DIVISION OF NEUROPATHOLOGY

UNIVERSITY OF PITTSBURGH SCHOOL OF MEDICINE
DEPARTMENT OF PATHOLOGY

NEUROPATHOLOGY TRAINING MANUAL

For the Residents rotating through the Neuropathology Division: All of us in the Division of Neuropathology want you to have a profitable and pleasant rotation on this service. The following guidelines will clarify our expectations.

1. The daytime working hours in the Division of Neuropathology are from 8:00 a.m. to 5:00 p.m., Monday through Friday. On occasion you may be called in at other hours to see special cases.
   
   
2. We need the phone numbers, pager numbers and addresses of all trainees and staff.
   
   
3. Permission for absence from the laboratory must be obtained from Dr. Wiley. A short note should request and specify the time-off and the reasons. In Dr. Wiley's absence Dr. Hamilton may give permission. Once permission is obtained, the resident will inform Karen Weber and the Neuropathology Fellow. Written requests for vacation time during the rotation must be approved by Dr. Wiley and coordinated with the Neuropathology Fellow at the beginning of the rotation.
   
   
4. If for any reason, you are going to be late, or if you are sick, the division secretary must be notified, 412-647-9417, preferably before starting time.
   
   
5. Residents should check the surgical schedules every afternoon. The clinical histories, imaging reports and previous surgical material should be reviewed the afternoon before the intraoperative consultation.
   
   
6. Residents should be ready to attend and assist the Fellow in Autopsy Neuropathology in the removal and examination of the nervous system (CNS & PNS) in every case with neurological findings and in all cases from the Neurology and Neurosurgery services.
   
   
7. Residents will be assigned cases on Friday for the Neuropathology Brain cutting conference the following Monday morning. Clinical charts and imaging studies should be reviewed, summarized and imported into the NP report by the resident before the Neuropathology Brain Cutting Conference. During the conference, the residents will provide a concise, neurologically relevant summary of each case. Residents will perform a gross examination of each case and submit appropriate samples for microscopic evaluation. A gross diagnosis and description will be inserted into the Gross NP portion of the autopsy report before noon the day of Brain Cutting. The residents will preview the microscopic slides before reviewing with the responsible Neuropathologist.
   
   
8. Residents should attend all conferences of the Neuropathology Division (See Conference listings).
   
   
9. Residents will review microscopic slides of all surgical specimens and consultations prior to Neuropathology surgical sign out. If additional clinical information or previous surgical material is needed, residents will obtain these prior to sign-out.
   
   
10.  Residents, Fellows, and students should use all technical material (microscopes, projectors, books and visual aids) in the Neuropathology Conference Rooms with consideration for others
    
    
11. Microscopes should be kept clean. The objectives and eyepieces should not be touched with the fingers, face or hair. Microscopes should not be handled roughly; the extension tube and other attachments are easily damaged. OIL IS NOT used with any objectives.
    
    
12. Visual aids (e.g. 2 X 2 color transparencies, projector) should never be taken from the Neuropathology Signout room. Replace them in the proper place on the shelf and in the proper order.
    
    
13. Books in the Neuropathology Signout Room may be used at any time during daytime working hours, but should never be removed from the room.
    
    
14. Whenever leaving the Neuropathology Library unoccupied always make sure that the door is securely locked.

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RECOMMENDED READING

• Burger, Scheitauer and Vogel: Surgical Pathology of the Nervous System and it's Coverings
• Ellison & Love: Neuropathology
• Rubenstein: Pathology of Tumors of the Nervous System

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• Assist the Neuropathologist in performing frozen sections and imprints
• Review clinical history, imaging studies and previous surgical material prior to intraoperative consultation
• Review all gross specimens, dictate per flow of schedule with Neuropathologist
• Review slides prior to sign-out sessions
• Review pertinent clinical history, MRI and CT scans, generate tentative diagnosis and differential
• Review Neuropathology texts on suspected diagnosis
• Dictate diagnosis and micro reports as per flow schedule
• Assist in interpretation of special stains, immunoperoxidase, EM on pertinent cases
• Cover surgical Neuropathology service when fellow is away
• Review atlas of Neuropathology study slide sets and CD-ROMS (Brainstorm)
• Attend all conferences at the Division of Neuropathology

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AUTOPSY MATERIAL

Obtain clinical history and imaging studies of assigned cases, summarize neurorelevant history
Perform gross examinations of CNS, generate tentative diagnosis and differential
Dictate gross diagnosis and description by the end of the Monday that the brain was cut
Review slides of autopsy brains before Friday signout
Signout with attending at Friday Autopsy microscopic conference
Dictate final diagnosis and microscopic description by the end of that Friday
Assist the Neuropathologist with the removal of the CNS and PNS as necessary