions about various other therapies such as chemotherapy and radiation therapy.

Cytopathology is the examination of cells which no longer have intact architectural relationships with large tracts of tissue. The samples that cytopathologists work with are limited in the amount of information they can provide compared with surgical tissue fragments. Cytologic diagnoses are correspondingly limited in scope and often need confirmation by more invasive procedures that obtain tissue. George Papanicolaou pioneered the use of cytology on cervicovaginal (Pap) smears and now cytopathology has gained acceptance in numerous body sites. Typical sites sampled by fine needle aspiration as performed by pathologists include enlarged lymph nodes of the neck, armpit and groin, salivary gland lumps, breast lumps, and thyroid nodules. With the use of radiologic guidance, radiologists routinely sample lung, liver, and spinal masses using fine needle aspiration and send the samples to pathologists for evaluation.

For the purposes of this discussion, autopsy pathology is taken to mean hospital-based autopsies. Pathologists are best known for performing autopsies. This is probably due to the success of Jack Klugman in the role of Quincy. Even with advances in modern medicine, sometimes patients die in the hospital for unclear reasons. While the cause of death is not always revealed in the autopsy, the autopsy is still the best procedure to find out.