Department of Anatomic Pathology

Breast Pathology offers rapid, accurate morphological diagnosis of breast lesions from needle core biopsies, lumpectomies and mastectomy specimens.

To complement the traditional histologic diagnosis of breast cancer, our pathologists also provide interpretation of special studies, such as immunohistochemistry testing for estrogen/progesterone receptors and molecular testing, including Her2 FISH. Research interests include the application of biomarkers to determine new means of predicting prognosis and therapeutic response.

Our breast pathologists are presenters at national continuing medical education courses in breast pathology and participate in leading professional organizations in the field.

Cardiovascular Pathology has more than 30 years of experience in conjunction with Cleveland Clinic’s world-renowned cardiology and cardiovascular surgery programs. The cardiovascular pathologists offer expertise in pediatric and adult cardiovascular pathology, including cardiomyopathies; cardiac allograft vasculopathy; and acquired and congenital aortic and valvular diseases.

A full range of cardiovascular pathology services is available, including evaluation of congenital cardiovascular malformations, heart valve pathology, vascular pathology, and acquired heart disease; diagnosis of cardiomyopathies; diagnosis of primary cardiac disease by light, immunofluorescence and transmission electron microscopy; heart transplant surveillance for cellular and antibody-mediated rejection; and evaluation of the cardiac conduction system evaluation and implantable cardiovascular devices.

Special interests include genomic profiling of the failing human heart; assessment of arrhythmogenic right ventricular dysplasia, and issues related to cardiac transplantation and developmental cardiac pathology. Pathologists on the service are editorial board members and ad hoc reviewers for major cardiology and pathology journals, participate in numerous collaborative research projects in the field and are involved in leading international and national professional organizations.

Cleveland Clinic's Cytopathology laboratory evaluates a large volume of gynecologic (75,000) and non-gynecologic (10,000) specimens in a wide breadth of disease categories.

Cytopathologists on the Fine Needle Aspiration (FNA) service aspirate and evaluate superficial lesions to provide rapid assessment and diagnosis for improved patient management. The laboratory also provides rapid assessment for clinicians performing FNA of deep-seated lesions to ensure that an adequate sample is available for diagnosis and ancillary testing if needed.

The staff includes 10 cytotechnologists and 5 board-certified cytopathologists with expertise in glandular gynecologic lesions, ThinPrep® gynecologic cytology, breast and respiratory cytology, among others. Many of the staff are nationally recognized for their expertise and are actively involved in teaching and research in cytology.

In addition to providing outstanding cytomorphologic diagnoses in a timely fashion, the laboratory has distinguished itself by implementing cutting edge technology and molecular cytology methods. A few examples are listed below:

• Computer-assisted pap smear screening with the Cytyc ThinPrep® Imaging System. The goal of the laboratory is to provide rapid, consistent, and accurate pap smear diagnoses to provide better patient care and allow for appropriate ancillary testing when needed.
• Implementation of UroVysion™ FISH testing as an adjunct test to the traditional cytologic interpretation. This technique provides valuable information for the management of bladder cancer patients undergoing surveillance for recurrence.
• Reflex HPV testing for patients with atypical diagnoses on pap smear. This testing allows more accurate triage of patients for further clinical evaluation and biopsy.
• State of the art lymph node FNA diagnosis utilizing cytomorphologic, flow cytometric, and molecular techniques.

• The Laboratory offers an accredited fellowship in Cytopathology.

The Section of Dermatopathology specializes in the pathological interpretation of diseases of the skin as they present in patient tissue specimens. Section faculty have received subspecialty training and certification in Dermatopathology.

The breadth of activity encompasses inflammatory and other non-neoplastic skin disease, pigmented lesions, and neoplasms, with special expertise in melanocytic neoplasms. In addition to routine methods, adjunctive techniques including immunohistochemistry, immunofluorescence, molecular techniques, and electron microscopy are employed when necessary.

Section faculty participate in interdisciplinary conferences with multiple departments including Dermatology and Plastic Surgery and also communicate closely with other medical and surgical services that submit dermatologic specimens.

The Section supports training in dermatopathology for clinical Dermatology and Pathology residents. In addition, the Section offers an approved fellowship in Dermatopathology.

Section faculty participate in collaborative research efforts with Dermatology, Plastic Surgery, Medicine, and Taussig Cancer Center. The Section has special interests in pigmented lesions, tumors, inflammatory diseases and hair disorders.

Gastrointestinal Pathology Consultative Group

Specializing in gastrointestinal, hepatic, and pancreaticobiliary pathology. The gastrointestinal pathology consultative service of Cleveland Clinic's Reference Laboratory offers a complete gastrointestinal disease management program, including diagnosis, therapeutic monitoring, and disease tracking for neoplastic and non-neoplastic digestive diseases.

Experience and Expertise

Our faculty members are subspecialty trained in gastrointestinal, hepatic, and pancreaticobiliary pathology with years of subspecialty practice in a challenging multidisciplinary academic environment. Their interests cover the range of diseases, including Barrett’s esophagus; inflammatory bowel disease; cancer and precancerous conditions; mesenchymal lesions; hepatic and pancreatic diseases; and transplantation pathology.

This service attracts consultations from across the United States and internationally, provides expert diagnosis and second opinions on more than 4,000 cases annually, including the most rare and complex pathology in this field. We also provide pathologic interpretations for numerous large NIH and industry-funded gastrointestinal research trials each year and process more than 40,000 gastrointestinal, hepatic, and pancreaticobiliary cases annually in our clinical practice at Cleveland Clinic.

Recognized for Excellence

U.S. News & World Report has named Cleveland Clinic's Department of Gastroenterology among the top three departments in the country every year since 1998. The expertise of our gastrointestinal pathologists, who work closely with the clinicians in diagnosis and treatment planning, plays a significant role in this accomplishment. Our work in pathology is greatly enhanced by our access to the renowned clinical expertise at Cleveland Clinic.

National and International Reputation

Cleveland Clinic gastrointestinal pathologists have attained leadership positions in the premier professional organizations in the field, are welcomed as distinguished guest lecturers and speakers at respected conferences around the world, and publish extensively in leading medical journals.

Specialized Capabilities

In addition to conventional techniques for evaluation of gastrointestinal, hepatic, and pancreaticobiliary specimens, our laboratory offers an extensive in house immunohistochemical test menu and molecular pathology testing, allowing for accurate diagnoses and prognosis of gastrointestinal neoplasia.

Our Service Commitment

Cleveland Clinic's Reference Laboratory is committed to meeting the needs of referring physicians by providing expert diagnosis with rapid turnaround. Most diagnostic reports and detailed consultative reports are provided by fax within two to three days from the time that specimens are received. More complex cases or those that require additional testing may require additional days to complete.

Telephone consultation with a Cleveland Clinic gastrointestinal pathologist is available on all cases.
To arrange a consult, call Client Services locally at 216.444.5755 or toll-free 800.628.6816.

Genitourinary Pathology offers a complete genitourinary and adrenal disease management program, including diagnosis of biopsy and resection specimens, evaluation for histological and molecular prognostic markers, and therapeutic response monitoring.

Our dedicated faculty members are among the most experienced in the country in genitourinary and adrenal pathology. Their interests and diagnostic capabilities cover the spectrum of diseases of the prostate, testis, bladder, ureter, kidney and adrenal gland.

Gynecologic Pathology provides interpretation and analysis of the full spectrum of gynecological pathology, including surgical oncology. Frozen sections, biopsy and surgical resection specimens are received daily. Special interests among the gynecologic pathologists include breast cancer metastatic to the cervix, ovarian tumors, prediction of chemosensitivity of ovarian carcinoma, protein expression in vulvar intraepithelial neoplasia, and applications of micro-array analysis.

Our gynecologic pathologists are involved in numerous clinical and basic research studies related to the diagnosis and management of gynecologic malignancies.

Head and Neck Pathology analyzes a high volume of surgical and biopsy specimens each year, encompassing a wide spectrum of pathology. The pathologists work closely with surgeons and endocrinologists in the workup and evaluation of patients with a range of head and neck pathology, including endocrine disorders, salivary gland neoplasms, and benign and malignant squamous lesions.

The head and neck pathologists in the group also are experienced in the evaluation of complex head and neck resection specimens, including the oral cavity, larynx, ear, salivary gland, and nasopharynx.

The Hepatopancreaticobiliary (HPB) Pathology service provides diagnostic histopathology for biopsy and resection specimens from the liver, biliary tree and pancreas. Seven surgical pathologists with specialty expertise in liver, biliary, and pancreas pathology interpret over 12,000 HPB specimens annually and are actively involved in local, national and international research and teaching activities. Specialty interests among the HPB pathologists include viral hepatitis; fatty liver disease; primary biliary diseases; other chronic liver diseases; and hepatic, pancreatic, and biliary tumors. They also have expertise in allograft dysfunction after liver and pancreas transplantation and provide comprehensive consultation on these cases. Our pathologists hold joint appointments and work closely with the highly regarded Cleveland Clinic liver transplant program, supporting the diagnostic needs for the some 120 patients undergoing liver transplantation every year. Selected in-house and consult cases are reviewed regularly by the team in departmental consensus conferences and at multidisciplinary conferences. A weekly multidisciplinary liver pathology review conference is held weekly in the department and provides a venue for clinical care, collaboration and education of providers and trainees from pathology, surgery, pharmacy and gastroenterology and hepatology.

Our pathologists hold positions in the premier professional organizations in their field and frequently serve as guest lecturers and speakers at national and international pathology meetings and clinical gastrointestinal, hepatic, and transplantation conferences. They also publish extensively in leading medical journals and have authored several book chapters in the field.

Leveraging Digital Image Technology for Rapid Interpretation of Immunohistochemical (IHC) Stained Slides

Incorporating technological advances in digital imaging (eSlides) enhances research, education, and patient care across the street and around the world. Cleveland Clinic Laboratories now offers web-based eSlides of IHC-stained slides to help optimize clinical workflow for IHC.

In collaboration with Aperio, a provider and global leader of ePathology Solutions, a secure internet site provides access for clients to read immunohistochemically stained eSlides on a computer monitor anytime, anywhere. When a case is opened, all case, specimen and slide information, as well as controls are conveniently at your fingertips.

The service provides access to eSlide conferencing and secure messaging allowing the pathology community to engage in dialog and exchange information.

The opportunity to view stained eSlides within 24 hours after the blocks arrive at Cleveland Clinic may help clients follow a staining algorithm rather than requesting batches of stains, some of which may ultimately be unnecessary.

For more information, please contact:

Cleveland Clinic Laboratories Client Services
Phone: 216.444.5755 
Toll-free: 800.628.6816
Email: ClientServices@ccf.org

Medical Kidney Pathology is responsible for the diagnosis of non-tumor kidney diseases. Our dedicated faculty utilize immunofluorescence and electron microscopy to provide patients with a comprehensive evaluation of their specimens.

Neuropathology specializes in the pathological evaluation and interpretation of patient specimens from the central and peripheral nervous systems and skeletal muscle. The breadth of expertise encompasses neoplastic and non-neoplastic pathology, with special expertise in brain tumors, epilepsy-related conditions, and neuromuscular diseases.

Primary services include the performance of intraoperative consultation (frozen sections), interpretation of biopsy and resection specimens, and evaluation of autopsied tissue. State of the art molecular testing is performed in the evaluation of CNS neoplasms and includes 1p/19q loss of heterozygosity in gliomas, EGFR amplification, and p53 mutational analysis.

The Section participates in interdisciplinary patient management conferences and supports the educational efforts of multiple Institutes and departments throughout Cleveland Clinic, including Neurosurgery, the Brain Tumor Institute, Spine Center, Neurology, Rheumatology, and Endocrinology (for pituitary lesions), Epilepsy Center, and Neuromuscular Center. Members of the section are involved with over 100 interdisciplinary conferences annually.

The Section of Neuropathology plays important roles in multicenter trials, facilitating institutional participation as well as serving as central pathology reviewers for studies in which the primary investigator is based at Cleveland Clinic.

In addition to extensive collaborative research efforts, members of the section participate in individual research projects, primarily focusing on tumors, epilepsy, and multiple sclerosis.

Orthopaedic Pathology specializes in the diagnosis of musculoskeletal tumors and tumor like lesions, skeletal degenerative diseases, and metabolic bone disease and the evaluation of orthopaedic biomaterials. The pathologists on the service work closely with skeletal radiologists and musculoskeletal oncologists to achieve rapid diagnosis.

Specialty pathologists participate in prospective, preclinical research to characterize new skeletal substitute materials and elucidate the cell biology of bone and cartilage metabolism and repair. The orthopaedic pathologists are members of the editorial boards of several major journals and have published widely.

Pulmonary Pathology offers evaluation of specimens for neoplastic and non-neoplastic lung diseases, with specialized expertise in occupational lung disease and transplantation pathology. Pathologists on the service utilize molecular biology, immunohistochemistry, and ultrastructural techniques in their diagnostic workups. Ultrastructural and elemental/particle analysis are available for cases of occupational lung disease.

Research interests among the pulmonary pathologists include lung carcinogenesis and macrophage biology in interstitial lung diseases. They have presented national courses on a range of topics in pulmonary pathology and are members of leading professional organizations in the field.

Soft Tissue Pathology provides comprehensive diagnostic assessment of soft tissue neoplasms, in addition to morphologic and immunophenotypic characterization of lesions and molecular analysis of specific genetic aberrations, including sarcoma-associated translocations. Soft Tissue pathologists process a high volume of cases annually. Special interests of the pathologists on the service include the identification of immunophenotypic and genotypic markers for specific sarcoma diagnosis.

The Section of Surgical Pathology performs gross and microscopic examination and interpretation of tissue specimens that include biopsies and surgical excisions. The section evaluates approximately 80,000 specimens a year, in addition to specimens submitted for special procedures only. The diversity of the specimen material reflects the specialized medical and surgical practice of Cleveland Clinic.

Pathologists with particular interest and expertise in various subspecialty areas (e.g., gynecologic pathology, head and neck pathology, etc.) interpret the cases that fall into the subspecialty categories. This subspecialty sign out approach ensures excellent diagnostic interpretations, enhances collaboration with specialized clinical services and fosters scholarly activities.

A broad array of specialized techniques is available to augment routine morphologic examination, including an ever-expanding menu of immunohistochemical stains, chromogenic in situ hybridization for mRNA , immunofluorescence studies, and molecular pathology analyses, such as HER2 gene amplification by FISH. Electron microscopic analysis is also performed, with an emphasis in renal and neurological disease investigation.

Faculty members present pathologic findings in numerous interdisciplinary patient management conferences to departments and divisions throughout Cleveland Clinic, playing a key role in determining appropriate clinical decisions across the spectrum of medical and surgical subspecialties.

The faculty is active in a wide variety of research studies in all subspecialties. Involvement includes collaboration with clinical departments on projects, individual applied research studies, and translational research that bridges basic disease mechanisms and clinical applications.