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 ;)