Tissue is the issue

 TISSUE IS THE ISSUE 

For non medicos Pathology is the study of cells microscopically in diseases states and histology is the same study in normal states !

Histology is microscopic anatomy of the human body at cellular level and is studied as a basic science in medical curriculum ie during the first or second year while 

pathology is generally done in third or fourth year after starting medicine ,surgery and gynecology ,and knowing about diseased states .

Forensic science is the study of dead tissues and post mortem examinations also are a part of pathology but of a more investigative approach associated with criminology and post mortem examination to find cause of death etc a totally different and vast field by itself as a medical student one went through that in fourth year .

To us working in oncology or cancer medicine ,pathology is vital and pathologists are one of the most important specialists we work with as a team .

In these days of great advances in the molecular level of differentiation's pathology at many times decides on the treatment and the word of the pathologist is sacrosanct .

Getting a pathology or biopsy report for a patient too is very unnerving as it could be a diagnosis which would strike terror into his or her heart or rarely relieve him of his anxiety !

in oncology we always say tissue is the issue 

we have in most centers multidisciplinary meets with pathologists to discuss cases as subtle difference can alter the whole management 

in these days of highly specialized stains in immuno histochemistry and molecular tests and even genetic mutations the differentiation is so vast .

in the early days it was suffice to get a diagnosis of say in breast cancer what type of tissue it was either from glandular tissue called adenocarcinoma or from connective tissue a type of sarcoma called malignant phylloides whose treatment were diametrically opposite 

Today the sub classifications like the hormone status the aggressiveness by grade or by KI 67 range or specialized targets amenable to treatment like Her 2 or epidermal receptors ,the microscopical invasions into blood vessles lymph nodes or lymphatics or nerves are all vital .

In hematology too the sub classifications of lymphomas or leukemia's  deserve separate tomes and are in hundreds and each one is important for  prognosis or outcomes  ,

second opinions are taken at times when pathologists themselves are foxed over certain modulations in tissue .

Transformation of the tissue from one type to another as tumor grows , certain mutations that confer resistance to certain types of targeted treatment or monoclonal antibodies have all made pathology a highly specialized and meticulous science in oncology .

Selective pathologies for immunotherapy to work 

over the years I still remember some eminent pathologists I had the opportunity to work with  .

The reputed madam Pushpa professor in lakeshore hospital in kochi was one when there 

The Dept had been very helpful when requested for an early report during 2003 to  2006 when I was working in med oncology for those whom we wanted to waste no time to start treatment like in young patients 

Iam sure its still so today .

I still rememebr getting a bone marrow report on same day ( not full one but what was needed to start treatment ) something which would never happen abroad !!

in Tawam hospital in Al Ain UAE a John Hopkins hospital managed tertiary care center the pathology hematology had a great team there was an Italian hematologist who only specialized in lymphomas and he was an authority on that .

We used to have exhaustive monthly Hematology board meets like tumour boards in med oncology ( pathologists used to contribute thier inputs there too ) 

in the center I worked in Brunei The Brunei Cancer center  too we had a highly specialized and capable department of pathologists .

In  Ripas Govt  hospital the department of pathology was led by Prof Telesinghe  the main support structure in the diagnosis of our patients

with newer forms of tissue sampling like circulating tumor cells and plasma based DNA detection the paucity of sampling from difficult areas like lung will be met better in future ( Liquid biopsies)

so the kaleidoscopic world of starry cellular wonderland the home of pathologists is  dear to us too .

After all tissue is the issue