The surgical pathology laboratory annually receives approximately 26,000 in-house and consultation cases for diagnosis. Cases are assigned by site of surgery to the appropriate sub-service. In the first weeks, residents are rapidly introduced to basic principles of tissue fixation, preservation, histochemistry, gross dictation, tissue sectioning, microscopic analysis, frozen section techniques, electron microscopy and differential diagnosis, case work-up and generating the final report. Residents are responsible for every aspect of their cases including communicating with the appropriate physicians, up to the final sign out. All of these activities are performed with the level of attending supervision appropriate for the resident’s experience and capability.

General Surgical Pathology Rotation

Three residents share this busy service and rotate days in succession as main grosser, sign-out resident and helper grosser. Frozen sections for all services are performed by the grosser and helper on this rotation. The bulk of the specimens come from the thoracic, ENT, breast, genitourinary, and endocrine surgery services. Cases include a complete spectrum of neoplastic and non-neoplastic disorders. Residents present cases at the weekly interdisciplinary thoracic and breast tumor boards and discuss interesting cases at the weekly Monday morning conference.

GI/Bone/Soft tissue Pathology Rotation

This service is either shared by two junior residents or covered by a single more senior resident. The GI service examines about 5000 (usually multiple part) biopsy cases, 500 esophagus, bowel or pancreas resection cases and 50 liver explants per year, as well as small resection specimens (i.e. appendectomies and cholecystectomies). The GI biopsy specimens are grossed by a laboratory assistant. Residents are responsible for the large specimens, with help from a physician-assistant. Residents sit with Dr. Jakate to review biopsies and communicate with clinicians in the morning. A teaching set of over a thousand slides is available encompassing the entire gamut of diseases of the GI tract and liver, inflammatory, infectious, neoplastic, transplantation-related, genetic, and congenital. Pediatric GI pathology is well represented. Large specimens are signed out in the afternoons. Residents attend the weekly interdisciplinary GI conference. There are additional liver and GI teaching conferences are given by Dr. Jakate every other week. Residents are welcome to join the Rush GI pathology interest group run by Dr. Jakate and contribute cases for presentation.

The bone and soft tissue service assesses about 350 soft tissue and bone biopsy and resection cases per year, encompassing a wide variety of benign and malignant cases. Much of the material is from pediatric cases. We make extensive use of cytogenetic tests as well as immunohistochemistry for sarcoma work-ups. Residents accompany the attending to review the imaging studies prior to diagnosis of bone and soft tissue masses when necessary. Teaching sets of many classic and unusual tumors are available and a study outline is provided. Residents are responsible for properly photographing and managing their multi-faceted cases. Residents on this rotation attend the biweekly interdisciplinary sarcoma conference.

Gynecological Pathology Rotation

This service is either shared by two junior residents or covered by a single more senior resident. Approximately 6500 cases are examined per year, encompassing all aspects of benign and malignant pathology, from placental and developmental pathology to disorders of uterus and ovaries. Residents learn to diagnose ovulatory and endometrial abnormalities related to hormonal disturbance, viral and dysplastic and malignant changes of the cervix and genitalia, and the entire gamut of benign and malignant tumors of the ovaries, uterus, Fallopian tube and mesothelium. This busy service diagnoses about 400 malignant specimens per year. Residents are helped in their grossing by a physician-assistant for the placentas and simpler cases. Residents manage their cases, and rapidly assume increasing responsibility for case work-up and preparing reports. Residents present the cases at the weekly interdisciplinary conferences.