AUTOPSY SERVICE

Overview

The autopsy service performs autopsies on patients who die at the Massachusetts General Hospital plus patients who die outside of the hospital and have had some MGH care. The service has performed between 350 and 500 cases per year over the last five years. This constitutes approximately 15% of hospital deaths.

Autopsy Faculty
Massachusetts General Hospital
Eugene J. Mark, M.D., Director, Professor and Deputy Medical Examiner
E. Tessa Hedley-Whyte, M.D., Professor (Neuropathology)
David Louis, M.D., Professor (Neuropathology)
Atul Bhan, M.D., PMay 12, 2007.D., Associate Professor
Drucilla Roberts, M.D., Associate Professor (Perinatal pathology)
Esther Oliva, M.D., Associate Professor (Perinatal pathology)
Matt Frosch, M.D., Assistant Professor (Neuropathology)
Anat O. Stemmer-Rachamimov, M.D., Assistant Professor (Neuropathology)
James R. Stone, M.D., PhD., Assistant Professor
Rex Neal Smith, M.D., Assistant Professor, Associate Director
Rosemary Tambouret, M.D., Assistant Professor (Perinatal Pathology)
Stuart Houser, M.D., Assistant Professor
Cambridge Hospital
John Grabbe, M.D., Clinical Associate in Pathology
Katherine Kosinski, M.D., Assistant Pathologist
Rebecca Osgood, M.D., Assistant Pathologist
Eva Patalas, M.D. Clinical Associate in Pathology (Forensic Pathology)

Chief Autopsy Technician
Mr. James Taralli
Autopsy Secretaries:
Mrs. Carole Fleming
Mrs. Ellen Melchionno

Clinical Autopsy Program

Approximately one autopsy is performed daily so that the two residents on service can each expect to do three or four cases per week. Supervised by staff the autopsies cover the full spectrum of diseases and include specialized studies such as blood transfusion, chemistry (including toxicology), microbiology, clinical immunology, immunopathology, and electron microscopy.

Autopsies are presented to the pathology staff and attending physicians at a weekly autopsy conference. Histologic sections are expedited for the conference to enhance the teaching value of the gross pathology. Autopsy residents and staff participate in a weekly cardiovascular/pulmonary/autopsy consensus conference.
The autopsy service provides for a provisional anatomic the day after the case is complete. The autopsy service attempts to complete the sign-out of the case in four weeks.

Special procedures are used for autopsies with organ transplantation (heart, lung, liver, kidney) to archive data for the many clinical transplantation protocols. Findings include studying complications of therapy and degrees of rejection. Special procedures are also used for autopsies dealing with cardiac surgery including postmortem angiography.

Some cases under the jurisdiction of the Office of the Chief Medical Examiner of the Commonwealth of Massachusetts are performed at MGH. Forensic issues highlighted by this teaching expose our residents to additional unique aspects of forensic medicine. A series of lectures by the OCME is delivered monthly through the academic year. Residents also rotate for two weeks through the Office of the Chief Medical Examiner of the Commonwealth and perform prosections at that office. The off-site rotations include the opportunity for crime scene investigation. Dr. Mark has served as consultant to the Office of the Chief Medical Examiner of the Commonwealth of Massachusetts for cases of pulmonary pathology, and Dr. Drucilla Roberts has served as consultant to Chief Medical Examiner of the Commonwealth of Massachusetts for cases of obstetric and neonatal pathology.

The neuropathology service examines cases for brain, spinal cord, and muscle pathology. Cases of neurodegenerative disease and dementia are referred to the Department from patients through the Alzheimer Disease Research Center. The general autopsy service and neuropathology autopsy service perform autopsies on patients who have lived 100 years or more as part of a clinicopathologic study on centenarians.

Perinatal Autopsy Service
The perinatal autopsy service, under the direction of Dr. Drucilla Roberts, includes the full range of perinatal pathology services, including placental pathology, perinatal neuropathology, and cytogenetics. Perinatal autopsies include fetal and pediatric autopsies from 20 weeks gestational age to 3 months of life. The service performs approximately 50 perinatal autopsies per year, generally providing each resident with experience of 5-10 perinatal autopsies during their 3-5 year training period. The perinatal autopsy service also performs all fetopsies (intact fetal abortal examinations <24 weeks gestational age, generally considered as surgical specimens) using the same complete autopsy procedure. Most perinatal autopsies are presented to clinical conferences including pediatric, obstetric, and surgical services.

Academic Accomplishments
The autopsy service provides basic materials for investigators throughout the department and the hospital and also provides material for Case Records of the Massachusetts General Hospital.

Educational Autopsy Activities
The autopsy service provides when needed clinicopathological correlations and didactic teaching at the following conferences:

Medical Service Morbidity and Mortality conference, weekly
Surgical Grand Rounds, weekly
Pediatric and Obstetrics Clinical Conferences
Medical and Surgical Sub-specialties
Transplantation Morbidity & Mortality Conference, quarterly
Neurology and neuropathology clinical and pathological conferences, twice weekly

Medical students who rotate through the department for one month or longer are assigned in part to the autopsy service. The student observes autopsies on their first few days in the department and then serve as the prosector on a case during the end of their first week. During their fourth week, they complete the histologic study, the clinicopathologic correlation, and the final written document with the attending staff pathologist. They may present an enlarged version of their findings at a small lecture at the conclusion of their rotation. Senior residents may sign out autopsy cases if desired.

Some members of the autopsy service lecture at the departmental postgraduate course in surgical pathology, Current Concepts in Surgical Pathology. Dr. Mark chairs autopsy sessions for the International Society of Pathology.

Facility
The autopsy suite has undergone a one million dollar renovation in 2006. There are two L-shaped dissecting tables with continuous water cleansing and surgical lighting. A separate conference room has a large viewing window into the dissecting area. There is a shower area in the autopsy complex.