Midway on Round 3

Today marks the beginning of my fourth week here at UPMC Shadyside and it has been an eventful rotation so far.  Since this is a "Center of Excellence" as I noted in my last post, my last couple of weeks have been filled with bladders, kidneys, prostates, and lower extremity amputations. In addition to these daily specimens, I also had the opportunity to gross a sarcoma, which was very interesting since I hadn't had the chance to do one before.  It wasn't as difficult to gross as I had expected it to be after seeing the size of it, but it ended up being an interesting case.  I started out the case by differentially inking the specimen like a "box," so I inked the medial, lateral, superior, inferior and deep margins.  The anterior surface would normally be inked as well, but in this case, the anterior aspect was covered entirely by skin. Then, I described the lesion on the epidermis and it's relationship to all the margins. Finally, I serially sectioned the specimen and submitted my sections, which included submitting the medial and lateral margins completely, the lesion to all margins, and sections of just the lesion. 

Another case I received was a lymph node search for a melanoma case. I have a love/hate relationship when it comes to doing lymph node searches, just because sometimes you find them and sometimes you don't.  I could have a giant container full of fibroadipose tissue (fat) to search through and may only find one lymph node.  Luckily, in this case, I found over 20 and it made if feel more worthwhile and successful (in my eyes that is), than only finding one or two.

Other than rotations, I've just been keeping up on my readings and preparing for a presentation I have to give at the UPMC Regional Conference.  I will be presenting with my classmate, Sierra Sheppard, on rectal cancer specimens and different grossing techniques. We are a little nervous, but I think it will be very worthwhile to do it!

Round 3 is Underway

My time in the morgue has ended, but the new adventure of UPMC Shadyside has begun. I just completed my first week at my new rotation and I'm pleasantly surprised at how much I am enjoying it.  UPMC Shadyside is a "Center of Excellence," which means they specialize in a certain area of pathology and in this case, it's bone, soft tissue, and genitourinary specimens.  Even though it was only my first week, I had the opportunity to work on several complex cases and gross specimens that I've never had before.  Some of the things I have received, such as hip and knee replacement hardware, were gross only specimens.  In this case, I just have to do a dictation to describe what I have in front of me.  These types of cases aren't difficult to do at all.  Some of the more complex cases include the following:

• Below the knee amputation (BKA): I had the opportunity to do two amputation cases this week.  One was for an non-healing ulcer on the foot and the other was a traumatic amputation due to a crushing injury.  The process of grossing these specimens isn't too bad, but it requires knowing the vessels of the leg and where they are located.  To gross a BKA, you begin by taking overall measurements, measurements of any lesions and/or scars and taking photographs.  Then, a bone saw is used to take the bone margin of the tibia.  A vascular margin and skin/soft tissue margin sections are also taken.  Then, for the fun part, you have to dissect the leg to find the anterior and posterior tibial arteries, the peroneal artery, and the dorsalis pedis.  These have to be evaluated for occlusion and atherosclerosis to determine if they contributed to the injury that lead to the leg having to be amputated.  Sections of these are submitted and sections of the lesion are also submitted.
• Cystohysterectomy: These are bladder resections that also come with the uterus, ovaries, and fallopian tubes.  Most of the time, these types of surgical procedures are performed because of cancer.  I received two of these this week for bladder cancer and it was one of those specimens that I never thought I would have the opportunity to see and I was able to do two in one week.
• Prostate: I had the pleasure of doing one prostate this week and that was an interesting process.  UPMC Shadyside has a special procedure with their prostates that isn't done in a lot of places.  They "strip" their prostates of the capsule so it can be evaluated separately.  I had never seen it before and it actually is quite easy to do.  You first differentially ink the prostate (right and left), take your proximal and distal urethral margins, and then score the prostate to separate the anterior and posterior halves of the capsule.  Then you just carefully remove the capsule so it can be submitted entirely.  I know that may not be the best way to describe, but it makes a lot more sense to see it in person than to describe it in words.  
• Nephrectomy: I received one kidney resection this week for renal cell carcinoma and it was a very interesting tumor to see in person, especially after learning about it throughout last year.   

Needless to say, it was fulfilling to finally be able to see and do specimens that previously, I had only heard about and seen in textbooks.  I learn something new everyday and I can tell I am getting better day by day as well.  I look forward to what the next 5 weeks have in store for me.

On a more fun note, I hope everyone has been enjoying the craziness of March Madness this year.  Even though my bracket was busted after the first round, I have still enjoyed all the games and upsets that have occurred and am excited to see who wins it all on Monday night.  Oh, even more exciting news, baseball season starts this weekend and I'm quite excited to see how my Cubbies do this year! Maybe 108 years without a World Series title will finally come to an end ;)