Divisions > Anatomic & Molecular Pathology

Figure 1
Lauren V. Ackerman, MD
A leader in the development of the discipline of surgical pathology, he was also responsible for establishing the training program for surgical pathologists at Washington University School of Medicine, one of the earliest such training programs.

The modern era of surgical pathology at Barnes Hospital and Washington University School of Medicine began with the arrival of Dr. Lauren V. Ackerman in 1948. The appointment of Dr. Ackerman (Figure 1), who was not a surgeon, signaled formal recognition that the field of surgical pathology had become sufficiently advanced to require practioners specifically trained in the discipline. By the early 1960s, surgical pathology had been subsumed by the Department of Pathology, transforming Anatomic Pathology from 'pathology of the dead' based strictly on autopsies, to 'pathology of the living' based on the evaluation of surgical specimens.

Although examination of tissue by light microscopy continues to be the fundamental diagnostic technique in Anatomic Pathology, modern practice is dependent on several other laboratory methodologies to precisely categorize both benign and malignant disease. These other methodologies include immunohistochemistry, electron microscopy, flow cytometry, and molecular genetic testing. The applied and basic science research environment of Washington University Medical Center ensures the Division of Anatomic & Molecular Pathology will continue to play a leading role in medicine. And the development of Genomic and Pathology Services at Washington University (GPS@WU), a reference lab focused on clinical application of so-called NextGen sequencing approaches for genome-wide analysis, has established the Division as a leader in personalized medicine.

Anatomic Pathology At Washington University Medical Center

The Department of Pathology and Immunology at Washington University School of Medical provides unsurpassed training in Anatomic Pathology through a subspecialty emphasis practice model.

Figure 2

Barnes-Jewish Hospital, St. Louis Children's Hospital, the Siteman Cancer Center, and the Center for Advanced Medicine, all located at Washington University Medical Center, provide a volume of case material that is necessary for residents to learn to diagnose the entire spectrum of human disease. The faculty's expertise and commitment to resident education, coupled with daily teaching conferences and one-on-one sign-out, ensure that full advantage is taken of the educational opportunities provided by the case material.

Further evidence of the focus on resident and fellow education is provided by the Washington Manual of Surgical Pathology (Figure 2), the Division's response to the immediate needs of trainees who never seem to have enough time to get it "all done." The fact that the list of contributors to the Manual includes not only faculty members but also a number of residents and fellows emphasizes that surgical pathology at Washington University has always been a collaborative venture between faculty and trainees.

In addition to a strong foundation in morphologic-based diagnosis, the training program also provides thorough training in the ancillary techniques that are essential components of modern surgical pathology. Immunohistochemistry, flow cytometry, electron microscopy, and molecular genetic testing are fully integrated into the diagnostic activities of the Division (Figure 3), and the practical use of ancillary diagnostic techniques is emphasized in teaching conferences and during sign-out.

At the end of their Anatomic Pathology training, residents are well prepared for a position as a practicing general pathologist. However, many trainees choose to pursue additional subspecialty training. The Division of Anatomic Pathology at Washington University offers fellowships in Neuropathology, Hematopathology, Dermatopathology, Cytopathology, Molecular Genetic Pathology and Pediatric Pathology, as well as general Surgical Pathology.

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Figure 3
Example of the application of molecular genetic testing in surgical pathology. H&E stained section of a malignant round cell tumor involving the kidney of a 60 year old woman (Panel A). Together with the morphology, the membranous expression of CD99 demonstrated by immunohistochemical staining (Panel B), suggests the diagnosis of Ewings sarcoma/peripheral neuroectodermal tumor. Reverse transcriptase-PCR demonstrates the presence an EWS-Fli1 fusion transcript, confirming the diagnosis (Panel C). Lane 1, molecular size markers; lane 2, positive control RT-PCR product from a Ewings sarcoma cell line (EWS exon 7 to Fli1 exon 5 fusion); lane 3, kidney tumor (EWS exon 7 to Fli1 exon 8 fusion); lane 4, negative control with no input DNA.