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Forensic Cases
November 18, 2004

The lunchtime lecture began with a presentation by Dr. Erin Thibault (PGY3 pathology resident) about the different components of Pathology. She explained that Pathology is an umbrella that covers many subspecialties and that it is a great career for those who enjoy doing many different things. This was followed by highlights of some of these areas including surgical pathology, autopsy (hospital and forensic), transfusion medicine, cytology, microbiology and hematology. She then explained that while many go on to be general pathologists, there are subspecialty fellowships in many areas including neuropathology, dermatopathology and molecular diagnostics in addition to the areas previously mentioned. She closed by emphasizing how interesting this broad array of topics makes pathology as a career and how pathology is always changing due to it’s “perfect mix of basic science and clinical medicine”.

The second speaker was Dr. Mary Jo Martin, Assistant Professor in Pathology, who is a local medical examiner. She started the lecture with a warning that what she considers “routine” photos may not be considered such by many people in various fields of medicine, and “how many doctors get to carry a badge and a gun?” Dr. Martin explained which deaths are investigated by the Office of the Chief Medical Examiner in the Commonwealth of Virginia, along with the differences in the various professions related to forensic/legal medicine. She went on to discuss the main differences between hospital and medicolegal autopsies. This was followed by a brief lecture on the interpretation of gunshot wounds. The remaining portion of the lecture was dedicated to various photos and descriptions of autopsy findings and their interpretation. The cases focused primarily on various gruesome gunshot shot wounds, but included some deaths due to various medical causes.

The Department of Pathology at VCUHS is composed of two major divisions: anatomic and clinical pathology. Anatomic pathology is made up of the cytopathology laboratory, the surgical pathology laboratory, and the autopsy room. Clinical pathology incorporates all other clinical testing laboratories--chemistry and toxicology, coagulation and hemostasis, microbiology and immunology, molecular diagnostics and the cytogenetics laboratories. It includes forensic pathology and transfusion medicine which houses the blood bank.

Pathologists' special training prepares them for many different roles and responsibilities in service to their patients and other medical professionals. One of those professionals is the laboratory technician. In surgical pathology at VCUHS, the day begins at the grossing station with biopsied tissue that is cut into cassettes. Inking is carefully applied to determine the surgical margins of lesions. A histotechnologist prepares histologic sections going through several detailed steps. Often, pathologists perform immunohistochemical staining to help determine a diagnosis. These special stains provide vital information about the diseased tissues.

Surgical pathologists also consult with surgeons. It's the pathologist's job to determine whether further surgery is needed. Because the patient is waiting, a quick decision is vital and usually made within 15 minutes. Surgical pathology collection materials and techniques include frozen sections, touch preps, gross examinations, and fine needle aspiration. When an organ needs evaluation before transplantation, it's the pathologist's job to evaluate and recommend the next step.

Clinical pathologist interpret challenging peripheral blood smears for diagnosis and recommended treatment in diseases and conditions like AIDS, hepatitis, leukemia, anemia, malaria, and lead poisoning. They perform and interpret bone marrow biopsies using new technologies in morphology, flow cytometry, clinical correlation, and molecular studies. They also evaluate patients with bleeding or clotting disorders, perform hemotherapy, including techniques in stem cell harvesting, plasmapheresis, leukopheresis, and red cell exchange. They coordinate blood transfusions, blood utilization and donation, and the identification of rare blood types. Most importantly, they oversee the care of trauma patients in need of massive transfusions.

Molecular pathologists are investigators of genetic structure and changes. They test for oncogenes in the diagnosis of cancer and for inherited genetic defects. They also provide DNA fingerprinting.

Research pathologists operate at the cutting edge of scientific inquiry into the cellular, molecular and genetic mechanisms behind aging, cancer, AIDs and other infectious diseases. At VCUHS we have pathology research programs in Aging & Cancer, Cellular & Molecular Pathogenesis, CTRF Cancer Genomics, Cytogenetics, Cytoproteomics, Functional Genomics, Molecular Diagnostics, Oncogenomics & Proteomics, and Paleopathology.