Resident education in anatomic pathology is accomplished by a combination of practical hands-on experience under direct supervision, with progressive graduated responsibility from novice to independent practitioner.
Multiple venues are utilized.
Multiple grossing stations with state-of-the-art safety features are utilized in handling tissue samples. Expert guidance is provided in developing skills of description, dissection, and processing of specimens, with abundant opportunities to develop increased proficiency in addressing common and more unusual material. All major subspecialty surgical services are active, ensuring that all residents gain experience in grossing specimens from all body sites.
Our department occupies a large space in the operating room facility, providing immediate response to requests for intraoperative consultation. Many surgical teams utilize this service throughout the day, delivering samples to this laboratory and awaiting our interpretation to guide additional surgery. Our residents serve a primary role in this consultation, developing skills in selecting the optimal sample for frozen section, creating a high-quality glass slide for interpretation, and ultimately providing the diagnosis to be delivered in person to the surgical team. This experience is vital for our residents to develop confidence in providing intraoperative consultation, including an understanding of limitations of this procedure and the preferred approach to frozen section diagnosis in these multiple surgical arenas.
Our residents rotate through each of the many subspecialty areas of anatomic pathology, gaining experience in the variety of specimens in these disciplines. Signout occurs almost entirely via multi-headed or two-headed microscopes with an attending pathologist expert in these areas. Residents progress in their reporting abilities and are ultimately expected to create a complete, comprehensive, and accurate pathology report.
Albany Medical Center's morgue performs a large number of forensic autopsies and a significant number of hospital cases, the latter entirely performed by our residents. The number of hospital cases easily provides sufficient experience for each resident, and the forensic material is also available for additional experience if desired by the residents. As with all other residency training in pathology, there is an initial close supervision, with progressive graduation to independent performance.
Resident education in clinical pathology develops broad comprehensive skills in clinical consultation and interpretation of test results from all clinical laboratories. This is accomplished using a curriculum combining bench experience, tutorials, conferences, and case discussion with faculty and technical staff devoted to each discipline.
Residents spend three to four months in each of the major laboratories (Transfusion Medicine-Apheresis, Clinical Chemistry, Hematology-Coagulation, and Microbiology) and also have rotations in Serology, Histocompatibility (HLA), Flow Cytometry, Laboratory Management, and Informatics. Educational opportunities are further enhanced by off-site rotations at the American Red Cross and the Stratton VA Medical Center. Laboratory administration and quality improvement programs are integrated into each rotation. Resident education begins with exposure to the technical aspects of the laboratory bench and instruments, advancing to the understanding of test results and interpretation, and progressing to acquiring experience with administration including quality control/quality improvement, personnel management, regulatory requirements, and budget development.
Introduction in FISH Testing
With progressive graduated responsibility, residents ultimately function as consultants addressing clinical, technical, and administrative issues which confront these laboratories. Some of our residents have embraced laboratory medicine as a career choice, pursuing additional fellowship training in clinical pathology. Our graduates finish the program with a well-rounded skill set which enables them to function as independent laboratory directors in any arena, and they are well received by fellowship training programs as well as by prospective employers.
Residents may choose to spend their elective time in either clinical pathology or anatomic pathology.
In recognition of the necessity for residents to apply for fellowship positions by the end of their second year of training, we offer the residents an elective in the second half of their PGY-1 year. This provides an opportunity to explore areas of interest, to define possible fields for future subspecialization, and to begin developing research activities to enhance their resumes.
The choices for electives in anatomic pathology include additional rotations in areas of subspecialty training as well as forensic pathology. Residents may also choose to spend elective time in areas not always well represented in subspecialty sign-out, such as medical renal pathology. Our active nephrology team and our renal transplant service both provide many kidney biopsies for analysis, with our specialty pathology group evaluating histochemistry, immunofluorescence, and ultrastructural material in generating comprehensive diagnoses.
We also offer unique opportunities to explore disciplines further outside the core curriculum, including diagnostic digital pathology. The practice of pathology is evolving rapidly, and it is clear that the future is digital. Therefore, it is vital that any residency training provide hands-on exposure to the basics of pathology informatics. This training should include digital image acquisition (whole slide imaging and real time remote robotic telepathology), automated image analysis (CellaVision peripheral smear screening and quantitative immunohistochemical analysis), and laboratory information system (LIS) implementation and integration. Real time evaluation of remote images for frozen section, and analysis of captured images from peripheral smears and other fluids for diagnosis in Hematology are active parts of our clinical practices, and utilization of these technologies also serve as components of clinically related research activities.
Electives are also available in Executive Physician Leadership and as Acting Medical Director, which serve as introductions to management skills necessary for career development.
Designed to reinforce and expand the skills and knowledge base developed through practical experience as outlined above, the many conferences include didactic lecture series in anatomic pathology and clinical pathology, interactive teaching sessions, unknown conferences, and multidisciplinary tumor boards. Resident participation often entails presentations by both junior and senior trainees, with development of resident skills in presentation.
Residents are strongly encouraged to engage in clinically related research, as part of their overall residency training experience. Resident participation in research activities generally begins in the latter part of their first year, with progressive responsibility through the years in developing each project, under the direct supervision of a more senior resident and an attending faculty member. Residents thereby gain an understanding of proper methods of investigation, interpretation of results, and manuscript development and submission for publication. Support is provided in the form of a clinical research laboratory dedicated to investigative efforts, as well as full-time research technicians and administrative staff. Additional financial support is provided to residents presenting abstracts at national meetings.
Kmeid M, Aldyab M, Brar R, Lee H. Histologic Findings and Tissue B-Cell Depletion in Endoscopic Mucosal Biopsy Specimens of the Gastrointestinal Tract After Treatment With Rituximab. Am J Clin Pathol. 2022 Mar 3;157(3):353-364.
Kumaresan T, Rodriguez D, Preece J, Kmeid M, Foulke L, Gildener-Leapman N. Oral Tongue Spontaneous Tumor Regression after Biopsy: A Case Report and Genomic Profile. Ear Nose Throat J. 2022 May 10:14556.
Fu Z, Kmeid M, Arker SH, Lukose G, Lee EC, Lauwers GY, Lee H. Diversion colitis in inflammatory bowel disease (IBD) is distinct from that in non-IBD: Reappraisal of diversion colitis. Hum Pathol. 2022 May;123:31-39.
Aldyab M, El Jabbour T, Parilla M, Lee H. Benign vs malignant pancreatic lesions: Molecular insights to an ongoing debate. World J Gastrointest Surg. 2021 May 27;13(5):406-418.
Drinane J, Aldyab M, Roth MZ. Epidermal Paracrine Signals May Regulate Dupuytren Contracture Myofibroblasts. J Hand Surg Glob Online. 2021 Nov 6;4(1):61-62.
Fu Z, Li H, Arslan ME, Ells PF, Lee H. Hepatic Langerhans cell histiocytosis: A review. World J Clin Oncol. 2021 May 24;12(5):335-341.
Mundackal N, Arslan ME, Decker C, Lee H, Nigam A. The removal of ectopic pancreas to prevent carcinoma development. Am J Surg. 2021 Dec;22(6):1196-1197.
Saade R, Najjar S, Arslan ME, Rady P, Tyring SK, Nazeer T. Concurrent Adjacent Merkel Cell Carcinoma and Chronic Lymphocytic Leukemia without Simultaneous Merkel Cell Polyomavirus Detection: A Case Series. Dermatopathology (Basel). 2021 Jun 7;8.
Ashraf MF, Richter S, Arker SH, Parsa N.A Rare Case of Esophageal Leukoplakia: A Potential Precursor to Esophageal Malignancy. Cureus. 2021 Aug 15;13(8):e17205.
Kmeid M, Liu X, Ballentine S, Lee H. Idiopathic Non-Cirrhotic Portal Hypertension and Porto-Sinusoidal Vascular Disease: Review of Current Data. Gastroenterology Res. 2021 Apr;14(2):49-65.
Fu ZY, Kmeid M, Aldyab M, Lagana SM, Lee H. Composite intestinal adenoma-microcarcinoid: An update and literature review. World J Gastrointest Endosc. 2021 Dec 16;13(12):593-606.
Kmeid M, Lukose G, Hodge K, Cho D, Kim KA, Lee H. Aberrant expression of SATB2, CDX2, CDH17 and CK20 in hepatocellular carcinoma: a pathological, clinical and outcome study. Histopathology. 2021 Nov;79(5):768-778.
Abdelwahab H, Friedman D, Lightle A, Mian B, Fisher H, Akgul M. Distinct mutational status in GATA3-Positive clear cell adenocarcinoma of the urinary tract: A CASE report. Urol Case Rep. 2021 Aug 1;39:101793.
Kmeid M, Arker SH, Petchers A, Lukose G, Li H, Lee EC, Qualia CM, Arslan ME, Lee H. Appendiceal inflammation in colectomy is independently correlated with early pouchitis following ileal pouch anal anastomosis in ulcerative colitis and indeterminate colitis. Ann Diagn Pathol. 2021 Dec;55:1
Li H, Arslan ME, Lee EC, Qualia CM, Mikula MW, Fu Z, Petchers A, Arker SH, Kmeid M, Boguniewicz A, Lee H. Pyloric gland metaplasia: Potential histologic predictor of severe pouch disease including Crohn's disease of the pouch in ulcerative colitis. Pathol Res Pract. 2021 Apr;220:153389.
Mikula M, Najjar S, El Jabbour T, Dalvi S, Umrau K, Li H, Koo BH, Lee H. Increased cytoplasmic yes-associated protein (YAP) expression in mismatch repair protein-proficient colorectal cancer with high-grade tumor budding and reduced autophagy activity. Appl Immunohistochem Mol Morphol. 2021 Apr 1;29(4):305-312.
Howe AS, Pearce J, Lian F, Ribbons L, Chumbalkar V, Nazeer T, Kogan BA. A case of Ewing sarcoma of the bladder presenting in early infancy. J Pediatr Hematol Oncol. 2021 Mar 31.
Li H, Arslan ME, Lee EC, Qualia CM, Mikula MW, Fu Z, Petchers A, Arker SH, Kmeid M, Boguniewicz A, Lee H.
Pyloric gland metaplasia: Potential histologic predictor of severe pouch disease including Crohn's disease of the pouch in ulcerative colitis. Pathol Res Pract. 2021 Apr;220:153389.
Pantaleon Vasquez R, Arslan ME, Lee H, King TS, Dhall D, Karamchandani DM. T3 versus T4a staging challenges in deeply invasive colonic adenocarcinomas and correlation with clinical outcomes. Mod Pathol. 2021 Jan;34(1):131-140.
Najjar S, Ahn S, Umrau K, Arslan M, Jennings TA, Whyte C, Lee H. Increasing Trend of Calretinin-Positive Mucosal Innervation from Aganglionic Zone toward Transition Zone in Hirschsprung's Disease. Eur J Pediatr Surg. 2021 Jan 29.
Adepoju A, Narayan A, Aldyab M, Foyt D, Peris-Celda M. Absence of contrast enhancement in a petroclival meningioma: Case report and systematic literature review. Surg Neurol Int. 2020 Dec 4;11:418.
Arslan ME, Li H, Jennings TA, Lee EC, Nigam A, Lee H. Frequency of Plexiform Fibromyxoma relative to gastrointestinal stromal tumor: A single center study. Ann Diagn Pathol. 2020 Oct;48:151568.
Kmeid M, Zuo C, Lagana SM, Choi WT, Lin J, Yang Z, Liu X, Westerhoff M, Fiel MI, Affolter K, Choi EK, Lee H. Interobserver study on histologic features of idiopathic non-cirrhotic portal hypertension. Diagn Pathol. 2020 Oct 23;15(1):129.
Fu Z, Aldyab M, Arslan M, Karamchandani D, Boguniewicz A, Lee H. Lymphocytic colitis pattern of injury presenting as endoscopic polyps: case series. Pathol. 2020 Jul;101:10-17.
El Jabbour T, McHugh K, Patil D, Zuo C, Koo B, Kim S, Lee H. Histologic Lesions of Porto-sinusoidal Vascular Disease Following Phlebotomy in Hemochromatosis. Gastroenterol Res. 2020 Feb;13(1):32-39.
Cubero Rego D, Lee H, Boguniewicz A, Jennings T. Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP) is rare, benign lesion using modified stringent diagnostic criteria: reclassification and outcome study. Ann Diagn Pathol. 2020 Feb;44:151439.
Cordeiro-Rudnisky F, Ahn S, Sheuka N, Whyte C, Boguniewicz A, Fan R, Lin J, Jennings T, Lee H. Transition Zone in Total Colonic Aganglionosis and Colorectal Hirschsprung Disease Shows a Similar Trend of Mucosal Innervation: Image Processing and Analysis (IPA) Study. Pediatr Dev Pathol. Mar-Apr 2020;23(2):127-131.
Zhang D, Gonzalez R, Feely M, Umrau K, Lee H, Allende D, Karamchandani D, Zaleski M, Lin J, Westerhoff M, Zhang X, Alpert L, Liao X, Lai J, Liu X. Cinicopathologic features of Buschke-Löwenstein tumor: a multi-institutional analysis of 38 cases. Virchows Arch. 2020 Apr;476(4):543-550. Khan A, Shahzad S, Najjar S, Foulke L. Disseminated Histoplasmosis with Concurrent Hairy Cell Leukemia. Cureus. 2020 Jan 31; 12 (1):