The Beginner’s Guide to Anatomic Pathology

Global life expectancy has more than doubled over the past two centuries. The advancement was due to improvements in medicine.

The branch of anatomical pathology (anatomic pathology) has expanded the average human lifespan. The field continues to expand how long we can expect to live. 

Have you wondered how pathologists diagnose diseases? We’ll explore what pathologists do, including how biopsies work, in this overview. 

What Is Anatomic Pathology?

Anatomic pathology examines how diseases affect structures of the body. The field is sometimes called anatomical pathology.

The physicians who work in this field are pathologists. Pathologists have medical degrees. They go on to specialize in pathology after medical school.

Their primary task is to find abnormalities that help locate diseases. Doctors can then treat the disease.

Pathologists help diagnose conditions as well as diseases. Pathologists can find liver disease and autoimmune disorders.

Anatomical pathologists also help with post-mortem examinations. When a person dies of an unknown disease or condition, the pathologist can help properly diagnose the cause of death. This is always done with the consent of the family of the deceased. 

A suspicious death requires a forensic pathology report. Those types of legally required autopsies do not need family consent. 

Anatomic Pathology vs. Clinical Pathology

Anatomic pathology differs from clinical pathology, which is also known as laboratory medicine. Clinical pathology deals with the analysis of blood cells, bodily fluids, and microbes.

As anatomical pathology evolves, there is less distinction between anatomic and clinical pathology. Both disciplines frequently use molecular pathology, flow cytometry, and cytogenetics. Another overlap between the two fields of pathology involves the use of whole slide imaging. 

Histopathology vs. Cytopathology

Within the field of anatomic pathology are two important subdivisions: histopathology and cytopathology. Histopathology involves the examination of tissue from biopsy under the microscope.

The samples may come from tumors and cancers. This step uses special staining techniques. Antibodies are also used to identify components of the sample tissue. 

Cytopathology examines single cells or groups of cells. A doctor scrapes or removes them from aspirated fluid. A Pap smear is one example of a cytology test. The pathologist handles giving the definitive diagnosis of the sample.

A Look at Biopsies  

Histopathology is the examination of tissue samples under a microscope. The tissue samples are often taken through a biopsy. During this step, a pathologist takes a very small sample from an organ or another area of the body. 

Surgeons can also take samples during surgery. A pathologist then slices the tissue. The doctor then treats the sample with other chemicals before a pathologist can view them under a microscope. 

Paraffin Fixation

The standard technique for preparing tissue samples for biopsy involves placing them in formalin. This preserves the cellular orientation of the cells. Pathologists place the sample in various chemicals before embedding the tissue in a wax block made of paraffin. 

The paraffin block is then cut using a very sharp knife that can shave tissue to widths of 0.0002 inches. The samples are then easily viewable under a microscope. 

Frozen Sections

Frozen sections are used during surgery when a surgeon needs a fast biopsy result. The process bypasses the normal fixation process. Instead of using paraffin to stabilize the tissue, the sample is rapidly frozen. 

Once a device called a cryostat freezes the tissue, a pathologist can perform the biopsy. The procedure takes 10 to 20 minutes. Once the pathologist has examined the frozen tissue, the results can be relayed to the surgeon. 

If cancerous cells are found, for example, the surgeon can take steps to remove the affected tissue or organ. This can save the need for further surgeries. Prompt removal of cancerous tissue can also lead to better health outcomes for patients. 

Biopsy Results

The samples are typically taken from an area where the disease is suspected. Depending on the biopsy results, extra diagnosis techniques may be used or a treatment may be prescribed based on one biopsy. 

Excisional Biopsies

In some cases, the biopsy may include the entire affected area. These excisional biopsies include the area in question and adjacent areas. This allows doctors to know that the diseased tissue has been completely removed.

Whole Organ Biopsy 

A pathology laboratory may also receive whole organs or parts of organs that were removed during surgery. A uterus is a common organ that is removed during a hysterectomy. The organs are then examined for external or internal abnormalities. 

Special Procedures and Techniques

Immunohistochemistry uses antibodies to detect specific proteins. Pathologists use this technique to distinguish between disorders. Pathologists also use immunohistochemistry to detect the molecular properties of cancers.

Pathologists may need to identify specific RNA and DNA molecules using a technique called in situ hybridization. Doctors can add a fluorescent dye to detect the molecules. Pathologists call this technique “Fish.”

Cytopathology refers to the examination of loose cells. Pathologists examine them on glass slides. Electron microscopy employs an electron microscope that allows for even greater magnification.

Tissue cytogenetics allows pathologists to identify genetic defects. The defects are caused by chromosomal translocation.  

Learn More About Anatomic Pathology

The field of anatomic pathology allows doctors to accurately diagnose serious diseases. Doctors can then prescribe life-saving treatments to patients. The field is continually driven by scientific innovations that improve the quality of each diagnosis.

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