Pediatric Pathology

The University of Rochester Department of Pathology and Laboratory Medicine offers antenatal and postnatal pediatric pathology rotations for its residents. These rotations involve multidisciplinary interactions within the Medical Center using a set of didactic lectures, defined laboratory bench exercises, and various clinical experiences. Faculty members from the Departments of Pathology and Laboratory Medicine, Obstetrics and Gynecology (in the antenatal rotation), and Pediatrics (in the postnatal rotation), actively participate in these rotations.

Rotation Components

A printed schedule that is compiled using Excel software is issued to each resident at the beginning of the rotation that includes didactic topics, faculty names and room numbers, learning objectives, specific skills to be learned, and available study sets. In addition to the scheduled activities, the residents gain experience in designing and conducting a perinatal epidemiology project. These projects have included a review of the clinical utility of performing perinatal autopsies (Fall 2000) that resulted in a poster at the Department of Pathology and Laboratory Medicine Research Day; and a comparison of morphology and cytogenetics in diagnosing molar pregnancies (Spring 2001).

Sample Week

Antenatal Rotation

The antenatal rotation includes didactic lectures covering placental biology, fetal development, central nervous system development and disorders, infectious disease in the perinatal period, cardiovascular development and malformations, topics in hematology, and genitourinary developmental abnormalities. There are various clinical experiences including attending the genetic counseling clinic and two meetings with medical ethicists to discuss ethical issues surrounding genetic testing, abortion, etc. Laboratory activities include preparing and interpreting polyacrylamide acetylcholinesterase gels; evaluating congenital cardiac malformations in archived specimens; learning reproductive endocrinology; learning the use of gas chromatography/mass spectroscopy in fetal toxicology; polymerase chain reaction (PCR) amplification and identification of cytomegalovirus in paraffin-embedded tissue samples as an example of transplacental infection; preparing a conventional karyotype and evaluating fluorescent in situ hybridization technology in the cytogenetics laboratory; and molecular testing for cystic fibrosis and other genetic diseases in the Molecular Diagnostics Laboratory. In addition, each resident performs perinatal autopsies, processes placentas and attends a weekly pediatric autopsy conference and a daily placenta sign-out conference. The residents meet with the rotation coordinator at the beginning of each rotation for orientation and at the end of each week to review the week's activities. The residents review a microscopic placenta teaching set independently and with the rotation coordinator. When interesting cases are seen at placenta sign-out, these new teaching cases and slides are added to the collection. In addition, there is ample required reading material compiled by the rotation faculty members that is provided in a three-ring binder.

Topic Didactic Lab and Clinical
Fetal Development MSAFP Screening; PUBS/Rh iso-immunization; ultrasound abnormalities; developmental biology/embryology; Internet challenges in teratology/dysmorphology; teratology Antenatal testing/Triple Screen; perform PAGE for AChE
Placental Biology Placental development, morphology, infarction, chorioamnionitis; placentral function Process and daily signout of placentas and POCs
Reproductive Endocrinology   B-hCG ICON, LH/FSH, Prostaglandins, L/S ratio
Cardiovascular Gross review of normal cardiac anatomy; gross review of cardiac malformations - unknowns  
Hematological Cord stem cells; thrombocytopenia: immunological and otherwise  
Genitourinary Renal development; renal developmental abnormalities and cystic diseases; lower urinary tract developmental abnormalities  
Central Nervous System Disorders Normal brain development and malformations; CNS infections, metabolic, degenerative and toxic insults  
Perinatal Infectious Disease Pathogenesis of fetal infections PCR CMV detection
Toxicology Methods in fetal toxicology Toxicology Lab - GC-MS
Genetics   Genetics Counseling Clinic - 4 sessions
Molecular Diagnostics Molecular testing for cystic fibrosis CFTR molecular testing
Medical Ethics   Medical Ethics - 2 sessions

Postnatal Rotation

The postnatal rotation was structured largely on the model of the antenatal rotation but includes more pediatric clinical experiences. The rotation is offered once or twice a year, depending on resident availability, and is staggered through the year with the antenatal rotation. This rotation emphasizes more clinical experiences, including observation in the neonatal intensive care unit, the pediatric gastroenterology clinic and endoscopy suite, the pediatric hematology/oncology and radiation oncology clinics, and the clinical genetics metabolic and dysmorphology clinics (Table 2). In continuity with these experiences, the residents follow and participate in the sign-out of perinatal lab studies and biopsies, gastrointestinal (GI) biopsies, pediatric bone marrow biopsies, bone and soft tissue tumors, and metabolic lab studies, respectively. Didactic lectures cover pediatric GI disease, pediatric bone pathology, hemophilia and pediatric renal tumors. Laboratory experiences include rotating through the neuromuscular lab, a vaccine development lab, and the metabolic lab that performs amino acid and organic acid studies.

Residency credit for pathology board certification for the two months spent in each of these two rotations is divided equally between Clinical and Anatomic Pathology because the residents are exposed to both facets of pathology during the rotations.

Topic Didactic Lab and Clinical
Neonatology Rotate in neunatal intensive care unit - 2 weeks  
Gastrointestinal (GI) Pediatric gastrointestinal disease Pediatric GI clinic; GI endoscopy suite; signout pediatric GI biopsies.
Hematology Pediatric hematologic malignancies; Neonatal transfusion medicine Sickle cell clinic
Oncology Neuroblastic tumors; rhabsomyosarcoma; pediatric bone tumors; renal tumors; Children's Oncology Group (COG) Radiation oncology clinic; review COG rhabdomyosarcoma cases
Infectious disease Sepsis/meningitis in the neonate  
Neurology Neuromuscular disease Neuromuscular laboratory
Genetics Point of care testing; amino acid and organic acid testing Review of metabolic testing methods; metabolic clinic; dysmorphology clinic
Molecular diagnostics Congenital adrenal hyperplasia; Von Hippel-Lindau  

Pediatric Pathology Cases

Residents and student fellows taking pediatric pathology rotations have an opportunity to contribute cases to this site.

Pathology Contributor Date
Edward's (Trisomy 18) Dr. Enzo Fallone June 2002
Neonatal Meningitis Dr. Sandra Vella May 2003
Placental Mesenchymal Dysplasia (PMD) Tobechi Ebede June 2004
Triploidy Syndrome Derek Masden June 2004
Twin-Twin Tranfusion Syndrome (TTTS) Kristina Wolf Subik June 2005
Ebstein's Anomaly Alan Sherbourne March 2006
Myocardial Infarction with Incipient Left Ventricular Rupture After Mitral Valve Replacement for Endocarditis in a 69-day-old Infant Abigail L. H. Kroening December 2006
Tacrolimus and Eosinophilia in a Pediatric Liver Transplant Patient Rene Myers March 2007
Complete Congenital Heart Block and Maternal Systemic Lupus Erythematosus Nadia Granger December 2009

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