Histopathology is the most challenging and stimulating discipline which you can pursue in your postgraduate career! Essentially you will be working at the hospital's epicentre, acting as a consultant in your own right but also providing expert advice to most of the other clinical departments in the hospital.

Histopathology is the branch of pathology which deals with the tissue diagnosis of disease. A tissue diagnosis can be made on the basis of biopsy material taken from the patient on the ward or in the operating theatre, or from autopsy material. The latter is a small but important component of the work, establishing the cause in cases of sudden or unexpected death, monitoring disease progression or the response to treatment, and in criminal cases (forensic pathology - a separate specialty in which you have to undergo a different training programme) helping police in their investigations. The former is by far the larger component of a histopathologist's workload. In any patient subjected to biopsy the final diagnosis is made by the histopathologist and this in most cases determines the clinical management.

Histopathologists need a broad-based knowledge and understanding of the pathological and clinical aspects of disease. With the help of the interventional radiologist and sophisticated imaging techniques, biopsy tissue can now be obtained from previously inaccessible sites such as the pancreas or retroperitoneum. This may involve direct contact with the patient, with the pathologist undertaking fine needle aspiration to obtain material for cytological examination for a woman with a lump in her breast or a man with an enlarged prostate. Special staining techniques allow you to examine the specimen immediately and in 90% of cases the diagnosis can be made before the patient leaves the clinic.

In addition to light microscopic examination of tissues the histopathologist may also use

• sophisticated immunohistochemical techniques to demonstrate antigens which are specific to a certain tissue - thus you can establish where a metastatic tumour in the liver has come from;
• electron microscopy to identify sub-cellular changes which indicate the disease process;
• molecular biological techniques to identify cytogenetic and molecular genetic abnormalities which may be a feature of certain inherited disorders and of certain tumours.

And I could go on!

You will be involved with patients of all ages. You will interact with surgeons, gynaecologists, neurologists, nephrologists and many others. You will be involved in regular clinicopathological meetings discussing diagnosis, clinical management and clinical outcome. You can develop a sub-specialty interest and become an expert in neuropathology, hepatopathology, respiratory pathology etc. Is it little wonder therefore, that I have made the claim that histopathology is an intellectually satisfying discipline: it is an exciting discipline in which to become involved: you will never regret choosing it as your postgraduate career.

For further information on training programmes, please contact the Training & Educational Standards Department on 020 7451 6741 or email education@rcpath.org

Professor Roddy MacSween

Further information:
A working life: histopathologist Dr Mary Sheppard
The College Specialty Advisory Committee on Histopathology