Dr Aruna Chakarabarty, Neuropathologist
Can you tell us what neuropathology is?
Neuropathology is the study of diseases of the central and peripheral nervous system. Although it is a sub-specialty of histopathology, it requires knowledge of the various neurological sciences and close interaction with clinical neuroscience colleagues. A neuropathologist has many aspects in their work – diagnostic neuropathology, autopsy neuropathology, academic or experimental neuropathology and sometimes forensic neuropathology.
What kind of work does your job involve?
I am one of two neuropathologists in the department and my colleague and I arrange our rota so that we spend one month doing surgical work (providing a diagnosis while the patient is undergoing surgery, tumour biopsies, other surgical biopsies and multidisciplinary team meetings) and the next on autopsies, muscle and peripheral nerve biopsies (and multidisciplinary meetings).
We provide a regional neuropathology service to the whole of West Yorkshire. The neurosurgical service (adults, paediatric and teenage and young adults) for the region is based in Leeds with a large team of neurosurgeons, neuro-radiologists, neurologists and all other allied clinical services. The neurosurgical tumour service is one of the busiest services in the country with about twelve neurosurgeons, so we receive requests from a large number of hospitals in the region. For nearly every tumour case operated, the neurosurgeon requests an opinion during surgery which keeps us busy through the day often until late. This is also one of the very challenging (and enjoyable) aspects of the job.
We work very closely with our neurosurgical and neuro-radiology colleagues. Our job is to correlate what we see down the microscope with what our colleagues have seen to come to a final diagnosis. To reach a diagnosis and provide further clues as to the prognosis of the tumour we routinely look for specific gene mutations in all the tumour specimens. This helps the oncologist to tailor the management accordingly and provide information to the patient with regards to the tumour behaviour and prognosis. Every week we meet formally with our clinical colleagues (surgeons, physicians, radiologists, oncologists) and colleagues from allied specialties (nurses, physiotherapists, occupational therapist, speech therapists, social workers) to discuss each tumour case and plan further management.
Any death which may have potentially been due to a neurological condition is referred to us for investigation. We do full autopsies for the coroner and the local hospital, and are asked to look at brains referred from any hospital in the region. We examine up to 100 brains a year, a large number of these are from people with epilepsy who have died suddenly or from an elderly person found collapsed at home. Autopsy on these cases requires a full and thorough examination of the body, toxicological analysis and detailed examination of the brain and other organs. All the results are gathered together and a final report is issued.
Why did you choose this specialty?
In my early days as a postgraduate student in India studying pathology I was exposed to one of our internationally renowned professor in neuropathology who would conduct the most interesting and entertaining weekly training sessions in brain anatomy and pathology. My interest was kindled then, but at that time there was no structured training in neuropathology available. Following my move to the UK, I completed my training in general histopathology and took the opportunity to sub-specialise in neuropathology.
What do you enjoy most about your chosen specialty?
It is a small specialty; there are only about 70 neuropathologists in the UK so everyone knows everyone. If I have a difficult case I know who to send for an expert opinion. We have annual scientific meetings which are excellent opportunities to exchange knowledge and ideas, and to connect with colleagues on a scientific and social level. We work very closely with our clinical colleagues, discussing cases, planning management, and therefore not chained to our chairs and microscope all day. The brain and its diseases are still a long way from being completely understood, so there is a lot of scope for research into the many different aspects of this science.
What do you find most rewarding about the role?
I feel most rewarded to see the look of understanding and calm in the faces of family after they have heard the explanation of the cause of death from us. In many ways it gives them a sense of closure and they are better able to move on from that point. I have had family members who after the inquest have come up to me and thanked me for explaining the cause of death to them. Knowing that my job makes a difference is extremely rewarding.
What advice would you give to students looking to enter your field?
After medical school and foundation years, you need a good broad-based pathology or clinical neuroscience training to begin with. Knowledge of both is very useful. Once you make it known that you are interested in neuropathology, your local neuropathologist will fall over themselves to help you. We are all keen to get more people interested in what is a superbly rewarding and scientifically exciting job.