Specialization Programme
|
|
Specialization Programme |
PATHOLOGICAL ANATOMY - 10 months a) at the Autopsy Department - 2 months q independent performing of macroscopic and
microscopic examination of organs together with making an autopsy report, as well as
attending autopsy - in total 30 autopsies
(actively and passively ) b) at the Biopsy Department - 8 months q participation in taking over the material for
emergency (intraoperative) and other biopsies, and in technical processing of the material
(for histological, histochemical and
immunohistochemical analysis), q microscopic analysis of histological
preparations (standard, histochemical and immunohistochemical) from everyday practice, as
well as the archival preparations - in total 4000 slides, with special attention
paid to biopsies of the throat, cervix, uterus, adnexa, lymph nodes and
spleen, bone-marrow, liver, stomach, intrathoracal organs, breast, thyroid gland, prostate, testicles and tumors of
other localizations on the relevant
departments as follows: q gynecological pathology - 2 months q hematological pathology - 1 month and 15 days q pulmonological pathology - 1 month and 15
days q other pathologies (breast, thyroid gland,
gastroenterologic pathology and other tumors in childhood) - 3 months Preliminary exam GYNECOLOGICAL CYTOLOGY - 6 months q Technique of obtaining specimens (smear,
aspirate, FNA aspirated fragments without and with the ultrasound control, tissue
fragments etc.) of different localizations (vulva, vagina, cervix, endocervix,
endometrium, parametrium, adnexa, amniotic cavity, buccal mucus as well as the other
localizations occurred with disease proliferation, lymph node, abdominal and pleural
cavities, urinal tract) for cytologic, cytochemical and immunocytokerniac analyses. q Processing samples (smear, sediment, imprint), fixation and staining
techniques for cytological, cytochemical and immunocytochemical examinations. q Microscopic-cytological, cytochemical and
immunocytochemical analyses and interpretation - including diagnosis and differential
diagnosis: the assessment of specimen adequacy regarding obtaining and processing of
samples, their fixation and staining; normal genital tract cells in different female ages,
and abdominal and amniotic cavities cells etc. Cytohormonal analyses in normal and
pathologic states; grades of cleanness
regarding the number of leukocytes and Doderleinīs bacilli; inflammation, degeneration,
metaplasia, reparation, agents of sexually transmitted diseases; tumors of similar
formation, benign tumors, intraepithelial pre-malignant and malignant lesions, invasive
malignant tumors, metastases and metastatic malignant tumors, changes on benign and
malignant cells in radiation and/or chemo-therapeutics, intra-operative cytological
analysis; sex determination; assessment of fetus maturity; assessment of the possibilities
for early amnion breaking; differentially diagnostic difficulties in
gynecological cytodiagnostics. q Acquaintance with the diagnostical and
therapeutical procedures in gynecology and perinatology. q During residency, an applicant should analyse
2000 - 2250 specimens, out of which: 1600 - 1750 VCE smears (50 normal, 200 benign, 1500
abnormal), 200 - 250 endometric aspirates (100 benign, 150 abnormal), 200 - 250 other
specimens. HEMATOLOGICAL CYTOLOGY - 5 months q Obtaining material for cytological analysis (blood smears, bone-marrow fine needle
aspiration - sternum, crista posterior and anterior, fine needle aspiration of lymph node,
liver and spleen with/without the control of ultrasound or CT), collecting material for
cytogenetical analysis, phenotyping and cell cultures, as well as bone biopsy. q Processing of material - 1. standard
staining (according to Papenheim and Papanicolaou), 2. cytochemical staining and fixation
(PAS, MPO, ANE, SUDAN BLACK, ACIDIC PHOSPHATASE, ALCALIC PHOSPHATASE, METHYLENE BLUENESS
and so on), 3. immunophenotyping of hematopoietic
cells on smears (PAP, APAAP and others) and
on suspensions (immunofluorescence and flow
cytometry). q analysis of a smear stained with standard
cytochemical and immunocytochemical methods (qualitative, semi-quantitative and
quantitative). Normal cell elements of the hematopoietic organs, pathological changes in:
the stem cell diseases for myelopoiesis (chronic and acute myeloproliferative diseases, myelodysplasia), erythrocytic diseases
( anemia and polyglobulia) granulocyte diseases (neutrophilic, eosinophilic and
basophilic), diseases of monocytes and makrophages, diseases of lymphocytes and cell
plasma (lymphophenia and lymphocitosis, syndrome of mononucleosis, lymph node benign
diseases, neoplastic diseases of lymphocytic system, chronic lymphatic leukemia,
prolymphocytic leukemia, tricholeukemia, acute lymphatic leukemia, malignant lymphoma,
immunoproliferative diseases, spleen diseases (hyper and hypospleenism),
thrombocytopoiesis, histocitosis, parasites, "strange cells" (metastases) in
bone-marrow, morphologic changes in bone-marrow in transplantation. q During residency, an applicant should perform
100 bone-marrow fine-needle aspirations, 200 lymph node fine-needle aspirations, assist in
fine-needle aspirations of liver and spleen and analyse: 3000 slides (at least 200
pathological) including smears of bone-marrow, peripheral blood, lymph nodes, aspirated
fragments of spleen, liver and of other localizations caused by disease proliferation
stained with standard, cytochemical and immunocytochemical methods.
Preliminary exam q Obtaining material for cytological
examinations (valid specimen of cough sputum, nasal pharynx smears, bronchial secretion
aspirate, BAL (broncho-alveloar lavage), bronchi "brushing", forceps excision of
mucus or pathologic changes of the bronchial wall, transbronchial lung biopsy,
transbronchial and transtracheal fine-needle aspiration, pleural fine-needle aspiration,
pleural biopsy, transthoracic fine-needle aspiration, as well as extrathoracic changes
caused by proliferation of the primary process). The role of a clinical cytologist and his contribution in planning of the
diagnostical procedure performance, indications and counter-indications, as well as the
possibilities of complications and their solving. Controlling of independent performing of
cyto-fine-needle aspirations of thoracic and extrathoracic localizations. Intra-operative
cytodiagnostics. q Methods of material processing and
preparation of valid cytological slides depending on the type of material (direct smear,
negative slides, separation, sedimentation). Staining methods, selection of an appropriate
method. Cytochemical and immunocytochemical methods. q Cellular morphological characteristics of the
organs, systems and tissues of the whole thoracic area (lungs, pleura, thoracic wall,
mediastinum). Cytomorphological characteristics of pathological processes: 1. changes on
normal cells (iritative forms, degenerative changes, atypia, metaplasia, proliferations).
2. prevalence of cells characteristic for
certain pathological processes, 3. recognition of agents which cause disease (pneumocystis
carinii, echinococus, fungi and so on). 4. cytomorphology of the primary benign and
malignant tumors, possibility for recognition of metastatic changes, 5. changes on normal
and tumor cells after the therapy (irradiational and cytostatic ones). Controlling of morphology, first with the
mentorīs assistance, and then independently through the analysis of cytological slides
and interpretation of the test results supervised by mentor. q During residency, an applicant is to analyse
altogether 3250 smears, perform 15-20 transthoracic and possibly pleural fine-needle
aspirations, as well as other ones (of lymph
node and other localizations occurred by the amplification of pathological process)
depending on the pathology. Preliminary exam
1. Breast cytodiagnostics q Breast structure and function. Obtaining
material technique for exfoliative examinations (secretion/exprimate, scarification),
breast FNA according to palpatory results, oncologic indications and presence of other
diagnostic procedures (serogram, thermogram, ultrasound). q Exfoliative breast examination - the problem
and significance of secretion presence, its unilateral or bilateral manifestation,
quantity, colour with special review on significance of bloody secretion. The secretion
analysis accompanied by inflammatory changes (subareolar abscess, inflammation of
Montgomeryīs gland). The control of mamillary changes
in terms of eczema and M.Paget. q Aspirational breast examinations - morphological breast tissue picture, inflammatory
changes, necrosis of fat tissue and fibrocystic breast disease; special attention is to be
paid to morphological macrocyst changes, fibroadenoma and proliferative changes with and
without epithelial atypia. Clinical and macroscopic picture of breast carcinoma and
possibilities of sub-classification of certain carcinomas. FNA and analysis of nodes
after non-radical surgery of breast carcinoma. The appearance and significance of radiated
malignant and benign cells of glandular breast epithelium. If a biopsy is performed, the
comparison of cytological opinions and histological results. The team work for breast
diseases. Values of determination of oestrogen and progesterone receptors in general,
other tumor markers in serum and/or aspirated breast tissue. The male breast diseases
(gynecomastia, carcinoma), and breast changes during the puberty and pregnancy. q During residency, an applicant should perform
at least 500 morphological analyses of aspirated fragments and breast secretions and 50
FNA-s. Preliminary exam 2. Cytodiagnostics of thyroid and parathyroid q Cytodiagnostical FNA of the thyroid and
parathyroid with/without the ultrasound control (getting acquainted with the ultrasound
operation and targeted FNA, material processing, screening of adequate and inadequate
specimens). q Cytological analysis of aspirated fragments
of the thyroid and parathyroid - normal
elements in cytological smear, as well as changes in functional disturbances,
inflammations and tumors of the thyroid gland, recognition of the parathyroid material and
interpretation. The usage of educational slide sets for that purpose. q Practising: the cytological analysis and the
manner of result recording of the aspirated thyroid and parathyroid fragments (for that
purpose, one has to microscope, with mentorīs supervision, everyday material and
preparations from the archive by looking through registers, i.e. PC). q It is suggested to examine: 300-400 aspirated
fragments - the material should comprise all the mentioned processes and pathologic
changes of the thyroid and parathyroid, 10-15
aspirated fragments per day (with 4 slides each in average) with self-control and
occasional mentor control. Preliminary exam 3. Cytodiagnostics of
ejaculate and male gonads q The ejaculate analysis (preparation of
examineee, processing and quantitative morphologic analysis of ejaculate). Evaluation of
oligo- and azoospermia. Determination of spermatozoon
mobility and vitality. q Practising: complete morphological
examination of ejaculate (minimum 6 per day while the examinations are being performed -
supervised by a mentor). q Cytodiagnostical FNA of male gonads,
processing and staining of slides. Spermatogenesis, Sertoli and Leydigīs cells in a
stained smear as well as observation of changes in functional disturbances of
spermatogenesis and inflammations. Testicle tumors. Usage of educational sets of
preparations. q Practising: on every-day slides and materials
from the archives. q During residency, an applicant should examine
5 aspirated fragments daily, self-controlled and occasionally controlled by the mentor.
The examined material should comprise all the mentioned processes on totally 50 aspirated
fragments. The results of analysed slides to be registered in an enclosed list, which is
to be examined by a mentor within the knowledge tests. Preliminary exam 1. Cytodiagnostics of kidneys and conveying urinary tract q Cytodiagnostical renal FNA (under the CT or
ultrasound control), material processing and cytological smear analysis (normal cell
element and cells present in different pathological conditions). Cytological examination
of spontaneously obtained urine (material processing technique, smear analysis - normal
cell elements and cells present in different pathological conditions). Cytological
examination of other kinds of material in this area (catether urine, washing of urine
bladder, urethra smear, imprint of surgically obtained material). 2. Prostate cytology q Cytodiagnostical prostate FNA (participation
in FNA, material processing), cytological smear analysis (normal cell elements and cells
present in certain pathological conditions). Cytodiagnostics of the prostate secretion
(collecting material and technical processing), cytological smear analysis. q The applicant participates in his/her work,
under the mentorīs supervision, in collecting material, then becomes familiar with
technical processing and analysis smears from the everyday laboratory work. Practising of
urological cytodiagnostics on smears prepared for education, in order to face, during the
specialization period, all the pathologic
processes in that area. Special attention to be paid to urinary cytological analysis and the
prostate aspirate . q During residency,
an applicant has to analyse 750 urinary cytological slides and 200 slides of the prostate and kidney aspirated fragments. Preliminary exam GASTROENTEROLOGIC CYTOLOGY - 2 months q Obtaining material (smear in gastro- and
rectoscopy, washing, aspirated fragment with/without ultrasound control) of different
localizations (oral cavity, oesophagus, stomach, colon, rectum, liver, pancreas and other
localizations occurred by amplification of the primary process) for cytological,
cytochemical and immunocytochemical analyses. q Material processing, fixation, staining
(standard, cytochemical and immunocytochemical). q Smear analysis: of normal gastro-intestinal
tract; Berettīs esophagitis, oesophagus tumors (papillary planocellular, adenocarcinoma), morphological stomach changes in hyperplasia,
intestinal metaplasia, dysplasia, inflammation, stomach ulcus disease, polypous changes,
stomach carcinoma, leomyoma, lymphoma, pseudolymphoma); The morphologic characteristics of
normal liver elements as well as the changes caused by inflammations and chronic
degenerative changes, primary and secondary tumors; normal pancreas cell elements,
morphological changes in inflammatory degenerative
states, benign and malignant tumors of endocrine and exocrine parts; gallbladder tumors;
benign and malignant tumors of large and small intestine). q During residency, an applicant has to perform
at least 500 analyses: 200 analyses of stomach, rectum and colon smears; 300 analyses of
the aspirated fragments of liver, pancreas and other localizations. Preliminary exam CYTOLOGY OF THE HEAD AND NECK - 15 days q Obtaining material (nasal mucus smear,
ear smear, oral cavity and oropharynx smears, laryngeal mucus smear, FNA of salivary
glands and tumorous formations of head and neck with/without ultrasound, imprint of tissue collected for pathohistological
analysis and intraoperative analysis, sinus washings, conjuctive smear). q Material processing (standard staining
- MGG, PAP; cytochemical: PAS, alcal phosphatase, acid phosphatase, Sudan black,
immunocytochemical - PAP, APAAP - on the smears of aspirated fragments and tissue
imprints. q Microscopic analysis, finding
interpretation and formation of final opinion: 1. normal cell elements of smears of nose, buccal cavity,
oropharynx , larynx, and aspirated fragments of salivary gland, 2. nasal mucus diseases
(inflammations - vasomotory and allergic rhinitis, epithelial tumors, mesenchymal tumors -
sarcomas). 3. diseases of oropharynx oral cavity - inflammations, tumors, 4. salivary
gland diseases: acute and chronic inflammations, benign lymphoepithelial lesion, Sjogren
syndrome, tumors - pleomorphal adenoma, cystadenolymphoma, onkocytoma, cylindroma,
adenocarcinoma, anaplastic carcinoma, planocellular carcinoma, metastatic tumors,
melanoma, sarcoma, paraganglioma. q During residency, an applicant has to examine
400 specimens. Preliminary exam LIQUOR CITOLOGY - 1 month q The basis of anatomy, histology and
physiology of the central nervous system (CNS) (hematoliquor
barrier), origin and significance of cells in liquor (in new-borns, nursing age and
grown-ups). Basic clinical knowledge about inflammatory and non-inflammatory processes in
the CNS, techniques of lumbar, suboccipital and ventricular FNA. q Preparation of liquor for cytological
analyses (sedimentation in cytocentrifugation, staining: MGG, Papanicolaou, cytochemical
and imunocytochemical) q The analysis of liquor slides, giving opinion
about differential diagnosis of the process based on cytological test results:
inflammatory processes (serous inflammations, purulent inflammations, hemorrhage
inflammations, problem of chronic CNS inflammations), primary tumors, secondary tumors and
other metastatic processes in the CNS, systematic diseases characteristic for the CNS
(collagenosis, sarcoidosis, Bechet), bleeding in the CNS (subarachnoid, intracerebral,
traumatic), reactive pleocytosis, cytological characteristics, differential diagnosis -
proteins, glucose, chlorides, lactates, immunoglobulin, pigments), basic things about the possibilities of
etiological diagnostics of inflammatory processes (implanting of liquor on different
media, serological methods, rapid tests for etiologic diagnostics). q During residency, an applicant should examine
500 liquor slides (mostly from the area of inflammatory changes). Preliminary exam
q How to approach a child, as well as various
techniques of aspirational needle biopsy or of material obtaining for the exfoliative
cytology adjusted to certain age of a child
(infant, up to two years, pre-schooling age and schooling age). q Material processing (standard, cytochemical,
immunocytochemical). q Normal morphology of the developing organs,
which is distinctive from the adult
morphology. q The analyses of peripheral blood smear as well as the manner of
obtaining material (in particular significant for premature babies); bone- marrow FNA
(sternum, crista posterior, anterior, tibia) and a smear analysis with special review of
the diseases characteristic for that age: histiocytosis X, eosinophilic granuloma, Hand -
Sehuller - Christianoca and Letterer - Siwe disease), tezaurismosis (Gauche, Niemann - Pick disease etc. ) malignant
reticulohistiocytosis, embrional and other tumors characteristic for children
(neroblastoma, Ewiing sarkoma, Wilms tumor, teratoma and teratocarcinoma), parasitosis
(Leishmaniosis and Babeziosis), thyroid gland changes (very frequent are lymphocytic
thyroditis and hypertireosis which differ from their morphologic features in adults),
testis analysis (changes during growth as well as cryptorchic testis), technique of spleen
and liver FNA in children with/without anesthesia, collecting vaginal smear (differing in
various ages of a child) and analysis concerning the late or early puberty as well as
inflammatory changes; modes of preparing urine for analysis of cytomegalic cells plus
staining and examination of urine on metachromatic bodies
(important in leukodystrophy). q During residency, an applicant should perform
200 analyses and 50 various FNA. Preliminary exam CYTOLOGY OF LOCOMOTOR SYSTEM AND SOFT TISSUES - 1 month q Obtaining material for cytological analysis
of locomotoric system changes and its processing. q Analysis of the bone and cartilage tumors:
benign ones (cysts, eosinphilic granuloma, gigantocellular tumor, chondroma, inflammatory
processes and so on) and malignant ones (osteogenic sarcoma, Ewing sarcoma,
chondrosarcoma, metastases etc.) as well as tumors of pertaining soft parts: benign ones
(lipoma, fibroma, myxoma, benign angiomatosis) and malignant ones (fibrosarcoma,
rhabdomyosarcoma, liposarcoma, angiosarcoma, malignant histiocytoma), tumors of neurogenic
origin etc. The method assumed is FNA. The numerous benign bone tumors are not appropriate
for cytological processing, therefore, only elimination of malignant process and biopsy
can be applied. The programme also comprises cytological analysis of articular liquid in
the traumatic and inflammatory processes. q At the same time it is essential to get
familiar with the clinical picture and biologic behaviour of particular tumors. q During residency, an applicant should examine
at least 150 specimens and perform at least 30 FNAs. Preliminary exam
q The application and achievements of electron
microscopy in cytology. q Getting familiar with the preparation and
processing of cytological specimens in electron microscope examination. q The analysis of electronic microscope
screening of certain cell and tissue types that are being
used in cytodiagnostics. Preliminary exam
q The principles and techniques of
immunocytochemistry, cyto- and molecular genetics (hybridization and amplificational
methods of DNA contents analysis) and image analysis. q The principles of flow cytometry operating. Preliminary exam During residency, an applicant is obliged to enrol in 2
semesters of post-graduate studies in clinical cytology and pass the prescribed exams. After completed specialization practice, the resident sits for the specialization exam which can be taken at latest six months after successfully completing the specialization practic e.(Narodne novine 1994 (33),1246-9.) |
