Paediatric pathology

Paediatric Pathology

Dr Sophie Stenton is a speciality trainee in paediatric and perinatal pathology.

Tell us about yourself…

I am one of two paediatric and perinatal pathology trainees in the Yorkshire and Humber Deanery. I’m currently in ST3 and based at Sheffield Children’s Hospital but will soon rotate to St James’ University Hospital in Leeds. I came into the training programme following completion of the foundation programme and two years of general histopathology training.

In my final year of medical school I did a student selected component in the histopathology department, shadowing consultants performing autopsies, dissecting specimens in the cut-up room and reporting microscopy. I really enjoyed the experience and I felt as though I had found something that I wanted to pursue.

Why did you choose paediatric pathology?

At medical school I enjoyed learning about the diseases that occur in children including abnormalities that arise during fetal development. When I began histopathology training I kept in mind the possibility of sub-specialising into paediatric pathology.

The work is satisfying intellectually, particularly in regards to the autopsy work. We undertake many more ancillary tests in coronial autopsies (compared with adult coronial post mortems). Deciding which results are clinically relevant, correlating the findings with histology and generating a sequence of events prior to death can be very challenging.

The surgical histology is varied as we receive specimens from all organ systems. Most of the specimens we receive are for benign condition, sometimes related to congenital abnormalities.

I think the quality of training in histopathology (and its subspecialties) is excellent. I have regular hours, without on-call work and typically receive several hours of one-on-one contact time with a consultant every day.

What is the application process

The recruitment process in centralised and applications for a training post are twice yearly. The earliest opportunity to apply for the paediatric and perinatal pathology training programme is after 18 months of general histopathology training. Applicants are required to complete an online form, provide several references and an up-to-date CV. The applicants are shortlisted and invited for interview. Successful interviewees are given a ranking and asked to select their preference(s) of deanery. The number of vacant training posts vary from year-to-year, with only about a dozen trainees currently in the programme. There are some prerequisites: A successful applicant is required to have completed at least two years of histopathology training prior to commencing the post. The applicant is also required to have the FRCPath Part One exam before starting the post.

Describe a typical working day

My typical working day starts at 9am. I usually alternate between a week of autopsies or surgical reporting. If there are any hospital post-mortems to perform I will do these in the morning, asking the consultant for support if necessary. There are always placentas to cut-up and I generally spend at least a couple of hours each week in specimen-cut up.  In the afternoon, I’ll look at the histological slides from previous autopsies, collate any results from ancillary tests and then start to piece together the autopsy report. If on surgical reporting, the biopsies usually come through in the afternoon and I’ll spend the afternoon reviewing these and formulating a report before discussing with a consultant.

What is the best part of your job?

The job is incredibly rewarding. We provide information for parents in one of the most difficult, distressing times of their lives. The investigations we perform and results we provide can shape the management of future pregnancies.

What is the worst part of your job?

Some autopsy cases can be particularly upsetting, such as the intrapartum deaths or post-term stillbirths.

How is it different from adult histopathology?

The approach to autopsy practice varies considerably with post-mortem imaging, ancillary work and histology undertaken in most cases. In a sudden unexpected death, I may have the results from 20 ancillary tests to chase, including metabolic results, genetic studies, microbiology findings, toxicology, skeletal surveys and in some cases post-mortem CTs. That’s in addition to the histology which can also be about 50 slides! By comparison, the cause of death in adult coronial autopsy work can largely be achieved by internal examination.

There is not as much surgical work to report in paediatric pathology. I receive about a dozen surgical cases a day, most of which are for non-neoplastic conditions. We do however receive many placentas from premature births, multiple gestations and intra-uterine fetal deaths.

What is the future of histopathology?

The changes we will see in the future will not be dissimilar to those of adult histopathology. We will digitise our service in the coming years. This involves the scanning of histological slides using a high resolution slide scanner. The microscope will become obsolete in favour of visualising histological slides on a computer screen. This will improve our efficiency in surgical reporting, acquiring second-opinions, arranging MDTs and sharing a library of cases for teaching purposes.

Genetic testing and molecular pathology techniques are already utilised for most oncology specimens. With further research, the emphasis on molecular profiles of tumours and the relation to prognosis will only grow.

Autopsies are still an essential part of paediatric pathology and have not declined in number the way adult coronial and hospital autopsies have done. There may however, be more use of the limited autopsy in some hospital post-mortems with the use of MRI, chromosomal karyotyping and external examination only.

Advice for anyone considering paediatric pathology as a career

Paediatric pathology is a very friendly specialty and we are always encouraging of people who show any interest! My advice would be to shadow a consultant and gain exposure to the specialty early. There are always undergraduate essay competitions to consider or interesting cases that can be written up into a case report.

As a foundation doctor, a rotation in obstetrics or paediatrics is beneficial but by no means essential. A few taster days with the histopathology department would always be viewed favourably. I’d advise undertaking an audit or getting involved in teaching where possible. It does not need to be pathology related but these are generic skills that are frequently asked about in the application process.