Pediatric Pathology

[Enkidu]

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Do you guys have regular interactions with pediatric pathologists? What do those interactions consist of and what do pediatric pathologists bring to the table? I'm considering a career in pediatric pathology and I wanted to get the pediatric view of the field.

 

[J-Rad]

I would imagine the ones to have the most interactions with a pediatric pathologist would be the peds heme/onc folk. Otherwise, the only path person I had substantial contact with in my peds residency was the head of the blood bank who was awesome and would frequently come to the NICU, PICU, or ward to answer transfusion or blood bank related questions. In my cardioogy fellowship our heart failure/transplant guy interact with one of the pathologists (who has a PhD in immunology) for transplant related path (from endmyocardial biopsies). When an autopsy is done on a kid with a complex heart, one of our staff is usually asked to help with the cardiac morphology portion of the autopsy. Beyond that, I haven't had much interaction with peds pathologists.

 

[Enkidu]

When an autopsy is done on a kid with a complex heart, one of our staff is usually asked to help with the cardiac morphology portion of the autopsy. Beyond that, I haven't had much interaction with peds pathologists.

Do you mean that the pediatric pathologist doesn't know how to autopsy a heart? That seems bad.

 

[J-Rad]

Do you mean that the pediatric pathologist doesn't know how to autopsy a heart? That seems bad.

Why do pathologists routinely get training in the morphology of complex malformations such as right atrial isomerism with L-TGA, straddling valves, PS, AV canal, LSVC, Cor triatriatum variant? 😉

No what I am saying is that the pathologists often don't have specific training in very complex congenital morphology and the pediatric cardiologist who does may be quite helpful. In my world, the heart doesn't always have four chambers and everything going where you would expect it to. That isn't to say that there are no pathologists with specialized training in congenital cardiac morphology, though (in fact, Tal Geva, who is quite well known in the pediatric cardiology world trained as a cardiac pathologist in addition to his training as a cardiologist)

 

[Enkidu]

Why do pathologists routinely get training in the morphology of complex malformations such as right atrial isomerism with L-TGA, straddling valves, PS, AV canal, LSVC, Cor triatriatum variant? 😉

No what I am saying is that the pathologists often don't have specific training in very complex congenital morphology and the pediatric cardiologist who does may be quite helpful. In my world, the heart doesn't always have four chambers and everything going where you would expect it to. That isn't to say that there are no pathologists with specialized training in congenital cardiac morphology, though (in fact, Tal Geva, who is quite well known in the pediatric cardiology world trained as a cardiac pathologist in addition to his training as a cardiologist)

Interesting. Actually I imagined that pediatric pathologists should be the experts in congenital malformations, since it is a major portion of their field. Not that they would know anything about treating it, but not to be able to recognize a congenital malformation seems to undercut their qualification as a pathologist to me. That's actually all that they're required to do, recognize and describe disease... Generally so that they can deliver the report to a clinician. If they actually require the clinician to come in to deliver the diagnosis to them, then that is crushing.

Thanks a lot for the discussion, I suppose it doesn't put too impressive a spin on pediatric pathology for me, but I appreciate your comments.

 

[oldbearprofessor]

Do you guys have regular interactions with pediatric pathologists? What do those interactions consist of and what do pediatric pathologists bring to the table? I'm considering a career in pediatric pathology and I wanted to get the pediatric view of the field.

In my world, we work very closely with the pediatric pathologists in clinical care, research and education. Clinically, they are involved both in assisting and working with us on issues like point-of-care testing, and of course pathology samples from a whole range of rare conditions we see not-so-rarely.

Research-wise they work with us on lab issues in our research and also in collaborative studies in a range of areas I won't go into here.

Educationally, they are active participants in our mortality conferences and other related conferences.

Occasionally, they will meet with us alongside families in an autopsy discussion. Even when not doing that, we are in close contact with them during the process of understanding autopsy findings in unusual conditions.

They do not take night-call with us though.😛

 

[J-Rad]

Interesting. Actually I imagined that pediatric pathologists should be the experts in congenital malformations, since it is a major portion of their field. Not that they would know anything about treating it, but not to be able to recognize a congenital malformation seems to undercut their qualification as a pathologist to me. That's actually all that they're required to do, recognize and describe disease... Generally so that they can deliver the report to a clinician. If they actually require the clinician to come in to deliver the diagnosis to them, then that is crushing.

Thanks a lot for the discussion, I suppose it doesn't put too impressive a spin on pediatric pathology for me, but I appreciate your comments.

I think you are misunderstanding. Very complex malformations of the heart can be so esoteric that intensive training in that particular morphologic assessment might not be very high yeild for anyone other than the very interested. It does not undercut the value of the contribution of the pathologist. The extra hand would only be for the esoteric gross morphological assessment of the complex malformed heart. I think that would be only one small part of the "total package" that the pathologist would provide. There is nothing crushing in my eyes.

 

[Stitch]

Another group that fairly routinely works with peds pathologists would be the child abuse/forensic pediatricians. Unfortunately there are plenty of abused kids who end up in the morgue, and the autopsy can be very helpful in court.

 

[btlwhulka]

The above statement more speaks to your lack of understanding of what a pathologist does than the lack of qualifications of a pathologist. And yes, pathologists need to know how the disease is going to be treated before they make a diagnosis--now that would make a bad pathologist. You don't just give a diagnosis and move on. By the way, once the diagnosis is made, my grandmother can look up the treatment, so the pathologist plays a vital role.

 

[J-Rad]

The above statement more speaks to your lack of understanding of what a pathologist does than the lack of qualifications of a pathologist. And yes, pathologists need to know how the disease is going to be treated before they make a diagnosis--now that would make a bad pathologist. You don't just give a diagnosis and move on. By the way, once the diagnosis is made, my grandmother can look up the treatment, so the pathologist plays a vital role.

I'm not sure to whom you are addressing this statement.

 

[Enkidu]

The above statement more speaks to your lack of understanding of what a pathologist does than the lack of qualifications of a pathologist. And yes, pathologists need to know how the disease is going to be treated before they make a diagnosis--now that would make a bad pathologist. You don't just give a diagnosis and move on. By the way, once the diagnosis is made, my grandmother can look up the treatment, so the pathologist plays a vital role.

I think you are addressing me here.

I said that if the pathologist is unable to identify the morphological manifestation of a disease on autopsy, and the clinician needs to come and do it for him, then it undercuts his qualifications as a pathologist. I gather that you disagree... but maybe if you elaborated it would be a little more helpful.

I'm also getting the sense that you have a high opinion of pathologists, given your statement about the simplicity of treating a disease as opposed to making the diagnosis. I think that pathology is really important and interesting, which is why I'm planning on going into the field, but I would probably give the clinicians a bit more credit for actually treating the patient.

If you actually are a pediatric pathologist, maybe you could go into a little more detail about how pathology is involved in the patient's treatment after making the diagnosis.

 

[btlwhulka]

I think you are addressing me here.

I said that if the pathologist is unable to identify the morphological manifestation of a disease on autopsy, and the clinician needs to come and do it for him, then it undercuts his qualifications as a pathologist. I gather that you disagree... but maybe if you elaborated it would be a little more helpful.

I'm also getting the sense that you have a high opinion of pathologists, given your statement about the simplicity of treating a disease as opposed to making the diagnosis. I think that pathology is really important and interesting, which is why I'm planning on going into the field, but I would probably give the clinicians a bit more credit for actually treating the patient.

If you actually are a pediatric pathologist, maybe you could go into a little more detail about how pathology is involved in the patient's treatment after making the diagnosis.

I apologize for the tone. I wrote the reply in a rush and that is always a bad idea. As for the morphology of the complex heart disease, I don't think it undercuts a pathologist's qualifications. Complex heart disease often has intervention and no one is more qualified to understand what is going on with the heart than the cardiologist or cardiothoracic surgeon. It looks nice in Netter, but inside the body it is much more difficult. Plus, a pediatric pathologist will be able to identify the morphology, but the work of a pathologist is describing and communicating the findings so the report makes sense even ten or twenty years later. This, of course, is much more effective when a specialist is present to help point out what is most important in his or her mind.

Pathologist are more active in making histologic diagnoses and that is their primary role. Autopsy is about 5% of what a pathologist does. And we are all on the same team. It is perfectly fine for a pathologist to get input from a clinician just the same as it is fine for a clinician to seek input from a pathologist.

I didn't mean to say that clinicians don't play a vital role in treating. My grandmother could look it up, but it takes sophisticated understanding to apply the treatment. That being said, the pathologist doesn't just sit in a black box and make a diagnosis and forget about the case. You have to know what the clinician is going to do with that information. Are they going to wait and see, give steroids, start chemo, do a wide resection? Are they going to take this guy's tongue out over the next two hours if I call carcinoma on frozen section? A pathologist who doesn't understand what treatment implications will follow his or her diagnosis will get into trouble very quickly.