Surgical Pathology and Autopsy Pathology
Core concepts
Surgical pathology questions test whether you can move from a gross or microscopic finding to a defensible diagnosis and then to the clinical consequence. Anchor your study in: tissue handling and fixation (10% neutral buffered formalin, roughly 1 mm/hour penetration, adequate volume-to-tissue ratio), frozen section indications and limitations, margin assessment (true margin vs. artifactually inked, en face vs. perpendicular), and staging rules per AJCC. Know the morphologic hallmarks of common entities - squamous cell carcinoma vs. adenocarcinoma vs. small cell carcinoma, the desmoplastic response, and the difference between dysplasia and invasive disease (breaching the basement membrane).
Autopsy pathology emphasizes cause vs. mechanism vs. manner of death, the sequence of external and internal examination, and the value of ancillary studies (toxicology, cultures, vitreous chemistry). Know the difference between proximate cause of death and underlying cause, and how clinicopathologic correlation is documented in the final report.
Traps
Questions love borderline scenarios: a frozen section that cannot distinguish in situ from invasive disease (answer: defer to permanent sections); margins reported as "close" without a defined distance; and conflating cause with mechanism ("exsanguination" is a mechanism, not a cause). Watch for questions that assume a stain (e.g., mucicarmine, cytokeratin) confirms lineage when morphology and a panel are needed. Autopsy questions often hinge on whether permission was required or whether a medical examiner case supersedes consent.
Worked rule
For any margin question, apply the rule: state the distance, state the orientation, and state whether the margin is involved at the inked surface. If the tumor is present at ink, the margin is positive; if within a defined threshold (commonly 1–2 mm depending on tumor type), it is close. Do not infer negativity from a clean gross appearance alone.