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Hong Li
Pathology department of Binzhou Medical University
From March to June 2016, I have studied in the Pathology Department of McGill University Health Center (MUHC). During this time, I have learned gastrointestinal (GI) and liver pathology under the supervision of Dr. Zuhua Gao.
The MUHC is the main affiliated hospital of McGill University, it is the largest hospital in Montreal, and it is one of the most famous hospitals in Canada. The Pathology Department includes routine diagnostic areas, technology rooms, frozen pathology room, immunohistochemistry lab, cytopathology lab, molecular pathology lab and so on. There are more than 100 staff here, including 26 pathologists, more than 50 technicians, 32 residents, 10 pathologist assistants and some managers. They have done excellent work in 2015. Over the span of one year, the Pathology team of the MUHC examined 75,000 adult and 7,000 pediatric surgical specimens as well as over 70,000 cytology specimens. More than 400 diagnoses were made every day.
Dr. Gao is the chief pathologist in MUHC. In addition to pathology diagnostic work, he is busy in dealing with many other things related to the pathology department and research groups. If I have any questions about the GI and Liver pathology, I could ask for help from Dr. Yu Shi, a fellowship trainee in this specialty. Sometimes I turned to other residents for help as well. After the three months of training, I have made improvements in pathology diagnostic skills, and I have also learned a lot from the resident training and research groups.
1. GI and Liver pathology
GI and Liver pathology is divided into neoplastic diseases and non- neoplastic diseases. Generally, we focus on the neoplastic diseases, including dysplasia and tumor. We diagnose many GI tumor cases in our hospital (BMUH) every day and we have learned the diagnostic criteria of the neoplastic diseases according to the WHO classification of tumours of the digestive system. As such, it was not difficult for me to diagnose these cases at the MUHC.
However, non- neoplastic diseases of GI and Liver are difficult for me. Although more than 30 cases of inflammatory GI diseases were diagnosed everyday in our hospital, most of the pathological reports were “mucosa with chronic inflammation”. We haven’t found the reason causing the inflammation. At the MUHC, pathologists of the GI and Liver group have done microscopic examinations very carefully. Usually, they would find “which kind of inflammation the patient has and what caused it”. Sometimes, special stains such as Giemsa staining, PAS staining and Congo red staining were used for GI biopsies. It can help pathologists to find the reasons of inflammation.
2. Cytopathology
Cytopathology is a branch of pathology that studies and diagnoses diseases on the cellular level. It’s usually used to aid in the diagnosis of cancer, certain infectious diseases and inflammatory conditions. In our hospital, liquid-based cytology, DNA content analysis and exfoliocytology were carried out and performed very well. However, cytology of fine needle aspiration has not been well implemented.
At the MUHC, the cytology group has done excellent work in 2015. They have examined more than 70,000 cytology specimens, including fine needle aspiration specimens, liquid-based cytology and exfoliocytology. More than 98% of cases established definitive diagnoses. Besides, the department runs a national Cytopathology review course each year. It’s a great work. I think that it is important to further develop fine needle aspiration cytopathology at our hospital.
3. Special staining
Special staining is widely used in the pathological diagnosis. For example, PAS stain is used to test glycogen and Congo red can stain amyloid. It can help pathologists to distinguish and diagnose some diseases. In my daily work in our hospital, immunohistochemistry is preferred, and widely applied in the diagnosis and differential diagnosis of tumor diseases. Unfortunately, special staining was almost lost in the corner. Maybe I have known less knowledge about special staining in the past. From now on, I will change my mind and make more effort to use special stains.
4. Molecular pathology
Molecular Pathology emphasizes the study and diagnosis of diseases through the examination of molecules within organs, tissues or bodily fluids. It includes the development of molecular and genetic approaches to the diagnosis and classification of human tumors. It is also leading the way towards personalized medicine.
There were no obvious differences in the design, equipment of molecular pathology lab between MUHC and developed hospitals in China. However, some kits and primers for the detection of gene mutations were developed by PhD scientists. Moreover, these tests have the high level of sensitivity and specifity for the detection of very small tumors.
5. Placental pathology
In the last 2 weeks before I came back, I followed Dr. Chen and learned placental pathology. Placental pathology is helpful for finding the causes of spontaneous abortion, premature delivery, intrauterine infection, intrauterine fetal death and so on. We have met few cases of placenta in our hospital, but I don’t know how to examine it, so I asked Dr.Chen for help. I joined her teaching and discussion group and learned the basic knowledge about the placenta.
From the naked eye observation to microscope examination, I now know how to approach placental pathology. I believe that we should further develop placental pathology at our hospital.
6. Residents training
There are more than 30 residents in the pathology department of the MUHC. They came from different countries and they were trained at different medical universities in the past. At the MUHC, I was seated in the resident office, and we studied together, joined teaching classes, and learned slides together. They gave me a lot of help in the past 3 months. They are smart, diligent, and have done excellent work in 2016. Six residents have passed the Royal College Medical license examination in 2016. Their pass-rate for this examination is approximately 86%. So it’s a good work in North America.
Every Monday morning is teaching time, from 8: 15-12: 00, which includes case report, autopsy, black box and lectures. Residents play an important role in the teaching time. From 8: 15 to 9: 30, residents share cases, autopsy, and black box with the staff pathologists. Next, the pathologists give lectures to the residents from 10:00 to 12:00.
They have learned diseases including etiology, pathogenesis, pathology changes, differential diagnosis, special staining, immunohistochemistry, molecular changes and so on. The residents learn almost all the different aspects of the diseases. Dr. Gao also suggests that I should study the diseases carefully. After training at the MUHC, I have learned a lot from the residents, their learning attitude, learning methods, patience and humor ……
I will miss you, my friends at the MUHC.
7. About research
When I met Dr. Gao the first time, I showed my C.V. and introduced my research subject to him. He invited me to join his research group discussion every Friday afternoon. Most of the research members in his research team come from universities of China. They have published two articles in Cancer Research and Nature Medicine in 2015.
Since I graduated from Nanjing Medical University in 2011, I have learned and practiced surgical pathology in our hospital. Although I had received two research grants, I found it difficult to dedicate my time to research because of my other obligations.
From the discussion with researchers at the MUHC, I have learned new techniques and methods, and they gave some good suggestions for my research. I have more confidence for my experiments.
My research will go on!
The three-month visit to the MUHC is a short but valuable moment in life. I have spent a happy and fruitful time at the MUHC. I have made some friends at the MUHC, and they also gave me a lot of help. I would like to thank Dr. Gao and all the staff at the MUHC.
I will try my best to use what I have learned here to do everything better.
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