Histopathology: A Whistle-Stop Tour of GOSH Pathology
Histopathology is the study of changes in tissue, which can have immunological, metabolic, oncological, or infection-based causes. We deal with a pediatric population – from fetal to about 16 years of age – and there are nuances to the pathology of those patients that you wouldn’t necessarily see in an adult. To give you an example – consider the development of a kidney. A fetus may have a kidney, but because it has not completely finished its growth phase, there will be differences in its appearance to that of an adult kidney. To the average pathologist, it might look unusual or even pathological – but actually, for patients at that stage of development, it is the norm. Another classic example is the thymus; in a fetus or newborn, there’s a prominent thymus to permit T cell maturation – but in adults, the thymus is atrophied or even completely absent, because it’s no longer required. If you have a specialty service, you need specialty support. And there are a number of subtleties that our pathologists need to be aware of to best serve a specialty population like ours.
The histopathology department here at GOSH has records going back to post-mortems in the 1850s and archived material dating from about 1900. It’s all FFPE (Formalin-Fixed Paraffin-Embedded), which means it’s stable and safe indefinitely at room temperature. Recently, we went back to the archival material, cut fixed sections, removed the wax, and put it through mass spectrometry to see what proteins were present – and what anomalies existed in them (1).
Because our tissue archive is so huge, we can look back and see how disease has changed through time. So if you look through our records in 1900, a large number of children were affected by infectious diseases, such as tuberculosis – and, with the advent of antibiotics, we see a huge reduction in the number of children affected by infectious disease. And as children then began to live longer, cancer and chronic illnesses became more prominent.
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