| Anatomic Pathology
Autopsy / Forensic Pathology
The autopsy rotation is designed to provide a comprehensive exposure to all aspects of clinical and anatomic pathology. The main purpose is to make the resident proficient in the various techniques for performing an adequate medical autopsy in order to:
- discover or confirm the cause of death,
- educate the residents in gross and microscopic pathology, and
- provide clinical and pathologic correlations.
Approximately 150 autopsies are performed in our program annually between theLoyola University Health Systemand Edward Hines, Jr. VA Hospital. By performing a careful, thorough autopsy, the pathologist provides a useful service for clinicians as well as for patients' families. The autopsy is presently the best quality control available for the practice of medicine and is utilized as part of the hospital's quality assurance program.
The Medical Examiner's Office of Cook County offers a rotation of one month to the pathology residents of the Loyola University Medical Center. This rotation provides pathology residents with the basic knowledge in the area of medical-legal investigation. This office performs approximately 3,200 autopsies yearly. During this rotation, the resident learns how to handle medical-legal cases. The resident also accompanies the investigators to the death-scene investigation and to court. Lectures in Forensic Pathology are given on a weekly basis. The resident also attends the daily signing-out session.
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Cytopathology
Cytopathology is the study of cell samples from various body sites for the detection of pathologic processes. In some organ systems, such as the cervix, exfoliative cytology is the screening technique used for the detection of cancer. For other sites ( e.g., breast, thyroid, lymph nodes, etc.) fine needle aspiration biopsy (FNAB) is the technique of choice for obtaining material. The role of a cytopathologist is that of manager, consultant to the clinicians, as well as teacher to other pathologists, medical students, residents, fellows, and cytotechnologists. At the Loyola University Medical Center, residents receive training in interpreting all types of cytologic material. These are correlated with clinical presentation and supplemented by ancillary studies including: immunohistochemistry, flow cytometry, image analysis, electron microscopy, and molecular pathology. The residents are also trained in quality assurance of cytologic diagnosis and correlating cytologic material with the corresponding histologic specimens. Several teaching conferences are integrated into the core of this rotation.
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Dermatopathology
Dermatopathology is a continuously evolving discipline of both Pathology and Dermatology. The pathology residents at the Loyola University Medical Center/Edward Hines, Jr. VA Hospital have the opportunity to study pathology of skin diseases on a daily basis as part of their Surgical Pathology rotation as well as an elective during their senior years. There is emphasis on "low power" pattern recognition of the various inflammatory and neoplastic diseases of the skin. Also, a criteria-based systematic approach to the differential diagnosis of common neoplastic and inflammatory entities is stressed.
The section of Dermatopathology, which is closely associated with the Department of Dermatology, highlights the importance of clinicopathologic correlation in the practice of dermatopathology. The study of skin sections by immunofluorescence is also included in the rotation. the Loyola University Medical Center is a referral center for community hospitals which do not offer this specialized technique. Supplemental teaching materials consist of an extensive glass slide library as well as numerous Kodachrome study sets of dermatopathology and clinical dermatology. In addition to pathology residents, the dermatopathology rotation is offered to dermatology residents and medical students. Opportunities for clinical research are available, particularly in the areas of malignant melanoma, Kaposi's sarcoma, and psoriasis.
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Neuropathology
The section of Neuropathology has three board certified neuropathologists who serve both the Loyola University Medical Center and the Edward Hines, Jr. VA Hospital. In addition, the service receives muscle and nerve biopsies as well as autopsy brains from a number of regional hospitals for consultation. The laboratory is fully equipped to perform the numerous special techniques needed for diagnostic neuropathology including enzyme histochemistry, immunohistochemistry, computer morphometry, electron microscopy, and immunofluorescence. The section maintains a large teaching collection in all areas of neuropathology. The teaching material includes gross specimens in acrylic, Kodachrome, and microscopic slides as well as indexed material on laser disk contributed by Loyola to "The Slice of Life." Teaching is provided to Loyola medical students as well as residents in Pathology, Neurosurgery, Neurology, and Neuroradiology. The section is approved for two Neuropathology Fellows.
The major focus of the research program is the normal and abnormal aging process in the CNS. In 1992, The Loyola University / Hines Brain Bank was established for systematic collection of autopsy brains from normal aging as well as neurodegenerative diseases such as Alzheimer's disease. The material collected is used as a resource for neuroscientists from the university-wide Neuroscience and Aging Institute as well as regional institutions. The Brain Bank has been and will continue to be a resource for obtaining outside funding from agencies such as the National Institutes of Health, private foundations, and the pharmaceutical industry.
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Pediatric Pathology
Senior residents are required to complete a one month rotation at Children's Memorial Hospital. The main goal of this rotation is to familiarize the resident with the common diseases characteristically seen in infants and children.
The residents' responsibilities include:
- Pediatric autopsies
- Processing all pediatric surgical specimens
- Presenting at Intra & Interdepartmental conferences (including Pediatric Tumor Board and Pediatric Surgical Pathology Conferences)
At the end of the rotation, the resident should be familiar with pathologic lesions such as perinatal lung disorders, congenital malformations, small cell tumors, neuroblastoma, and Wilm's tumor; be able to identify current key sources of information to solve diagnostic problems in pediatric pathology; become aware of the multi-disciplinary approach to pediatric pathology problems for which light microscopy is not sufficient. The latter includes evaluation of metabolic or storage diseases, ploidy, oncogenes in childhood tumors, and molecular pathology in the study of childhood lymphomas and leukemias.
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Renal Pathology
The Renal Pathology rotation is designed to provide a general exposure to all aspects of renal pathology. It allows the residents to understand the basic concepts, the special techniques, and the role of the pathologist in renal pathology. The section handles about 400 native kidney biopsies annually. A large variety of cases, illustrating all major aspects of renal pathology, are represented in the files. Light microscopy is integrated with E.M., immunofluorescence, and immunohistochemistry when indicated. A regular schedule of interdepartmental conferences is maintained for presentation of interesting renal biopsy results, providing an ideal forum for clinicopathologic correlation. A renal transplant service exists which provides further material available for morphologic study. The resident also evaluates wet tissue for assessment of adequacy. At the end of the rotation, the resident should be familiar with handling of specimens, principles of special techniques, antibody panels, quality assurance, and interpretation of light microscopy, immunofluorescence, and immunohistochemistry.
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Surgical Pathology
The section of Surgical Pathology is responsible for the diagnosis of specimens obtained from the Loyola University Medical Center and Edward Hines, Jr. VA Hospital. The total volume is approximately 31,000 specimens: 24,000 at Loyola and 5,700 at Edward J. Hines VAH. Many cases are seen in consultation from outside hospitals and clinics. The section of Surgical Pathology at Loyola supports the clinical activities of a 523-bed hospital of adult and pediatric medical/surgical activities. Edward Hines, Jr. VA Hospital is a 495-bed medical/surgical facility. The residency training in Surgical Pathology, supervised by the faculty, includes gross examination, microscopic description, frozen section techniques, and the use of special stains and imaging as well as other ancillary studies. Special facilities in the Surgical Pathology division are available to assure the best diagnosis for patients. These include electron microscopy, molecular biology lab, immunofluorescence, immunohistochemistry, and DNA analysis of solid tumors. At the end of the Surgical Pathology rotation, the residents are competent in handling all surgical specimens, integrating light microscopy with special stains, cytology, electron microscopy, immunohistochemistry, and molecular pathology as indicated.
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Transplant Pathology
Transplant Pathology is an elective rotation of one month or more offered to the senior residents at the Loyola University Medical Center. Loyola's cardiac transplantation program is one of the most active in the country with more than 500 heart transplant cases performed to date. A very active lung transplant service is also well established -- the third largest in the country -- with more than 300 single-lung, double-lung, and heart-lungs transplants performed. The resident exposed to this material learns to interpret cardiac (7/week) and lung (4/week) biopsies and aids in the study of explanted hearts and lungs, congenital heart defects, ischemic and dilated cardiomyopathies, myocarditis, chronic restrictive lung diseases, and cystic fibrosis cases. Major research opportunities in this area include the study of acute and chronic rejection and complications of transplantation (e.g., opportunistic infections and post-transplant lymphoproliferative disorders).
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