Goals and Objectives:

This rotation, offered by the staff and fellows of the Women's and Perinatal Division, provides the opportunity to develop competencies in women's and perinatal pathology through a comprehensive overview of obstetrical and gynecologic pathology by gross room and frozen section supervision, diagnostic sign-out with one-on-one feedback, didactic, tutorial and interactive teaching formats, and formal testing. At the end of the first year, residents should be able to identify morphologically and understand the clinical significance of the most common obstetrical and gynecologic pathologic entities, including pre-invasive and invasive neoplasms of the lower female genital tract, benign endometrium, endometrial hyperplasia, endometrial carcinomas, myometrial neoplasms, benign ovarian conditions, ovarian neoplasia, placental alterations associated with infection, toxemia and fetal growth retardation, trophoblastic neoplasia, and common dysmorphic abnormalties associated with genetic disorders. By the end of the second year, the residents should be familiar with the differential diagnosis of the above, and be able to present a series of diagnostic alternatives when confronted with diagnostic situations in which the above described entities are under consideration.

Service Components:

1. Placental and Perinatal Pathology: This consists of spontaneous abortuses, molar pregnancies, ectopic pregnancies, second trimester fetal deaths, and placentas from second and third trimester requiring special evaluation.
2. Biopsy Service ("Quicks"): This comprises primary lower female genital tract and endometrial biopsies, and is the largest component of the W&P service.
3. Large Specimen Service ("Bigs"): This service comprises all routine hysterectomies, cone biopsies, oncology cases and occasional breast specimens. The W&P Service accessions approximately 400 new oncology cases yearly.
4. Perinatal Autopsy Service: Perinatal autopsies are conducted by residents rotating on the Autopsy Service (Dr. Winters) and is discussed under that section. However, the attending on Placental and Perinatal Pathology is responsible for signing out the case.
5. HPV Testing Service: This is supervised by Dr. Crum and is a component of the Molecular Diagnostic Laboratory (Dr. Longtine) conducted in the W&P Division. Individual residents are not assigned to this service, but may come in contact with it when rotating through the W&P Service and are welcome to participate in the case sign-outs.

Procedure:

General: Residents meet with the Director (Dr. Crum) and W&P Fellow the second day of their residency and are given an overview of the W&P Divisional activities and expectations. During the year, residents are closely supervised by the W&P Fellow, who instructs them in basic specimen handling and processing, under the guidance of the Director and Staff. Each resident receives her/his slides early in the afternoon and is expected to review the slides, inspect and correct the pathology report as needed, and present the cases to the designated attending the following morning. The resident is expected to have a written diagnosis for each case and will be instructed as to proper diagnosis, differential diagnosis and report formatting by the attending.

Frozen Sections: The procedure for frozen section diagnosis is as follows: Prior to noon, frozen section coverage is by the Fellow, to free the resident for sign-out with their attending. In the afternoon, the resident on the biopsy service is responsible for frozen sections. The senior staff member on the Large Specimen Service is notified by the fellow/resident and reviews the gross and microscopic pathology in the Frozen Section Room. The senior staff member signs the Frozen Section Report when completed and the resident/fellow calls the surgeon and gives an oral report.

Fetopsies: The gross room procedure for second trimester fetal deaths is as follows: The resident discusses any issues regarding parental consent, burial arrangements or other clinical questions initially with Kathleen Sirois, the pathology assistant on the W&P Service. The attending staff member on the Placental and Perinatal Service is notified when the case is ready for examination and reviews all cases at the bench with the resident, with attention to malformations or the advisability of obtaining cytogenetics. Drs. Genest and Bieber may be called if additional questions arise regarding diagnosis and handling of these cases. Fetal hearts are routinely saved and reviewed with Drs. Moskowitz and Roberts. Neuropathologic abnormalities are discussed with the fellow on the Neuropathology Service.

Educational Opportunities:

In addition to the hands-on contact in the gross room and at the microscope, residents are have the opportunity to participate in the following teaching activities to rapidly increase their skills in obstetric and gynecologic pathology, including:

1. The Women's and Perinatal Conference (all residents), devoted to timely topics, interactive teaching and occasional testing.
2. The Trophoblastic Disease, Pap Smear/Biopsy Correlation, W&P Diagnostic, and Gyn Tumor Conferences (residents on the service).
3. Teaching materials from numerous post graduate courses conducted by the W&P staff, including slide sets and syllabi.
4. A small reference library in the W&P Division is also available.

Clinical and Translational Research:

During their rotation in the W&P Division or when time permits, residents may participate in clinical or translational research with members of the staff. The staff and their principal subspecialty areas include:

Dr Crum - Pathobiology of lower genital tract neoplasia
Dr. Bieber - Fetal dysmorphology
Dr. Genest - Fetal-placental pathology
Dr. Lee - Cervical and ovarian pathology
Dr. Mutter - Pathobiology of uterine neoplasia
Dr. Nucci - Pathobiology of lower genital tract soft tissue and endometrial stromal neoplasia
Dr. Quade - Pathobiology of uterine smooth muscle tumors
Dr. Welch - Ovarian pathology