Approximately 500 autopsies are performed annually at the University Hospitals and nearby Veterans Administration Hospital. These cases represent a wide spectrum of diseases including pediatric as well as forensic cases from Washtenaw County. Because of the forensic experience of the pathology faculty, residents have not found it necessary to take separate rotations at other facilities.
The autopsy service also serves as an initial introduction to surgical pathology for many of the residents. Residents are instructed in proper dissection techniques as well as in the interpretation of histologic sections. Finally, the autopsy service serves as a forum for the instruction of medical students and house officers from other services.
Residents are assigned to cytopathology for two to three months, but they may elect to spend additional time in this area. The laboratory processes approximately 7,500 non-gynecologic and 40,000 gynecologic specimens annually. The non-gynecologic specimens are quite varied and include about 1,700 fine needle aspirates.
Residents attend the daily sign-out session usually of four hour duration. They also attend all the clinical procedures of fine needle aspirations involving deeply situated lesions. These aspirations are carried out in the Department of Radiology. Residents are taught how to prepare the aspirates for rapid, on-site evaluation. Residents also learn to carry out fine needle aspiration of superficial lesions and how to prepare and interpret the specimens rapidly.
This service has seen considerable expansion in recent years, in part due to the expansion of the Cutaneous Surgery and Oncology Clinic located in the Comprehensive Cancer Center and a large pool of referring private practice dermatologists. Over 15,000 cases are accessioned each year and range from diagnostic biopsies to full resections of larger lesions.
Dermatopathology specimens are separated from general surgical pathology and residents rotate on a dedicated dermatopathology service for 3 months during their training, with the option for additional elective experience. Supplementing the sign-out experience provided by three department dermatopathologists, is a monthly teaching conference held for all residents.
At weekly brain cutting sessions under the supervision of one of the neuropathologists, resident prosectors demonstrate material from their autopsy cases to an interdisciplinary group which includes neurologists, neurosurgeons, neuroradiologists, as well as pathologists. The same group participates in a monthly clinical pathologic conference. House officers are encouraged to review the neuropathology findings from their surgical and necropsy cases with neuropathologists. In addition to this ongoing practical experience, trainees are offered a didactic course in neuropathology each year.
The Surgical Pathology faculty in the Department of Pathology constitutes one of the strongest groups of diagnostic surgical pathologists in the world. The surgical pathology service is an active rotation in which efficiency and accuracy of specimen handling and diagnosis and "one on one" teaching are emphasized. Depending on the individual career goals, residents are assigned to surgical pathology for 14 to 18 months. Training is closely supervised by the attending staff, although house officers are expected to develop a sense of confidence and graduated independence as they progress through training. During their rotations, residents are responsible for the gross description, dissection, and microscopic review of specimens prior to “sign-out” with faculty. Approximately 60,000 specimens are processed annually by this service. The types of cases range from the uncomplicated to the highly complex specimens derived from the numerous patient referrals to this tertiary care complex. In addition, about 6,000 personal consultations referred to the faculty for expert opinion complement and augment surgical pathology material.
Approximately 6,000 frozen sections are performed each year and ancillary special studies (e.g. immunohistochemistry , FISH) are performed on a significant percentage of cases. Interesting cases are reviewed with the staff at a weekly surgical pathology conference, a bimonthly immunohistochemistry conference, and a monthly gross surgical pathology conference.