Division of Anatomic PathologyAnatomic Pathology Services at the University of Pittsburgh and the University of Pittsburgh Medical Center are based on a diagnostic Centers of Excellence model that encompasses all of surgical pathology and cytopathology. This model has been in effect for nearly 12 years and more as part of the commitment of the Department of Pathology to provide our clinical and surgical colleagues with subspecialty pathology expertise. All pathology material received from our four teaching hospitals including UPMC Presbyterian, UPMC Shadyside, Magee-Womens Hospital, and Children’s Hospital of Pittsburgh is triaged to subspecialty benches organized by organ system, an activity which can only be done with our current volumes of material of approximately 110,000 surgicals and 400,000 cytology specimens. Surgical pathology cases are triaged to Centers of Excellence at one of the four hospitals and are signed out by diagnostic pathologists who have both fellowship training and subspecialty interest in that organ system, an approach we believe provides patients with the best diagnostic pathology care and physicians with ideal collaborative relationships for bench to bedside care.
Resident and fellow education is fundamental to the Centers of Excellence model. Each subspecialty area has well defined goals, teaching sets, and teaching styles, each providing housestaff officers with comprehensive training throughout their residency. Subspecialty fellows on each of these benches help provide continuity of clinical care and teaching to housestaff officers rotating between the benches and they assist in the preparation of organ specific clinicopathologic conferences. It is our belief that housestaff training supplemented by subspecialty fellows and subspecialty diagnostic pathologists, translational pathologists and basic researchers provides the optimal pathology training in an academic setting.
Core Laboratories within the Division of Anatomic PathologyThe clinical practice of Anatomic Pathology at the University of Pittsburgh is supported by several core laboratories based at UPMC Presbyterian including the Molecular Anatomic Pathology (MAP) core facility, the fluorescence in situ hybridization/comparative array genomic hybridization core facility (FISH), an immunohistochemistry core facility which is present at both UPMC Presbyterian and UPMC Shadyside, a complete electron microscopic suite, a comprehensive University-wide tissue bank, and an Anatomic Pathology Proteomics Program utilizing formalin–fixed paraffin embedded tissue, currently under development. These core facilities also provide research opportunities for the pathology faculty and pathologists in training.
- Molecular Anatomic Pathology Lab: The MAP lab provides patients, clinicians, and national investigators with unique molecular testing of formalin fixed paraffin embedded tissue that is helpful in the diagnosis and prognostication of inflammatory and neoplastic disease. Using loss of heterozygosity analysis, methylation studies, DNA sequencing, and microsatellite instability testing, among others, material received in the surgical pathology laboratory is assessed for unique genomic abnormalities. In addition, this testing can be utilized for research projects by faculty and housestaff officers alike.
- FISH/CGH Lab: The fluorescence in situ hybridization/array comparative genomic hybridization laboratory allows us to study solid tumors and transplant cases utilizing in situ hybridization assays and a commercial Abbott/Vysis CGH chip. This would include analyses for microchimerism, translocations, and gene amplifications that are essential to the practice of surgical pathology in the 21st century.
- Immuno Lab: The two molecular laboratories supplement an enormous clinical and research immunohistochemistry laboratory, which provides a comprehensive and extensive array of antibodies for immunohistochemical analysis of various cellular glycoproteins.
- Autopsy: The Autopsy Service based at Presbyterian handles all autopsies for UPMC Presbyterian and Shadyside as well as the hospitals that comprise our community division. Approximately 300 autopsies are done per year and these autopsies are managed by a devoted group of autopsy pathologists led by Jeffrey Nine, MD.
Anatomic Pathology at UPMC PresbyterianIn our diagnostic model, UPMC Presbyterian represents the largest physical site for these Centers of Excellence, and includes the following COEs: gastrointestinal, otolaryngic, thoracic, cytopathology, neuropathology, medical kidney disease, transplant pathology, autopsy pathology, and hematopathology. The general Anatomic Pathology Division at UPMC Presbyterian is responsible for managing six of these Centers of Excellence: gastrointestinal, ENT, thoracic, cytopathology, medical kidney/electron microscopy, autopsy, and hematopathology. Each of these subsections of Anatomic Pathology represent a Center of Excellence managed by a Director and each has subspecialty fellowships focused on the unique material related to that specialty. Each of these programs share in a core training program for housestaff officers although for each bench the training experience is somewhat different based on the nature of the practice, clinical demands, research interests and the practice style of the diagnostic pathologists. Each of these Centers of Excellence has made an attempt to be vertically integrated, that is while it is dominated by diagnostic subspecialty pathologists, some of those subspecialty pathologists have primarily a clinical mission while others act as translational pathologists insinuating new molecular techniques into the practice of diagnostic pathology, while still others are expected to be NIH funded researchers. This admixture of clinically oriented, translational, and basic science oriented pathologists within a Center of Excellence creates a fertile environment for the development of new clinical tests and basic science opportunities. Because of this interaction, the Centers of Excellence at UPMC Presbyterian represent the model for the practice of pathology in the next 20 years and in fact the complexity of our diagnostic surgical pathology reports reflect the comprehensive morphologic, immunohistochemical, and molecular analysis that is essential for the practice of pathology over the next generation.