Specialised Histopathology

Module details

Title

Specialised Histopathology

Type

Specialist

Module code

SLS336

Credits

10

Requirement

Compulsory

Aim of this module

This module will provide the trainee with knowledge and understanding of application of histopathology to specialised clinical situations, including autopsy. They will apply this knowledge as they use cellular pathology techniques in specialised situations and gain experience of interpreting results from patient investigations.

Competencies

#	Learning outcome	Competency	Action
# 1	Learning outcome 1	Competency From routine requests, identify the histopathological specimens required to confirm a diagnosis for: ophthalmic pathology neuromuscular pathology central nervous system pathology haemopoietic pathology.	Action View
# 2	Learning outcome 2	Competency Perform and record details of macroscopic examination of tissue received from named diseases of: ophthalmic pathology neuromuscular pathology central nervous system pathology haemopoietic pathology.	Action View
# 3	Learning outcome 2	Competency Dissect and sample specimens received in accordance with local protocols.	Action View
# 4	Learning outcome 2	Competency Perform to quality standards basic and appropriate specialised histopathological techniques as part of the systematic investigation of tissue received from named diseases of: ophthalmic pathology neuromuscular pathology central nervous system pathology haemopoietic pathology.	Action View
# 5	Learning outcome 3	Competency Identify and describe relevant new equipment, methods or procedures that may be able to enhance the contribution of the histopathology laboratory specialised areas of medicine.	Action View
# 6	Learning outcome 4	Competency Report on the UK centres undertaking specialised histopathology investigations, giving examples from your own experience of the specialised tests provided in named disorders.	Action View
# 7	Learning outcome 5,7	Competency In discussion with a pathologist interpret in the correct clinical context the results of: macroscopic examination basic microscopic examination appropriate specialised techniques diagnostic algorithms from specimens received from a range of named specialist systems, to include: ophthalmic pathology neuromuscular pathology central nervous system pathology haemopoietic pathology.	Action View
# 8	Learning outcome 6	Competency Identify and apply the relevant legislation and guidance that applies to the autopsy and the retrieval of tissue.	Action View

Assessments

You must complete:

• 2 case-based discussion(s)
• 2 of the following DOPS/ OCEs:

Perform interpretation of clinical details from 10 examples of specialised organ or tissue resections and prioritise samples according to clinical urgency.	DOPS
Perform interpretation of clinical details from 10 examples of specialised organ or tissue resections and plan the investigations to be performed and annotate the request accordingly.	DOPS
Perform specimen dissection of a range of specialised organ or tissue resection sample types requiring dissection with a knife and select appropriate samples to enable a diagnosis to be made.	DOPS
Perform assessment and marking of relevant specimen excision margins to enable correct orientation of the samples.	DOPS
Perform dictated description of 10 specialised organ or tissue resection specimens being dissected, detailing all required descriptors.	DOPS
Perform microtomy on 10 different tissue types from different specialised organ or tissue resections and stain with H and E stain.	DOPS
Evaluate and perform a prognostic indicator assessment using the appropriate demonstration technique to a named disease type.	DOPS
Perform microscopical interpretation of stained slides and produce a quality assessment evaluation report.	DOPS
From evidence gathered and discussions with relevant clinical colleagues, produce a clinical pathway document detailing the impact of the diagnostic process on the overall patient pathway.	OCE
From evidence gathered and discussions with relevant clinical colleagues, produce a reflective account of the learning acquired	OCE
Perform microscopical interpretation of H and E stained slides from 6 different specialised organ or tissue types and demonstrate to a Consultant Histopathologist normal and abnormal morphology, relating their morphologic appearance to the clinical condition.	OCE
Perform microscopical interpretation of stained slides from 6 different specialised organ or tissue types and demonstrate to a Consultant Histopathologist the algorithmic processes used to determine a differential diagnosis.	OCE
In discussion with a Consultant Histopathologist, use information gathered from the algorithmic process to produce a preliminary diagnosis for 6 specimens from different specialised organ or tissue types.	OCE
From evidence gathered, discuss differential diagnosis at a relevant MDT meeting.	OCE

Learning outcomes

1. Identify the clinical presentation of a range of relevant disorders of specialised organ groups and clinical subspecialist areas.
2. Perform to quality standards a range of specialised histopathology techniques.
3. Identify and evaluate new equipment, methods, or procedures to enhance the contribution of the histopathology laboratory to the diagnosis and management of specialised organ groups and clinical subspecialist areas.
4. Support the organisation and use of specialised histopathology laboratory services in the UK.
5. Under supervision, prepare and interpret histopathology reports that involve specialised organ groups and clinical subspecialist areas.
6. Support mortuary operation, the autopsy process and the associated regulatory framework. Where appropriate, observe autopsy in action.
7. Work in partnership with other clinical specialisms as part of the diagnosis and review of patients with disorders of specialised organ groups and from clinical subspecialist areas.

Learning outcomes

1. Describe the structure and function of specialised organ groups in the human body and their interactions with each other.
2. Discuss and evaluate the application of histopathology in clinical sub- specialist areas, including paediatrics.
3. Discuss and evaluate the application of specialised histopathology equipment and techniques in a variety of clinical settings.
4. Discuss the contribution of the histopathology report to the diagnosis and further management of specialised organ groups and clinical sub-specialist areas.
5. Explain and evaluate the organisation and delivery of specialised histopathology services and the procedures required for use of those services.
6. Discuss the autopsy process and the associated regulatory framework.
7. Discuss the partnership of histopathology to other clinical specialisms in the investigation and management of cancer and patient care.

Indicative content

• Aetiology, pathogenesis and main clinical features of common diseases encountered in cellular pathology and their impact on patient management, including:
  • haemopoietic pathology, e.g. hyperplasia, lymphadenitis
  • neuromuscular pathology, e.g. neuroma, schwannoma, myology
  • central nervous system (CNS) pathology
  • ophthalmic pathology, e.g. trachoma
  • eye
  • brain
  • muscle
  • nerve
  • paediatric pathology
  • haematopathology
• Application of specialised techniques to a variety of tissues:
  • specialised immunocytochemistry
  • immunofluorescence
  • fluorescence in-situ hybridisation
  • molecular techniques, e.g. PCR
  • electron microscopy
  • image capture
  • quantitation
  • molecular databases
• Specialised techniques currently under development that may play a future role in cellular pathology
• Knowledge of autopsies and the underlying principle of consent:
  • perinatal and paediatric post mortems
  • coroner’s post mortems
  • forensic post mortems
• Human Tissue Authority (HTA) regulations relating to the retention of tissues and organs
• Tissue banking

Activities

• Participate in multidisciplinary review meetings at which histopathology results from relevant specialised areas of medicine are presented as part of the clinical record. Wherever possible include those cases in your portfolio. Record the outcomes of the multidisciplinary review meetings.
• Perform a detailed evaluation of one new piece of equipment, method or procedure. Critically appraise the results of the evaluation and produce a report with recommendations.
• Participate in the referral of five specimens for different specialised histopathology investigations and gain an understanding of the importance of the report returned in the context of patient diagnosis and/or management.
• Visit and be able to describe the role and operation of an NHS mortuary. If possible attend an autopsy examination and gain an understanding of the roles undertaken by the pathologist and by the anatomical pathology technologist.
• Attend wards and clinics at which patients from relevant specialised areas of medicine are being investigated and write a reflective report.
• Prepare a portfolio of illustrative cases with a minimum of one from each listed specialised area of pathology. Include the plan of laboratory investigation. Include details of investigations undertaken, with explanations, and details of results, interpretation and reports with explanations, in the portfolio of cases prepared for learning outcome 1 and 5.