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Anatomical pathology is the study of diseases based on microscopic and anatomical findings on organs and tissues. The article will focus on the training and different sub-specialties of this discipline, as well as the daily schedule of the specialist.

Anatomical pathologists focus on diagnosing conditions and diseases based on the microscopic, macroscopic, immunological, molecular, biochemical and immunologic examination of body tissues and organs. 

Training

In order to specialise in anatomical pathology, an Aspiring specialist candidate first has to complete their 5-6 year undergraduate degree in order to become a qualified medical doctor. This is then followed by a 1-2 year internship training phase and once this is completed will allow the doctor the opportunity to apply for a specialist post.

The residency programme for anatomical pathology takes 5 years to complete and the specialist may decide to sub-specialise further. In order to do so, they would have to complete a fellowship training programme that can take 1-2 years to complete.

The sub-specialties of anatomical pathology include the following disciplines:

  • Surgical pathology - this discipline is the most time-consuming sub-specialty for a lot of anatomical pathologists. It involves examining surgical specimens and biopsies sent by non-surgical specialists such as dermatologists, general practitioners and physicians.
  • Cytopathology - this discipline involves the examination of cells, under a microscope, that are obtained from fine-needle aspirates or smears. These specialists will also perform fine-needle aspirations of cysts, masses or superficial organs. They are then often able to give an opinion and diagnosis in the presence of the consulting doctor and the patient. 
  • Oral and maxillofacial pathology - the sub-specialists here are usually dentists, rather than medical doctors, who have chosen to specialise further.
  • Molecular pathology - here, techniques such as reverse-transcriptase polymerase chain reaction (PCR) and in-situ hybridization are used for specialised studies of diseases in cells and tissues. 
  • Forensic pathology - will be discussed in a separate article.

Procedures in Anatomical pathology

  • Gross examination - this is examining diseased tissues with the naked eye. For large tissue fragments this is important because the disease can be visually identified. 
  • Cytopathology - this is the examination of loose cells that are spread and stained on glass slides using cytology techniques.
  • Histopathology - histological techniques are used for staining tissue (histochemistry) so that it can be observed under a microscope.
  • In-situ hybridization - this technique helps to identify specific DNA and RNA molecules on tissue and organ sections.
  • Immunohistochemistry - here, antibodies are used to detect the localization, abundance and presence of specific proteins. This process is very important as it aids in characterizing the molecular properties of certain cancers, and distinguishing between disorders with the same morphology.
  • Tissue cytogenetics - this technique helps to visualise chromosomes in order to identify genetic defects in patients.
  • Electron microscopy - this microscope allows for greater magnification, which results in being able to visualise organelles within cells. 
  • Flow immunophenotyping - this technique is very useful for diagnosing different types of lymphomas and leukemias.

Practice settings for Anatomical pathologists

Anatomical pathologists may be involved in several setups and they can be associated with the following practice settings:

  • Academic anatomical pathology - this involves being associated with the university faculty. One of the responsibilities here is the training of under- and post-graduate doctors. 
  • Large corporate providers - here, pathologists are employees of a pathology company.
  • Group practice - a group of senior pathologists will run a partnership practice that employs junior pathologists to provide diagnostic services to hospitals.
  • Multi-specialty groups - these are composed of physicians from various specialties together with pathologists and radiologists to offer a complete diagnostic service.
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