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INTERNATIONAL PATHOLOGY DAY

Zimbabwe joins the world in commemorating the International Pathology Day on Wednesday 15 November.International Pathology Day (IPD) is a time set aside in the month of November to celebrate the pathology profession which includes the administrative staff, technicians, laboratory scientists, biomedical scientists, clinical scientists and pathologists.

 

Pathology is the medical specialty concerned with the scientific diagnosis of disease based on the laboratory analysis of body tissues and fluids such as blood, cerebrospinal fluid, urine and other effusions.

Pathology is generally classified into two main branches, namely Anatomic Pathology and Clinical Pathology.

Anatomic pathology has several sub- specialties which include surgical pathology (histopathology), cytopathology and forensic pathology. Clinical Pathology is composed of several subspecialties which include hematology, chemical pathology, medical microbiology, immuno-pathology and transfusion medicine. Molecular

pathology is the bridge that links anatomic and clinical pathology. For one to be a pathologist they have to study medicine to become a medical doctor followed by specialisation as a general pathologist or if they choose to pursue an academic career, they can specialise in one or more of the above mentioned branches of pathology.

Scientists and technicians work with pathologists in laboratories in a similar manner to nurses and medical practitioners in a medical ward or nurses and surgeons in an operating theatre. To be a Laboratory Scientist or Biomedical Scientist, one needs a minimum of a Bachelor of Science degree or equivalent in an appropriate area of laboratory science. 

Cancer Diagnosis

Pathology is integral to the diagnosis, prognostication and treatment of every cancer.Pathologists are the specialist medical practitioners who are trained, certified and licensed to diagnose cancer.

It is only after the Pathologist’s definitive diagnosis of cancer that other medical specialists such as surgeons and oncologists know what methods or protocol to use in treating the cancer.

Patient targeted therapy, also called personalised medicine, begins with the pathologist identifying the appropriate molecular or genetic markers of the cancer afflicting the patient. This is why pathology is the science behind the cure.

Due to popularity of many television programs on forensic medicine, “Pathology”conjures images of people in white laboratory coats investigating the cause of suspicious deaths for the police.

While that is correct, it is only a small fraction of the breadth and depth of Pathology.The greater part of pathology is in hospitals providing diagnosis to living patients, such as those with cancer, as alluded to above.

The doctors in hospitals, surgeries or clinics, all depend on the knowledge, diagnostic skills and advice of pathology.Studies have demonstrated that approximately 70% of clinical decisions are based on pathology laboratory tests.

For example, even after locating a brain tumour using CT scan or MRIs, the neuro-surgeons still require a definitive diagnosis of the true nature of the tumour, whether it is benign or malignant and that can only be determined by a pathologist.

Whether it is a general practitioner (GP) arranging a blood test or a surgeon waiting to know the nature of the lump removed during a surgical operation, the definitive answer is provided by a pathology laboratory.

Some pathologists also see patients and run clinics, they are directly involved in day-to-day treatment of patients such as in cytopathology and haematology.

The following is a brief description of the sub-speciality disciplines of pathology.

Surgical Pathology (Histopathology)

Surgical pathology is one of the primary areas of practice for most anatomical pathologists.

It involves gross and microscopic examination to provide a diagnosis of surgical specimens as well as biopsies removed from patients during surgical operations and submitted to the pathology laboratories by surgeons, gynaecologists, paediatricians, physicians, dermatologists or interventional radiologists.

The diagnosis is determined by a combination of gross (macroscopic), histologic (microscopic) and molecular examination of the tissue.

 Immunohistochemistry

 The advent of patient targeted therapy also involves the evaluation of molecular properties of tissue by immunohistochemistry for the presence or absence of molecules such as oestrogen or progesterone receptors and Her-2- neu whose status are essential in the treatment of breast cancer.

If the breast cancer is positive for oestrogen receptors then the patient can be treated with the drug tamoxifen and if positive for Her-2 (C-erb B2) then the drug Herceptin can be used treat that particular patient.

This level of targeted and personalised treatment of cancer is not possible without the immunohistochemistry and the pathologist.

These techniques are available at the Parirenyatwa Group of Hospitals pathology laboratories. Zimbabwe is one of four Sub-Sahara countries with capacity to provide immunohistochemistry techniques which are essential in providing diagnostic services whose quality meets international standards.

Cytopathology

Cytopathology is a branch of pathology that studies and diagnoses disease at the cellular level. It is generally a screening procedure used to aid in early detection of cancer.

The best known example is Pap smear examination in the early detection of cancer of cervix.This procedure is available at Parirenyatwa Group of Hospitals and Mpilo Central Hospitals in the Public Health Sector.

Forensic pathology

Forensic Pathology focuses on determining the cause and manner of death by post-mortem examination of the body of the deceased. During criminal investigations, an autopsy is performed under the supervision of the Coroner or Medical Examiner and in this role also confirms the identity of the deceased.

The minimum requirement for one to become a licensed Forensic Pathologist is to be a medical doctor with a speciality in general or anatomical pathology and subsequent training in Forensic Medicine.

The methods used in forensic pathology to determine the cause of death include gross and microscopic examination of tissues, interpretation of toxicology, radiology and DNA Tests.

The adversarial nature of our legal system has made forensic pathology less attractive to local doctors. The enactment of the Coroner’s Bill is currently going through the legislative processes to create a conducive legal framework for local doctors to specialise in forensic pathology.

The coroner system generally provides a buffer between the medical experts and the adversarial court environment.

The service is currently being covered by Cuban forensic pathologists who are also not testifying in courts because of the current deficiencies in our legal framework.

Clinical pathology

Clinical Pathology is concerned with the diagnosis of disease based on the laboratory analysis of bodily fluids such as blood, urine, cerebrospinal fluids, as well as tissues and is comprised of five sub-specialities.

Hematopathology is the study of diseases of the blood such as leukemia.

Chemical pathology focuses on the diseases affecting the chemistry of the body such as diabetes mellitus whereas, clinical microbiology includes diseases caused by infectious agents such as viruses, bacteria, fungi and parasites

Immunopathology which focuses on serological analysis such as HIV testing, syphilis and screening for hepatitis infections; blood transfusion focuses on screening and cross-matching of

blood between donors and recipients.

Molecular pathology which is the study and diagnosis of disease through the examination of molecules within organs, tissues or bodily fluids. Molecular pathology is commonly used in the diagnosis of cancer and infectious disease using techniques such as polymerase chain reaction (PCR), DNA testing, in situ hybridization, flow-cytometry, immunofluorescence tissue assays, molecular profiling of pathogens such as typhoid and analysis of bacterial genes for antimicrobial resistance.

DNA testing is also an important technique, among other tests, used during forensic pathology investigations in disaster victim identification (DVI) following mass disasters such as bus accidents or plane crushes.

Pathology plays a vital role across all specialities of medicine throughout life, from pre-conception to post-mortem. In fact, it has been said that “Medicine is Pathology”.

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