Pediatric Pathology Fellowship Program

About the program

The training program in Pediatric Pathology is designed to educate pathologists in the unique features of disease in the fetus, infant, child and adolescent. The focus of the program is in anatomic pediatric pathology, but rotations through the clinical laboratories are also included in the program.

The Department offers exposure to all aspects of pediatric pathology. Special strengths include tumor pathology, gastrointestinal and liver pathology, fetal pathology, hematopathology and neuropathology.

Although only one year of training is required for Board eligibility, the fellow is encouraged to remain in the program for an optional second year that is tailored to his or her specific interests. Possibilities include full-time research activities, additional training in general pediatric pathology or more intense training in one of several subspecialty areas accompanied by participation in clinical research activities. The first year of training is primarily devoted to clinical work.

Fellows who have completed the training program are currently on staff at Phoenix Children's Hospital, Children's Hospital of Wisconsin and The Children's Hospital of Philadelphia.

Research

If the fellow chooses to remain in the program for a second year, the fellow may become fully involved with experimental research in one of the many laboratories at Children's Hospital or throughout the campus of the University of Pennsylvania. Research in the Department of Pathology and Laboratory Medicine is focused around several themes.

An active area of research is transplantation immunobiology, with programs studying the role of costimulatory molecules in the functions of memory and effector T cells and their role in transplantation. Another program addresses the biochemical basis of T lymphocyte function and differentiation, particularly as it pertains to the cellular mechanisms of immune memory and tolerance.

A new area of research in immunopathology and proteomics will focus on the role of endoplasmic reticulum molecular chaperones in exerting quality control over the biosynthesis of membrane and secreted immunoglobulins.

Molecular pathology

There is a program in molecular pathology which aims to understand how mutated transcription factors cause acute leukemias and how to apply this knowledge to develop new therapies, with a special emphasis on the transcription factor E2A and its function during normal and leukemic B cell development.

There is also an active area of research in developmental neurobiology to elucidate key events in early nervous system development in order to examine the role of specific genes and gene products in patterning the embryonic brain.

Another focus is on the molecular and cellular mechanisms of cell migration in the developing CNS. Research in diabetes is aimed at signaling mechanisms involved in insulin secretion by islets of Langerhans, identifying the mechanisms of beta-cell death in type 1 diabetes and the role of novel cytokines and studying the function of human islets for transplantation.

Program leadership

Fellowship Training Program Director

Eduardo Ruchelli, MD
Department of Pathology and Laboratory Medicine
215-590-1728
ruchelli@email.chop.edu

Pathology

Pierre Russo, MD
Department of Pathology and Laboratory Medicine
215-590-1733
russo@email.chop.edu

Specific information by years and/or rotation

Surgical pathology

While rotating through the surgical pathology service, the fellow is responsible for following each case from point of accession to final sign out. The fellow is expected to reach a conclusion and a diagnosis and to answer all pertinent questions that may arise when a pathological lesion is found. When necessary, the fellow is expected to research difficult cases through reading and computer database searching.

The fellow's responsibilities include the gross examination and trimming of all surgical pediatric specimens, except for small biopsies. The fellow first receives the daily load of microscopic slides and is expected to formulate a preliminary diagnosis after reviewing the pertinent literature. The fellow's diagnosis and description are then reviewed over the microscope with the attending staff pathologist.

The fellow must preview the daily operating room list and become familiar with patients in the hospital. The fellow must be alert for procedures likely to require a frozen section diagnosis.

In those cases in which electron microscopy is performed, the fellow reviews the photographs with the attending pathologist prior to the final sign out. An attending pathologist will be available to answer questions and assist with difficult cases at all times.

The hematopathology rotation integrates a myriad of findings to generate a unified and comprehensive diagnosis. During the rotation, the fellow will be exposed to the numerous components of the hematopathology service. These components include morphology and immunohistochemistry of biopsy sections, bone marrow aspirate smears, peripheral blood smears, cytochemistry, flow cytometry, cytogenetics, molecular diagnosis and clinical history.

Autopsy pathology

While rotating through the autopsy service, the fellow is primarily responsible for handling, sampling and describing tissues and gross findings as well as reviewing the pertinent literature. All autopsies are performed under the supervision of a staff pathologist.

After examining the microscopic slides, the fellow writes a preliminary autopsy report and then reviews the slides and discusses the case with the attending pathologist. Pertinent clinical information and clinical laboratory findings are incorporated into the final report.

The fellow must also supervise residents from the Hospital of the University of Pennsylvania (HUP) when a fetal autopsy from HUP is performed at Children's Hospital. The fellow participates in all brain cutting conferences and reviews surgical specimens with the neuropathologists.

Number of cases

  • Approximately 8,000 pediatric surgical pathology accessions
  • Approximately 400 cytopathology accessions
  • Approximately 400 pediatric operating room consultations
  • Approximately 80 pediatric autopsies
  • Approximately 110 fetal autopsies

Research expectations and opportunities

During the first year, the fellow is expected to participate in clinical research in collaboration with the staff pathologists or interested clinicians. There is more time available for clinical research during the medical pathology rotation, but additional time can also be spent on research during the surgical pathology rotation.

At the beginning of the academic year, the staff pathologists give the fellow a selection of research projects to choose from. It is expected that the fellow become involved in at least one of these projects and submit an abstract to the annual meeting of the Society for Pediatric Pathology, which is held in late winter.

Conference schedules

Weekly

  • Interesting case conference (three times per week)
  • GI pathology conference
  • Tumor Board
  • Cardiac pathology conference
  • Fetal therapy/surgery conference
  • Virology conference
  • Pediatric Grand Rounds
  • Surgical Grand Rounds

Monthly

  • Autopsy conference
  • Surgery-Radiology-Pathology conference
  • Medical mortality conference
  • Neonatal mortality conference
  • Quality assurance conference

Quarterly

  • Regional Pediatric Pathology conference

Ad Hoc

  • Neuropathology conference

The fellow has primary responsibility for the preparation and presentation of cases at the mortality conferences, surgical pathology and interesting case conference. In the mortality conferences, the fellow is responsible for presenting the complete autopsy findings and discussing their clinical implications. In the surgical conference, the fellow prepares photomicrographs and has full responsibility for the presentation to and discussion of cases with members of the Departments of Surgery and Radiology.

In the interesting case conference, the fellow presents cases around the multi-headed microscope and discusses the differential diagnosis. The departmental interesting case conference, held three times a week, is a major teaching resource. All staff, rotating residents and fellows attend, with clinicians sitting in on occasion. The fellow is expected to be familiar with all clinical, laboratory and anatomic aspects of the cases.

As the fellow develops increased experience, he or she may be primarily responsible for the preparation and presentation of cases at the Fetal therapy conference and Tumor Board. When presenting cases, the fellow is responsible for preparing all visual aids, including photomicrographs and slides and reviewing the pertinent literature. Staff pathologists attend the meetings as well. When not presenting, the fellow is expected to actively participate in conference discussions.

How to apply

You may apply by downloading the application (PDF).

Print the application, complete the appropriate fields and mail the application to the address listed at the end of the application form.

Instructions for application

The fellowship seeks physicians who have completed full training in an ACGME accredited residency program in anatomic or anatomic/clinical pathology in order to sit for the American Board of Pathology certifying examination. The following should be sent to Eduardo Ruchelli, MD.

  1. Completed application
  2. Three supporting letters of reference
  3. Parts 1, 2 and 3 of the USMLE taken within the seven year time frame as required by the Commonwealth of Pennsylvania or equivalent scores
  4. If a graduate of a medical school outside the United States, Canada or Puerto Rico, valid ECFMG certificate or one that does not expire prior to the start of the fellowship
  5. If not a citizen of the United States, copy of permanent resident card or copy of current, appropriate visa

Tobacco-free hiring policy

To help preserve and improve the health of our patients, their families and our employees, The Children’s Hospital of Philadelphia has a tobacco-free hiring policy. This policy applies to all candidates for employment (other than those with regularly scheduled hours in New Jersey) for all positions, including those covered by the Collective Bargaining Agreement.

Job applicants who apply after July 1, 2014, will be expected to sign an attestation stating they’ve been free of nicotine or tobacco products in any form for the prior thirty (30) days. They will also undergo a cotinine test as a part of the Occupational Health pre-placement drug screen administered after the offer of employment has been accepted but before the first day of hire.

Exemptions: Attending physicians (excluding CHOP physicians in the Care Network), psychologists, principal investigators and/or Penn-based faculty are exempt from this process to better align with our colleagues at the University of Pennsylvania Perelman School of Medicine.