Anatomic Pathology Examination
Gross Slide Review Presented at the ACVP/ASCVP annual meeting
Atlanta, GA
Section leader - P. Pesavento
2013 Examiners and Proctors
Karen Terio (Chairperson), Nancy Kock, Dalen
Agnew, Keith Linder, Bradley Njaa, Dan
Rudmann, Patty Pesavento, Steven Lenz,
Andrew Miller, Tim Morgan
Proctors: Julie Schwartz, Justin Greenlee, Tim
LaBranche,
Objective of review
To provide insight into the nature of case
material, composition and questions asked in
the practical sections of the ACVP qualifying
examination
Objective of review
To provide insight into the nature of case
material, composition and questions asked in
the practical sections of the ACVP qualifying
examination
Information presented here will be
included on the ACVP website
Composition of Gross Exam
• 100 projected images – Parts A and B
• 1, 1.5, or 2 minutes per image
• No review of images at the end
Preparation of Gross Pathology Exam
• 22 images submitted by all 13 examiners by April
Preparation of Gross Pathology Exam
• 22 images submitted by all 13 examiners by April
• Draft exam (with options for many questions) prepared
by section leader
Preparation of Gross Pathology Exam
• 22 images submitted by all 13 examiners by April
• Draft exam (with options for many questions) prepared
by section leader
• Presented to entire committee in May/June
Preparation of Gross Pathology Exam
• 22 images submitted by all 13 examiners by April
• Draft exam (with options for many questions) prepared
by section leader
• Presented to entire committee in May/June
• All images, associated questions and points distribution
approved by exam committee, council, etc.
Preparation of Gross Pathology Exam
• 22 images submitted by all 13 examiners by April
• Draft exam (with options for many questions) prepared
by section leader
• Presented to entire committee in May/June
• All images, associated questions and points distribution
approved by exam committee, council, etc.
• Final draft prepared by section leader July/August
Selection of images
Image quality high priority
Final selection must fit matrix based on:
– Species
– Organ system
– Disease process
– Range of submitters
SPECIES
2009
2010
2011
2012
2013
Large Animal
35
Small animal
26
Laboratory Animal
20
Avian/Reptile/Fish
10
Wildlife
9
SPECIES
2009
2010
2011
2012
2013
Large Animal
42
40
40
35
35
Small animal
24
25
22
32
26
Laboratory Animal
20
19
19
18
20
Avian/Reptile/Fish
11
11
13
11
10
Wildlife
3
5
6
4
9
SPECIES
Too many
monkeys jumping
on the bed?
2009
2010
2011
2012
5
7
6
2013
SPECIES
Too many
monkeys jumping
on the bed?
2009
2010
2011
2012
2013
5
7
6
7
2013 Distribution by organ system
Urinary
Respiratory
Digestive
Liver
Reproductive
Nervous
Hemolymphatic
Cardiovascular
Skin
Musculoskeletal
Endocrine
Miscellaneous
Systemic
7
15
8
9
10
8
7
7
12
13
4
1
3
Instructions to candidates
• Answers should represent your interpretation of
the lesions/diseases presented (not a description)
Instructions to candidates
• Answers should represent your interpretation of
the lesions/diseases presented (not a description)
• If more than one disease is possible, choose the
most likely option
Nature of questions
• Morphologic diagnosis
• Etiologic diagnosis
• Cause
• Name the disease
• Name the condition
Nature of questions
• Histologic characteristics
• Immunohistochemical characteristics
• Cytologic characteristics
• Pathogenesis
Nature of questions
• Sequela(e)
• Associated lesion(s)
• Associated hematologic, serum chemical or
urinalysis findings
See ACVP website for details
Sample questions from
2013 gross exam
Tissue from a pig.
!
Histologic features
!
Tissue from a pig.
!
Histologic features:
Lack of endochondral ossification,
expanded physes, infractions, thin
trabeculae, increased osteoclasts
!
2, 4, 6 points?
Tissue from a pig.
!
Histologic features:
Lack of endochondral ossification,
expanded physes, infractions, thin
trabeculae, increased osteoclasts
!
Not accepted egs: bone, bony trabeculae
2, 4, 6 points?
Tissue from a calf.
!
!
Cause
Tissue from a calf.
!
!
Cause:
Bovine parapox virus
!
!
Tissue from a calf.
!
!
Cause:
Bovine parapox virus
!
!
Morph: Proliferative pharyngitis
!
Name the disease:
Bovine papular stomatitis
Tissue from a rhesus macaque.
!
Morphologic diagnosis:
!
Cause:
Tissue from a rhesus macaque.
!
!
!
Morph: granulomatous enteritis
(intestinal amyloidosis)
!
Cause: Mycobacterium avium
!
!
Tissue from a pig.
!
Morph
!
Cause
Tissue from a pig.
!
!
!
Morph: bilateral poliomyelomalacia
!
Cause: Selenium toxicosis
!
!
Tissue from a dog.
!
Morphologic diagnosis
!
Associated cytologic feature
Tissue from a dog.
!
!
!
Morph: hemangiosarcoma
!
Associated cytologic feature – acanthocytes,
schistocytes, metarubricytosis (anemia)
!
!
Tissue from a rhesus macaque
Cause
••
Tissue from a rhesus macaque.
!
!
!
!
Cause: Pneumocystis carinii
!
!
Tissue from a sea horse
!
Etiologic diagnosis
Tissue from a sea horse
!
Etiologic diagnosis: mycobacterial nephritis
Tissue from a rhesus macaque
!
Morphologic diagnosis
Cause
Tissue from a rhesus macaque.
!
!
!
Morphologic diagnosis: necrotizing placentitis
!
!
Cause: Listeria (and others)
!
!
Tissue from a foal
2 Possible causes
Tissue from a foal
2 Possible causes
!
Any 2 of:
Clostridium perfringens type C;
Clostridium difficile;
Salmonella spp
Tissue from a dog
Pathogenesis
Tissue from a dog
Pathogenesis:
hypothyroidism > hyperlipidemia >
coronary artery atherosclerosis
Tissue from a dog
Histologic features:
foamy macrophages, disruption of the
intima, subintimal expansion/proliferation
acicular clefts
Tissue from a cat
Morphologic diagnosis
!
Useful histochemical stain
Giemsa
Tissue from a cat
Morphologic diagnosis: Mast cell
tumor
!
Tissue from an opossum
Cause
Tissue from an opossum
Cause: Besnoitia darlingi
A few that were not used?
Morph, cause
Regional
Morphs
Difficult to orient
Morph
Obvious reasons