Monday, June 21, 2010

Pathological Immersion, Week 1

As Summer Immersion 2010 begins, I am excited to learn more about clinical oncology and pathology and enjoy summertime in New York City. During these six weeks, I will be shadowing Dr. Sandra Shin, who serves as an Associate Professor of Pathology and Laboratory Medicine as well as Chief of Breast Pathology at Weill Cornell. Working with Dr. Shin, I intend to round out my knowledge of breast cancer, following specimens from radiological detection to biopsy and excision to gross and microscopic pathology.

In only a few days in the Pathology Department, I have already learned a lot about the role of pathology in medicine. Generally, pathologists provide diagnostic services to in-house patients, perform consult diagnostic services to other medical institutions, and analyze specimens collected from autopsies. To successfully identify whether an organ is healthy or diseased, a pathologist must be exceptionally familiar with that organ at both the gross and microscopic level. These traits include, but are certainly not limited to, color, texture, mass, volume, cystic fluid characteristics, cellular composition, and cell morphology. A manifestation of this ability came in the form of rounds on Friday: slides showing morbidly-diseased mystery organs were presented to Pathology residents andthey were prompted to provide a differential diagnosis by sight. It should be noted that the organs were all so disfigured by their various pathologies that an attending pathologist in the room encouraged the residents by mumbling "that's nasty" when each organ appeared on the screen. What I thought was a heart turned out to be a malignant ovary, what looked like a bowl filled with mud was actually a fibrotic gall bladder, and an organ that I was certain would feel soft was described as nodular and firm. Indeed, I humbly admit that I only correctly identified one slide from the more than twenty that were presented, and that was only because the hysterectomized uterus was still attached to the ovaries.

In Ithaca, I work in the Reinhart-King lab, where I study the biophysical and biochemical characteristics of breast cancer at the single-cell level. This summer, I will build upon a collaboration between Drs. Shin and Reinhart-King that was recently established through the NCI Physical Sciences Oncology Center Grant. One of my first observations upon walking through the various rooms of the Pathology Department is how different the environment is here. There are no patients walking around, so it has the "feel" of a lab, but the samples are real, highly variable pieces of tissue taken from real, highly variable patients. Being a Biomedical Engineer, I am accustomed to a controlled style of experimental research where specific, well-characterized cells are put into a specific, well-characterized environment and there is some specific measurable outcome. Clinical research in Pathology is drastically different for a number of reasons, and rightfully so. The first priority, as it should be, is to characterize specimens and provide diagnoses for patients. Extracting data and trends from pathology reports seems to be the norm, and fittingly, I have spent the majority of the first week doing just that. The research project I am currently working on is focused on a certain variant of breast cancer, lobular carcinoma in situ (LCIS). By studying surgical pathology reports and slides from initial biopsies and later excisions, we will seek to demonstrate the extent to which LCIS is a precursor lesion or a risk indicator for future malignancy.

In week two, I am looking forward to spending several days in the Radiology, Surgery, Medical Oncology departments observing the other facets of cancer diagnosis and treatment.

Lesson of the week: variability in diseased biological systems, and especially cancer, is the norm and should never be understated; consistencies are often subtle, but are absolutely essential for diagnosis and treatment.

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