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Lab Manual for UCSF Clinical Laboratories

Lab Manual for SFGH

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Surgical Pathology Rotation

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  • UCSF Departments of Pathology and Laboratory Medicine
  • 185 Berry Street, Lobby 2, Suite 100
  • Box 0506
  • San Francisco, CA 94143-0506

Surgical pathology specimens are examined by residents at Moffitt Hospital, Mission Bay, San Francisco General Hospital & Trauma Center, and the San Francisco V.A. Medical Center as part of the general surgical pathology rotations at those institutions. A combined total of over 32,000 surgical pathology specimens per year are processed at these institutions. At Moffitt Hospital, Surgical Pathology is separate one-month rotation that each resident typically completes three to five times during the AP year. Surgical pathology responsibilities at SFGH and the SFVAMC are combined with autopsy duties on the combined general pathology rotations.

The resident experience in Surgical Pathology at UCSF is broad and wide-ranging. This is due in part to the three very different medical centers in which Anatomic Pathology residents receive Surgical Pathology training. Moffitt Hospital (also known as Moffitt-Long Hospitals, or UCSF Medical Center) is a major tertiary-care academic medical center that is routinely ranked as one of the top 10 medical centers in the United States, and includes the only Comprehensive Cancer Center in Northern California. The resident experience in Surgical Pathology at Moffitt ranges from endoscopic biopsies to organ transplants to complex surgical resections for malignancies. With the exception of heart transplants, virtually every type of surgical procedure is performed at Moffitt Hospital. The San Francisco General Hospital & Trauma Center, operated by the City and County of San Francisco, serves a large population of indigent and immigrant patients, including many from Central/South America and Asia. SFGH is consistently ranked as the best hospital in the U.S. for treatment of AIDS patients. The San Francisco V.A. Medical Center is a major referral hospital for the V.A. medical system in the Western U.S.

On Surgical Pathology rotations, residents acquire specimens and pertinent clinical history from the submitting clinician, dissect the specimens to reveal the extent of the pathologic process, sample the specimens for microscopic examination, and preview the glass slides before meeting with the attending pathologist for sign-out of the case. Acquiring the specimen and pertinent clinical history often involves intraoperative consultation (usually for frozen section analysis), in which the resident goes to the operating room to receive the specimen directly from the submitting surgeon. At this time, the resident obtains information concerning the type of procedure being performed, the surgeon’s differential diagnosis of the pathologic process, and the precise information that the surgeon needs from the pathologist, both intraoperatively and in the final diagnosis.

First-year Anatomic Pathology residents are guided through the process of acquiring and dissecting specimens with the help and under the direct supervision of the Gross Room Supervisor at Moffitt Hospital (who is a Fellow in Surgical Pathology) or the Pathology Chief Resident at SFGH or the SF VAMC (who is a skilled second-year resident chosen by the Program Director). Second-year residents generally acquire and dissect specimens independently, although assistance from more senior personnel is always available. Residents always preview their cases independently, then sign them out with members of the attending staff. First-year residents are encouraged, and second-year residents are required to have generated a differential diagnosis before meeting with the attending pathologist for sign-out, a process that often involves consulting surgical pathology textbooks and journals. At sign-out, the attending pathologist typically quizes the resident concerning the differential diagnosis, whether additional clinical history or special studies (e.g., immunohistochemical stains) are required for diagnosis, and if so which ones. In particularly difficult cases, residents may be required to search the medical literature for helpful studies, or to re-consult the submitting clinician to discuss the findings to date and seek additional clinical information that might be helpful in diagnosis.

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