Breadth of Subspecialties in Pathology

[Enkidu]

It seems like some subspecialties in pathology are just *bigger* than others. Hemepath seems to be just a lot more diverse than most, with a lot of benign conditions and a lot of complexity in the neoplastic conditions. On the other hand, my sense is that renal pathology might just encompass a fairly limited set of diseases.

I'm planning on some pathology rotations and I'd like to rotate through a subspecialty that has a lot of breadth to it, so that I get to see a lot of different entities. How would you guys rate the different subspecialties (I actually can only rotate through surgpath, but I'd like to hear thoughts on hemepath and cytopath as well, just out of curiosity)

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[TMZ2007]

Cytopath makes no sense whatsoever until you have a good basis in general surg path. Would not recommend for a med student rotation.

 

[pathstudent]

It seems like some subspecialties in pathology are just *bigger* than others. Hemepath seems to be just a lot more diverse than most, with a lot of benign conditions and a lot of complexity in the neoplastic conditions. On the other hand, my sense is that renal pathology might just encompass a fairly limited set of diseases.

I'm planning on some pathology rotations and I'd like to rotate through a subspecialty that has a lot of breadth to it, so that I get to see a lot of different entities. How would you guys rate the different subspecialties (I actually can only rotate through surgpath, but I'd like to hear thoughts on hemepath and cytopath as well, just out of curiosity)

That's true about hemepath but in academics, you'll have people who are subspecialized within the subspecialty. There are flow specialists, MDS specialists, etc...I met a guy from Mayo whose big things was NK cell diseases. I met another from Europe who only signed out nodal T-cell lymphomas. (it is not unlike oncology where at a large academic center, you have oncologists that only treat certain diseases.

 

[Enkidu]

What about GI? That seems to have a good number of neoplasms, but also inflammatory conditions as well. Probably there are also a lot of different metastatic tumors in the liver that would be worked up? That might be really interesting. Do you think that GI is broader than other subspecialties?

 

[thebouque]

If surg path is offered, why wouldn't you do your rotation in it? With a bit of luck, they'll let gross some specimens. You could also be involved in a few autopsies. When you're doing a rotation as a medical student you can usually personalize your rotation once you're in the department. If you're on surg path but want to learn a bit about cyto, you can ask to spend a few half days with the cyto staff. It's too early to do a ''system based'' rotation yet. You're not going to be proficient at GI or heme after 4 weeks as a medical student.

Most liver mets come from the colon. They're bad news for the patient but not that exciting/challenging for the pathologist. The path report on liver mets is more or less a formality.

 

[pathstudent]

What about GI? That seems to have a good number of neoplasms, but also inflammatory conditions as well. Probably there are also a lot of different metastatic tumors in the liver that would be worked up? That might be really interesting. Do you think that GI is broader than other subspecialties?

My experience is that GI pathologists pretty much cover the whole alimentary canal. I never have seen one that only did Distal Esophagus or something like that. But I have seen a few that signed out only pancreatic tumors. And of course there are plenty of liver pathologists that only do liver.

 

[KluverB]

Dermpath is pretty broad. A lot of entities, such as heme malignancies, soft tissue tumours, etc., can present in the skin, not to mention derm manifestations of various systemic disorders.

 

[KCShaw]

Eh, depends on what your goals are for doing a pathology rotation in the first place. For simple breadth of exposure though, it's hard to beat a straight up "surg path" rotation.

But for subspecialties, which was the question, that's a bit harder and can depend in part on who/where you would be doing it, and, still, on your underlying goals. Of course the nature of subspecialties is to narrow the field, which generally won't mesh with the goal of breadth. Yeah, a cytopath might see a lot of different things, or they might see almost nothing but thyroid FNA's, or just GYN,...or whatever. With a GI you might see a lot of different things, or you might not. Heme can have a lot of nuances involved, but you might end up sitting with someone who doesn't really open the door to those or only gets a narrow specimen set. Depends. A good teaching attending can make their subspecialty fun and seem interestingly complicated yet still accessible. A bad teaching attending.. well.

 

[2121115]

My experience is that GI pathologists pretty much cover the whole alimentary canal. I never have seen one that only did Distal Esophagus or something like that. But I have seen a few that signed out only pancreatic tumors. And of course there are plenty of liver pathologists that only do liver.

Its common for them to split up "tubular" GI and hepatobiliary.