Mindy said:
Hi AT:
It is a real shame that we don't mingle more. Should have a Boston Pathology Resident Social Hour?!
And just for a reciprocal plug, I also really enjoyed the Brigham when I was around for interviews. If the residents interacted more, I bet it would lead to more mingling by residents of the various strengths of the hospitals.
Sounds like a great idea...now we have to find a time that's mutually agreeable for as many people as possible. Easier said than done!
Yeah, it's always nice to just get some exposure to how other institutions do things.
Mindy said:
As far as your use of impox, I really do not hear much about it through the grapevine.
We really do tend toward morph diagnoses, when possible. That being said, we use impox when we have to, in cases of heme malignancies or soft tissue tumors, of course. Or carcinoma of unknown primary. We usually put our impox results as an addendum in the latter case, but will sign above line, simply "metastatic carcinoma". And generally, we have a solid differential going prior to impox (which really is key to the use of ancillary testing of any type) so are not too often surprised. In general I am satisfied with the quantity of impox we use.
Gotcha. I guess we're in the similar boat as well and maybe I was overreacting a bit. Yeah, heme cases are bound to get a huge panel of impox studies. Soft tissue tumors too...hell, they all look like spindle cell neoplasms (well, for the most part) to me! Hell, I've been getting quite a few of these neurofibroma, schwannoma, MPNST, GIST, various sarcomas, etc cases recently and everytime my initial reaction is like
😱 followed by putting my head down and banging it against the desk. Anyways, it definitely does help to order the typical panel of stains like c-kit, S100, CD34, etc to get a better sense of what's going on and/or to confirm what one is already suspecting. Of course, problems arise when one impox result seems like an outlier...then you have to explain it or dig deeper
It seems that this is also attending dependent. Some of our attendings are more liberal with regards to ordering many impox studies whereas others just put their foot down and make the diagnosis based on morphology. I guess that has to do with the art of pathology.
I do hear that MGH and BWH have great impox labs...which makes me feel that we might be spoiled. The one issue that arises then is that we take it for granted. I can imagine what the private practice folks have to go through since they typically don't have many of our fancy impox protocols at their disposal. And that's where solid training in heavily morphologic-based diagnostics really become important!
Anyways, I'll stop babbling. Anyways back to the initial point...how well do your residents attend these New England Pathology Society meetings? Meeting up at one of these would be a great stepping stone to organizing some social mingling occasion.
