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| ''Author: [[User:Mikael Häggström|Mikael Häggström]]''
| | {{Starting pathology - Initial}} |
| ==Using this handbook== | | =Emergent pathology= |
| The goal of this handbook is to make a new pathology trainee able to properly handle at least 80% of cases that are expected at an average general pathology department, including the exclusion of the most pertinent differential diagnoses thereof.
| | {{Emergent pathology - entire article}} |
| | {{Fixation, gross processing and evaluation}} |
| | {{Cytology, tumors, evaluation of suspected malignancies, immunohistochemistry, consultation and reporting}} |
| | =Gastrointestinal pathology= |
| | {{Gastrointestinal pathology - entire article}} |
| | =Breast pathology= |
| | {{Breast pathology - entire article}} |
| | =Autopsy= |
| | {{Autopsy - entire topic}} |
| | =Reproductive system= |
| | {{Reproductive system - entire topic}} |
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| It is recommended to scroll quickly through this handbook to get an idea of its content, and then keeping it at a known location for whenever information is needed for a corresponding patient case. It is not recommended to memorize its content indiscriminately. Other doctors and even laypersons can look up diseases and conditions themselves, including pathology characteristics, without the need for a pathologist consultation, so the expertise of memorizing such readily available information is expendable. In a world where diseases and conditions can readily be '''looked up''', a major skill that distinguishes a pathologist from any person with Internet access is mainly the ability to identify and put '''words''' to findings on microscopy or other non-written results, and to conceive most likely diagnoses based on both verbalizable and more abstract appearances. Another major skill is to be able to deal with '''unusual or equivocal''' presentations. Unusual or equivocal presentations of very common diseases and conditions are still generally more common than rare diseases, and constitutes a major workload in everyday pathology practice. However, most textbooks still give disproportionately large room for rare diseases compared to such presentations. Nevertheless, strive to '''master the common''' conditions (including the most common pitfalls) before diving into the uncommon.
| | =Skin= |
| | {{Skin - entire topic}} |
| | {{Vessels, soft tissue}} |
| | {{Oral and neck}} |
| | {{Lungs and lymph nodes}} |
| | {{Upper abdominal}} |
| | {{Other surgical pathology}} |
| | {{Clinical pathology - entire topic}} |
| | {{Last chapters}} |
| | =Notes= |
| | <references group=notes/> |
| | <references group=note/> |
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| ===What a pathologist needs to memorize=== | | =References= |
| The best method for memorization is generally through repeated exposure in everyday practice, but the following things are most important for a pathologist to focus on memorizing:
| | <references/> |
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| * '''Emergent pathology''', mostly relating to intraoperative or frozen section consultations. This includes information that usually cannot be timely looked up on the Internet when needed.
| | ==Image sources== |
| * Main '''pitfalls''': Most common and dangerous situations where a pathologist may not recognize the need to look something up further or ask a senior colleague.
| | <references group=image/> |
| * '''Patterns''' and '''signs''' which can be seen grossly or under the microscope. It confers the ability to translate visuals into words that can be looked up if needed.
| | <references group=images/> |
| * Knowledge of '''where to find information''' for various situations. It includes which person or which '''search engine''' is most useful for various clinical situations. Google is generally an appropriate search engine, but sometimes more specific or comprehensive databases are necessary, such as for example ClinVar to look up the pathogenicity of specific genetic variants. The chapter will include a '''directory''' of major databases and external guidelines.
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| * Proficiency in diagnosing '''equivocal or borderline cases''' where readily available sources and evidence usually deal with discrete and specific disease entities and subcategories thereof. Thus, in the question sections, many questions will be in the format of displaying readily available facts about diseases, including their typical immunohistochemistry patterns, but with equivocal or borderline case presentations.
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| * Having an idea of one’s '''unknowns'''; being aware of unfamiliar fields. For example, a pathologist generally does not need in depth knowledge about cases that are generally sent out to specialized centers (such as pediatric musculoskeletal oncology), as long as that pathologist is aware of lack of knowledge in that field.
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| [[File:What you need to memorize.jpg|350px|right]]
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| * '''Dealing with Internet denialists and their exams.''' With the ease of access to pathology information on the Internet through smartphones and computers, those studying to for everyday practice as a pathologists should not spend time memorizing what can essentially always be '''conveniently and timely be looked up''' in times of need. This includes most of the content of books that are sorted by titles of diseases and conditions, because if the name of a disease is already known, it can relatively quickly be looked up when needed. The topics listed above are already immense enough to cover a lifetime of learning. Nevertheless, the path to pathology certification includes one or more exams, whose questions are largely made up of people who act as if they were Internet denialists; as if they do not acknowledge the access to the Internet in everyday pathology practice. Therefore, this resource also includes a chapter on dealing with Internet denialists and their exams.
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| ===Using resources=== | |
| This resource is written with the intention to teach you what to do in various situations you are expected to encounter during your first years of pathology training, at least until the point that you are usually fairly confident about what disease or condition you have at hand, because then you know what words to use to look it up in the vast literature out there. At that point, the fastest way to get more information is generally by Googling the disease or condition name, followed by ''pathology'' or ''pathology outlines''. If you just want to see more micrographs of the disease or condition, the fastest way is generally to Google the condition and then clicking the Images tab. Specific searches for specific purposes include:
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| *Adding '''cancer.net staging''' in Google searches for definitions of cancer stages, for example Googling ''prostate cancer cancer.net staging''. The first search will then generally be the one from the American Society of Clinical Oncology.
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| *Considering a subscription for '''ImmunoQuery''' rather than trying to memorize all immunohistochemistry markers for all conditions.
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| '''Ask a colleague''' at least whenever your own memory or a resource search is not enough, and there is a significant risk that you will do something irreversible that will negatively affect a patient.
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| ==Emergent pathology==
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| '''Surprise frozen sections'''
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| While most frozen sections can be predicted from schedules of the operating room and thereby be looked up beforehand, this chapter deals with the most common ones that do not offer such preparation time, thus indicating memorization of how to handle them.
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| (Gather most common situations.)
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| '''Other frozen sections'''
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| Although these are generally given on schedules of the operating room, any pathologist may end up suddenly covering for another one, and subsequently be presented with the frozen section case without having had the time to look it up beforehand.
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| =Fixation=
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| {{Fixation - entire article}}
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| =Gross processing=
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| {{Gross processing - entire article}}
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| =Evaluation of tumors=
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| {{Evaluation of tumors - entire article}}
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| =Reporting=
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| {{Reporting - entire article}}
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| ==Notes==
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| <references group="notes"/> | |
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| ==References==
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| <references />
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