Johns Hopkins University School of Medicine

Johns Hopkins University

School of Medicine

Course Title

Virtual Surgical Pathology

Course/Session Director: Marissa White MD [email protected]

Office: 410-614-3964

Cell: 410- 952-9038

Course Coordinator: Nancy Nath [email protected]

Surgical pathology faculty:

Liz Thompson MD PhD [email protected] (small group leader)

Marc Halushka MD PhD [email protected]

Kevan Salimian MD PhD [email protected]

Christopher VandenBussche MD PhD [email protected]

Ashley Cimino-Mathews MD [email protected]

Examination Schedule: Last day of the rotation

Course Description: Online surgical pathology student rotation for medical students who have

completed the pre-clinical curriculum. This case-based rotation is designed to simulate a surgical

pathology resident experience, and will include remote previewing and sign-out of scanned cases

multiple times per week with surgical pathology faculty and/or senior residents. Assigned

reading will guide independent or group case previewing. Rotators will also be expected to

attend surgical pathology meetings hosted on Zoom including pathology grand rounds, daily QA

conferences, and resident lectures. Rotators will be evaluated at the end of the rotation in the

form of a brief 10-minute presentation on a pathology topic of their choice and a short

assessment.

Course Learning Objectives:

At the end of the course students will:

- Summarize the role of a general surgical pathologist as a member of the

multidisciplinary care team

- List the defining histologic features of several common pathologic entities

- Demonstrate how to determine the pathologic stage for an oncologic resection

- Describe how to approach assessing biopsy specimens

mailto:[email protected]



2020-2021 Syllabus Guidelines for Virtual Surgical Pathology Clinical Elective Page 2 of 12

Required Text and Other Materials

- Robbins and Cotran Pathologic Basis of Disease 9th edition (Available for free through

Welch Library and at https://www.clinicalkey.com/#!/browse/book/3-s2.0-

C20110055734) - The Practice of Surgical Pathology: A Beginner's Guide to the Diagnostic Process. Molavi

***Later referred to as the Molavi book *** (Available for free through Welch Library or if

on VPN https://link.springer.com/book/10.1007%2F978-0-387-74486-5) - Histology for Pathologists, 5th ed (available for free through the Welch library)

- Quick Reference Handbook for Surgical Pathologists (available for free through the

Welch library)

- College of American Pathologists Cancer Staging Templates:

https://www.cap.org/protocols-and-guidelines/cancer-reporting-tools/cancer-protocol-

templates

Additional resources:

- Basic histology:

Wheater’s Functional Histology

Junquiera’s Basic Histology Text & Atlas (available for free on AccessMedicine:

https://accessmedicine.mhmedical.com/book.aspx?bookID=2430)

- Grossing:

Manual of Surgical Pathology (available for free through the Welch library)

Assignments

1. Virtually attend all resident lectures which begin at or after 10AM (tentatively Monday-

Friday) and view all recorded resident lectures.

a. Final schedule will be sent via e-mail and available on the shared Google

calendar.

b. **Please use a ‘Meeting username’ for attendance purposes (e.g., first initial and

last name)

Meeting ID: 760 060 388

https://jhjhm.zoom.us/j/760060388

If you are calling in from a phone, dial 646-558 8656.

Feel free to call/text chief resident (703-321-6168) if you have any issues.

2. Assigned case previewing for small group “sign-out”:

a. While previewing, students should prepare to discuss the answers to the following

questions:

- What tissue type(s) do you see?

- What appears abnormal, and why?

- Does the abnormality appear non-neoplastic (i.e. inflammatory response,

ectopic tissue, iatrogenic, developmental abnormality, etc.) or

neoplastic, and describe the histologic findings which helped you arrive

at that conclusion.

- If you feel the abnormality represents a neoplasm, attempt to determine

the cell type of origin and if you feel it is benign or malignant.

https://www.clinicalkey.com/#!/browse/book/3-s2.0-C20110055734


https://link.springer.com/book/10.1007%2F978-0-387-74486-5

https://www.cap.org/protocols-and-guidelines/cancer-reporting-tools/cancer-protocol-templates

https://www.cap.org/protocols-and-guidelines/cancer-reporting-tools/cancer-protocol-templates

https://accessmedicine.mhmedical.com/book.aspx?bookID=2430



- Differential diagnosis

b. Render formal final diagnosis for each previewed case, including a grade and/or

pathologic tumor stage and resection margin status if applicable. For weeks 2 and

3, final diagnoses should be e-mailed to your small group leader (either Marissa

White - [email protected] or Liz Thompson – [email protected]) at least 1

hour prior to the start of sign-out. (This is for your educational purposes only and

will not be graded, have fun and do your best!)

- Tumor grading resources: Chapter 5 “Grading (and classification

systems),” Quick Reference Handbook for Surgical Pathologists

- College of American Pathologists Cancer Staging Templates:

https://www.cap.org/protocols-and-guidelines/cancer-reporting-

tools/cancer-protocol-templates

3. e-Lectures

a. Review of neoplasia histology

b. Careers in pathology

c. Review of cancer grading and staging

d. How to evaluate a surgical resection specimen

4. Additional suggested activities:

a. Head and neck tumor board – Thursdays at 7am (e-mail Marissa White if you

would like to attend)

b. Pathology subspecialty sign-outs and/or QA conferences – variable dates and

times (e-mail Marissa White if you have an interest in attending one of the below

subspecialty sign-puts and/or QA conferences)

- Neuropathology consults

- Cytopathology

- Gynecologic pathology

- Cytopathology

- GI mucosal pathology

- Hematopathology

- General surgical pathology consults

- Breast pathology consults

5. Brief 10-minute group presentation on any surgical pathology topic to be given on the

last day of the rotation on Zoom with screensharing

6. Surgical pathology unknown cases and questions during down-time

http://apps.pathology.jhu.edu/sp/

Required Attendance - Small group “sign-outs”

- Large group slide review sessions

- Pathology resident Zoom lectures beginning at or after 10AM

- Viewing of all recorded resident lectures

- Daily surgical pathology Zoom consensus conference: Monday – Friday, 1pm

- End-of-rotation group presentations – Last day of the rotation

Evaluation and Grading




A. Formative: How will students know how they are doing in the course?

1. Students will e-mail “final diagnoses” for cases previewed in weeks 2 and 3 to

Marissa White ([email protected]), at least 1 hour prior to the start of sign-out.

Students will receive formative feedback on their diagnoses through active

participation during “sign-out”

B. Summative: Indicate the basis for computing course grades and the relative weight of

each assignment, exam, etc.

Attendance to required lectures/conferences, e-mailing final diagnoses in weeks 2 and 3,

and active participation in “sign-out” (80%)

Completion of end of rotation presentation (15%)

Assessment (10 questions) (5%)

Grading Scale (grading scale is determined by the School of Medicine.)

P = Student has an average equal to or exceeding 70% and has met all required

assignments for the class.

U = Student completion of some examinations or assignments is below passing level.

These examinations or assignments must be remediated in order to convert to P.

I = Student has a passing average for the course, but has missed required events, because

of illness or emergency. Student should meet with course director to plan remediation.

F = Student has failed significant required elements of the course, or has an average score

below the passing level for the course. Student should meet with the course director to plan

remediation.

Expectation and Attendance

Participation in lectures, discussions, and other activities is an essential part of the instructional

process. Students are expected to participate regularly. Attendance at virtual sign out, resident

lectures, daily surgical pathology QA conference, pathology grand rounds, and end-of-rotation

presentations is required. Students must adhere to the school’s attendance policy regarding

absences and alerting the appropriate people about missed days.

If you need to miss classes, you are to notify the following individuals of the absence, as far as

advance as possible:

1) Marissa White [email protected] (Course Director)

2) Nancy Nath [email protected]

The JHUSOM policy on student attendance in the curriculum is posted on Blackboard. The

policy is also available at https://hpo.johnshopkins.edu/som/?event=manual&manualid=886.



Weather and Other Emergencies

The School of Medicine follows Johns Hopkins University policy regarding closure due to

weather emergencies. Weather emergencies are available at the phone numbers and website

below, as well as on radio and TV broadcasts

http://www.insidehopkinsmedicine.org/weather.pdf:

Baltimore 410-516-7781

Outside Baltimore 800-548-9004

URL: http://webapps.jhu.edu/emergencynotices

Examinations: 10 question assessment, to be taken on the last day of the rotation on Blackboard.

Classroom Accommodations for Students with Disabilities

If you are a student with a documented disability who requires an academic adjustment, auxiliary

aid or other similar accommodations, please contact the Office of Student Affairs at 410-955-

3416. If you have a documented disability that may impact your work in this class, please work

to get it documents so that we can get proper accommodation.

Statement of Diversity and Inclusion Johns Hopkins University is a community committed to sharing values of diversity and inclusion

in order to achieve and sustain excellence. We believe excellence is best promoted by being a

diverse group of students, faculty, and staff who are committed to creating a climate of mutual

respect that is supportive of one another’s success.

Teacher Learner Conduct Policy The Johns Hopkins University School of Medicine is committed to fostering an environment that

promotes academic and professional success in learners and teachers at all levels. The

achievement of such success is dependent on an environment free of behaviors which can

undermine the important missions of our institution. An atmosphere of mutual respect,

collegiality, fairness, and trust is essential. Students should review the JHUSOM Guidelines for

Conduct in Teacher/Learner Relationships, located on Blackboard.

Student Honor Code Students are reminded of the honor code developed by the medical student body, introduced in

September 1991, is as follows:

As a student at The Johns Hopkins School of Medicine, I pledge:

-To do my own work and be honest in my interactions with peers, faculty, and staff. This applies

to my work on examinations, assignments, and papers as well as work in the laboratory.

-To uphold the high standard of conduct in patient care which has always been maintained by the

Johns Hopkins medical community.

-To base my interactions with other students on mutual respect and cooperation.

http://www.insidehopkinsmedicine.org/weather.pdf

http://webapps.jhu.edu/emergencynotices


-To act on infractions of the honor code and to maintain the confidentiality of all parties

involved.

-To encourage my peers to uphold this honor code.

It is the expectation that Hopkins students live by this code.

Course Evaluation

Please remember to complete the course evaluation for this course. Evaluations will be required

from a rotating sample of 25% of the class. Other students will always have the option of

submitting an evaluation if they choose. This will reduce the overall burden of surveys for

students. There will be no extra credit for completing the evaluation. If you are in the designated

25%, you will receive an incomplete if the course evaluation is not completed by the time grades

are posted for the course. These evaluations are an important tool in the School of Medicine’s

ongoing efforts to improve instructional quality and strengthen its programs. The results of the

course evaluations are kept anonymous—your instructor will only receive aggregated data and

comments for the entire class.

Bibliography

Required:

1. The Practice of Surgical Pathology: A Beginner's Guide to the Diagnostic Process.

Molavi Available for free at https://link.springer.com/book/10.1007%2F978-0-387-

74486-5#authorsandaffiliationsbook)

2. Histology for Pathologists, 5th ed (available for free through the Welch library)

3. Robbins and Cotran Pathologic Basis of Disease 9th edition (Available online at through

Welch Library and at https://www.clinicalkey.com/#!/browse/book/3-s2.0-

C20110055734) 4. Quick Reference Handbook for Surgical Pathologists (available for free through the

Welch library)

5. College of American Pathologists Cancer Staging Templates:

https://www.cap.org/protocols-and-guidelines/cancer-reporting-tools/cancer-protocol-

templates

Suggested:

Wheater’s Functional Histology: A Text and Colour Atlas, 6th Edition

Junquiera’s Basic Histology Text & Atlas (available for free on AccessMedicine)

Manual of Surgical Pathology (available for free through the Welch library)

https://link.springer.com/book/10.1007%2F978-0-387-74486-5#authorsandaffiliationsbook

https://link.springer.com/book/10.1007%2F978-0-387-74486-5#authorsandaffiliationsbook




Course Outline

Virtual Surgical Pathology

In order to have a productive and engaging small group sign-out, the following are expectations

for independent/group case previewing:

1. Prepare to discuss the answers to the following questions:

a. What tissue type(s) do you see?

b. What appears abnormal, and why?

c. Does the abnormality appear non-neoplastic (i.e. inflammatory response,

ectopic tissue, iatrogenic, developmental abnormality, etc.) or neoplastic, and

describe the histologic findings which helped you arrive at that conclusion.

d. If you feel the abnormality represents a neoplasm, attempt to determine the

cell type of origin and if you feel it is benign or malignant.

e. Differential diagnosis

2. Render formal final diagnosis for each previewed case, including a grade and/or

pathologic tumor stage and resection margin status if applicable. For weeks 2 and 3,

final diagnoses should be e-mailed to your small group leader (either Marissa White -

[email protected] or Liz Thompson – [email protected] ) at least 1 hour prior

to the start of sign-out. (This is for your educational purposes only and will not be

graded, have fun and do your best!)

a. Tumor grading resources: Chapter 5 “Grading (and classification systems),”

Quick Reference Handbook for Surgical Pathologists

b. College of American Pathologists Cancer Staging Templates:

https://www.cap.org/protocols-and-guidelines/cancer-reporting-tools/cancer-

protocol-templates

WEEK 1

- Virtually attend resident lectures which begin at or after 10AM and view all recorded

resident lectures.

Meeting ID: 760 060 388




- Virtually attend daily SP QA conference

- Surgical pathology unknown cases and questions during down-time


- Monday:

1. Review SFM foundation of histology materials on mScope and Inversus

SFM Blood cells and stains – 5 Different stains

Muscle, connective tissue, bone, and cartilage

Epithelium 1

Epithelium 2






2. Rotation orientation: 1:45pm – Small group faculty leaders

- Tuesday:

1. Basic histology slide review session: 2pm – Dr. Ashley Cimino-Mathews (Zoom

invitation will be posted on Blackboard)

2. View “Review of neoplasia histology” e-Lecture

3. Read Molavi Chapters 1-3 “Using the Microscope/ Descriptive terms in Anatomic

Pathology / Infection and Inflammation”

- Wednesday:

1. Perform the following on-line learning modules available at

http://pathology.jhu.edu/campus/training-resources-residents.cfm (must be on the VPN or

virtual desktop)

“Introduction to Pathology of the Colon”

“Introduction to Pathology of the Esophagus”

“Introduction to Pathology of the Small Bowel”

“Introduction to Pathology of the Stomach”

- Thursday:

1. Introduction to Cytopathology session: 2:30pm – Dr. Chris VandenBussche

(Zoom invitation will be posted on Blackboard)

2. Preview GI biopsies 1, 2, and 3

GI_biopsy_1:

https://digital.pathology.johnshopkins.edu/repos/2551?slide=78945

GI_biopsy_2:


GI_biopsy_3: https://digital.pathology.johnshopkins.edu/repos/2551?slide=78942

- Friday:

1. GI biopsy slide review session: 2 pm – Dr. Kevan Salimian (Zoom invitation will

be posted on Blackboard)

2. Reading:

Molavi Chapters 19 “Breast,” and 25 “Salivary gland”

Histology for Pathologists chapter 18 “Thymus”

3. View “Review of cancer grading and staging” e-Lecture

WEEK 2


resident lectures.

Meeting ID: 760 060 388





http://pathology.jhu.edu/campus/training-resources-residents.cfm








- Monday:

1. View “How to evaluate a surgical resection specimen” e-Lecture

Additional tumor grading resources: Chapter 5 “Grading (and classification

systems),” Quick Reference Handbook for Surgical Pathologists

College of American Pathologists Cancer Staging Templates:

https://www.cap.org/protocols-and-guidelines/cancer-reporting-tools/cancer-

protocol-templates

2. Read Molavi chapter 28 “Soft tissue and bone”

3. Watch 3 gross dissection videos:

Thyroid Dissection

https://www.youtube.com/watch?time_continue=1&v=K7N86p2IYoc&feature=e

mb_lo

Gallbladder Dissection

https://www.youtube.com/watch?v=V1D8kj0adec&feature=emb_logo

Ascending Aorta

https://www.youtube.com/watch?v=yNo6I0-fSK4&feature=youtu.be

- Tuesday:

1. Preview four cases

1. 7610 https://digital.pathology.johnshopkins.edu/repos/451?slide=70431

35-year-old female, bowel resection for bowel obstruction, past surgical history of

c-section


60-year-old female, bilateral orchiectomy


30-year-old female, total thyroidectomy for hyperthyroidism


65-year-old male, soft tissue mass excision, history of a ventral hernia repair

- Wednesday:

1. Small group case sign-out with attending via Zoom

2. Start to prepare end-of-rotation group presentations

3. Read Molavi chapters 22 “Lung” and 11 “Prostate”

- Thursday: Preview five cases

1. Scanned slide https://digital.pathology.johnshopkins.edu/repos/2551?slide=78273

30-year-old male, superficial parotidectomy for a parotid mass


70-year-old female, lumpectomy for a palpable 2 cm breast mass


50-year-old male, local excision for a cheek mass



https://www.youtube.com/watch?time_continue=1&v=K7N86p2IYoc&feature=emb_lo

https://www.youtube.com/watch?time_continue=1&v=K7N86p2IYoc&feature=emb_lo

https://www.youtube.com/watch?v=V1D8kj0adec&feature=emb_logo

https://www.youtube.com/watch?v=yNo6I0-fSK4&feature=youtu.be










45-year-old female, breast biopsy for a 1cm hypoechoic mass detected on 1st

routine screening mammogram


80-year-old male, brain biopsy, recent history of intracranial hemorrhage

- Friday 1. Small group case sign-out with attending via Zoom.

2. Preview five cases:


75-year-old female, lobectomy for multiple lung lesions, history of

smoking


80-year-old male, lung wedge resection, history of bladder cancer status

post radical cystoprostatectomy and smoking


50-year-old female, lung wedge resection, new diagnosis of a

retroperitoneal mass detected on imaging and bilateral pulmonary nodules.

One pulmonary lesion is more amendable to excision and is excised first


30-year-old male, superficial soft-tissue mass excision, history of multiple

superficial soft-tissue masses


50-year-old male, resection of a soft tissue mass anterior to the

sternocleidomastoid muscle

WEEK 3


resident lectures.

Meeting ID: 760 060 388







- Monday:

1. Small group case sign-out with attending via Zoom

2. View “Careers in pathology” e-Lecture

3. Continue to work on end-of-rotation group presentations

- Tuesday: Preview three complete, multi-slide cases

1. Prostate needle core biopsies (7 scanned slides): 60-year-old male prostate needle

core biopsies, elevated PSA and family history of breast and pancreatic cancer

Prostate #1_1: https://digital.pathology.johnshopkins.edu/repos/2551?slide=78254


















2. Skin lesion resection (3 scanned slides): 80-year-old female, resection of a 1cm

lower extremity lesion

Skin #1_1 Lateral (blue ink), medial (green ink), and deep (black ink)

resection margins (perpendicular tissue sections to resection margins):


Skin #1_2 Lesion to deep resection margin (black ink):


Skin #1_3 Additional deep resection margin (perpendicular tissue sections

to resection margin):


3. Assign a pathologic stage to a cancer resection (5 scanned slides): 70-year-old

patient, distal pancreatectomy for 5 cm pancreatic mass with splenectomy and

partial hepatectomy

Pancreas tumor #2_1 Spleen:


Pancreas tumor #2_2 Liver:


Pancreas tumor #2_3 Four Peripancreatic lymph nodes:


Pancreas tumor #2_4 Pancreatic resection margin (resection margin

sampled en face):


Pancreas tumor #2_5 Representative section of 5 cm pancreatic tumor:


- Wednesday: 1. Small group case sign-out with attending via Zoom

2. Finalize end-of-rotation group presentations

3. Preview cardiovascular pathology cases (slide links and clinical histories will be

posted on Blackboard)

- Thursday:

1. Cardiovascular pathology slide review session: 2 pm – Dr. Marc Halushka (Zoom

invitation will be posted on Blackboard)

2. Finalize end-of-rotation group presentations

- Friday:

1. 10-minute end-of-rotation group presentations via Zoom with screensharing: 2pm

2. End of rotation assessment (Blackboard)















Website Links

e-Lectures: http://somlv.med.jhmi.edu/

mSCOPE tutorial: http://oacapps.med.jhmi.edu/bb/tutorials/mscope_tutorial.mp4

- Login: first_year

- Password: jhmi

JHH Digital slide set: https://digital.pathology.johnshopkins.edu - Login: personal JHED

Grossing Videos and Gastrointestinal Disease Tutorials (must be on VPN or virtual

desktop): http://pathology.jhu.edu/campus/training-resources-residents.cfm

Surgical pathology unknown cases and questions: http://apps.pathology.jhu.edu/sp/

You must be on campus or virtually on campus (VPN) to have access to mSCOPE and the

gastrointestinal pathology learning modules. You must use the FULL Pulse SecureVPN program

and not the web client. Inversus and JHH Digital pathology sites are accessible using your

JHED ID as a login.

http://somlv.med.jhmi.edu/

http://oacapps.med.jhmi.edu/bb/tutorials/mscope_tutorial.mp4

https://digital.pathology.johnshopkins.edu/

http://pathology.jhu.edu/campus/training-resources-residents.cfm


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