Meet the Detectives Behind the Diagnosis
Parents and families typically turn to their child’s doctor for answers when dealing with a strange or unexplained illness. But when that doctor is stumped, who do they turn to?
The answer is, oftentimes, a pediatric pathologist. The Department of Pediatrics at the University of Rochester has a team of two dedicated pediatric pathologists who specialize in pre- and postnatal cases as part of the health care team. They work to examine cases and find answers that lead to proper diagnosis and treatment for children at any age.
Philip Katzman, M.D., and Leon Metlay, M.D., are two of the most important doctors you’ll never meet; but if your child has a biopsy or testing for certain genetic or complex diseases, you may see their name on their lab report. They examine tissue biopsies from the GI tract and other parts of the body, as well as perinatal tissue, like placentas and products of conception, and work closely with physicians to precisely diagnose problems. And while it’s among the most emotionally difficult tasks they perform, their expertise in autopsies can help grieving families find closure and offer guidance for their future family planning.
Not every hospital has pathologists who specialize in pediatrics, so Golisano Children’s Hospital is somewhat unique. Furthermore, Â鶹ÊÓƵis the only academic medical center in upstate New York to offer a one-year “pedi-path” fellowship as a training opportunity for pathology residents looking to specialize in pediatric cases. It’s a career path that lets you positively impact children and families every day. It can also help pediatric colleagues provide better care.
“You always see something different every day,” said Katzman, who is trained in both pediatrics and pathology. At URMC, he is the go-to person for solid-tumor diagnoses, among other types of tissue. To him, a career in pedi-path is one that’s well-tailored to people with compassion and an eye for detail. “If you like to solve puzzles, there’s a lot of puzzle solving in pathology.”
Pediatric surgeon Derek Wakeman, M.D., interacts regularly with Katzman, and knows firsthand how critically important it is to have access to the knowledge and experience these specialists provide. He knows fellow pediatric surgeons who only work with general pathologists versus pedi-path experts.
“The Rochester community is blessed to have somebody with that expertise because it doesn’t exist everywhere,” said Wakeman.
What exactly do they do? A pathologist examines a patient specimen, which is most often a very thin tissue sample taken from a biopsy, looks at it under a microscope to detect cell patterns and other visual clues that indicate specific diseases. They give their diagnosis to the physician who can then create a treatment plan.
Being specialized, Metlay says, makes all the difference, since diseases are not one-size-fits-all. He uses the example of disease in a GI tract or organ system. Diseases do not present themselves the same way in children, who are growing and developing rapidly, as they would in an adult.
“One thing we bring to the examination of different specimens is a familiarity with the developmental changes that are happening and how these may affect the disease process,” said Metlay.
Katzman and Metlay may not see patients face to face, but they are familiar faces to physicians at tumor boards — group meetings where doctors from different areas gather to discuss cases, especially those that are particularly challenging.
Examples of these include pediatric Hematology/Oncology, Cardiology, Neonatology and Maternal-Fetal Medicine conferences.
“Many times (the pathologist) is the most important person in the room and nobody knows that,” said Wakeman. “If they get the wrong diagnosis, you’re going to potentially get the wrong chemotherapy.”
In addition to pinpointing diagnoses for newborns and children, the pedi-path team helps decipher many complications in pregnancy — whether it’s examining abnormal ultrasounds or tissue. Their findings can help physicians advise patients on how to plan for future pregnancies.
Maternal-Fetal Medicine and OB-GYN doctor Courtney Olson-Chen, M.D., sees patients at all stages of pregnancy. She and her colleagues often rely on information detected by the pathologists to figure out why a mother has complications during her pregnancy or, sadly, experienced a pregnancy loss. While these are always difficult conversations, having all the information can give some closure and provide families with more insight into their loss.
“They are really the hidden providers that often put all the clues together to figure out why a complication occurred,” she said. “It’s reassuring for us to know that they’re going to do the best job deciding if they can explain why a complication happened, because that’s one of the best ways we have to counsel patients about their next pregnancy.”
In addition to clinical work, the pedi-path team is involved in teaching and research. They recently collaborated on a study of 900 pregnant women whose placenta stuck to the uterus, which found that those patients are more likely to return to the hospital with bleeding, sometimes needing surgery. As a result, Olson-Chen said, doctors can use these findings to advise patients who have bleeding.
This October, Â鶹ÊÓƵwill have the honor of hosting the Society for Pediatric Pathology’s national meeting. While awareness of this profession is slowly gaining traction, our pedi-path doctors and their colleagues in this noble profession say they hope others — especially residents, medical students and other learners — will explore pedi-path as a career.
Metlay still remembers advice he received from a teacher years ago that inspired him to pursue it.
“If you do something that saves an adult, you give them a couple of years. If you do something that saves a child, you give them a lifetime,” he said. “That really stuck with me. The idea that any observations we can make that help children’s health can have a much greater impact.”
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