Expanding the PA Role: A Day in My Life

I felt maxed out in my previous position and was therefore looking for a position with more room for growth. The posting read as a Senior PA role specializing in neuropathology and hematopathology with skills in microscopic examination. I moved from Chicago to Boston’s Brigham and Women’s Hospital without hesitation, when I learned more about this pioneering position. The PA background is suited to this role, because we are trained to function at high-complexity levels. Although my knowledge in histology was rarely utilized in my prior PA work, this role gave me the opportunity to apply my histology skills, and to recognize patterns that are organ specific.

Now as a Pathologists’ Assistant, specializing in Neuropathology and Hematopathology, my current role is non-traditional. I am not in the gross room prosecting specimens. My function is to review cases in neuropathology and hematopathology, which includes ordering appropriate immunohistochemistry and molecular testing, interpreting results and preparing pathology reports for sign-out. At sign-out, I sit with the attending, and we go over my interpretations. The PA scope of practice dictates that we operate under the supervision of the pathologist, and it is the sole responsibility of the pathologist to render a diagnosis. The pathologist is still responsible for making a diagnosis; I help prepare all of the information and analysis in order for the pathologist to do so. The skill I use everyday were on-the-job trained through multiple modalities including reading the W.H.O. for my respective services. Furthermore, my training including sitting in on sign-out’s including molecular, brain cutting, tumor boards, and lectures as well as immersing myself in both fields. Following this training, I began working up my own cases and continued to learn through more hands-on training.

The following are two cases that begin to illustrate my workflow as the Senior Pathologists’ Assistant (PA) at Brigham & Women’s Hospital:

65 year old female with initial presentation of headaches for a 3-month period. Brain MRI shows a 3.0 x 2.6 x 1.0 cm T2 hyperintense lesion in the left temporal lobe with contrast enhancement. She underwent a craniotomy days later. The H&E slide shows dense cellularity, moderate to severe atypia, mitoses are present 5/10 hpf, vascular proliferation and necrosis are present. I order immunohistochemistry for IDH1 R132H and Ki-67 and molecular testing for MGMT promoter methylation, chromosomal microarray and oncopanel sequencing. The IHC results show: IDH1 R132H is negative, Ki-67 is at approximately 10% and MGMT promoter methylation is unmethylated. Diagnosis: GLIOBLASTOMA-IDH WILDTYPE, W.H.O Grade IV.

70 year old male with initial presentation of persistent low back pain and anemia. X-Ray identifies no lytic lesions. The bone marrow biopsy shows a hemorrhagic and apparently normocellular marrow (50% fat). Approximately 30% of the cellularity (20% of the intertrabecular space) is composed of a population of intermediate plasma cells occurring in small clusters as confirmed by immuno-peroxidase studies for CD138. Immunohistochemistry performed shows monotypic cytoplasmic kappa light chain restriction over lambda light chain. Of the remaining cellularity, the bone marrow biopsy shows the erythroid, myeloid, and megakaryocytes population are in normal proportion, exhibit maturation, and show no significant atypia. Bone trabeculae shows focal osteoblastic activity. Diagnosis: PLASMA CELL NEOPLASM.

I am passionate about our PA field and advocate for role expansion whenever possible. PA opportunities are the first step toward building momentum for profession-wide growth.

-Kristina C. Grieco, MS, PA(ASCP) is currently a Senior PA in Neuropathology/Hematopathology at Brigham and Women’s Hospital in Boston, MA. Her most recent project has been building the program Pathology Inspiration for Youth (PIY) to increase awareness of the pathology field among high school students and anyone exploring career opportunities in healthcare.

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