RxPG - Curriculum for award of CSST in Oral Pathology in UK

For the award of a CCST in oral pathology, a trainee will be required to demonstrate professional competency, at the levels specified, in the diagnosis of disorders of the tissues specified below. The MRCPath Part 2 examination in oral pathology will take account of these requirements. This will allow employing authorities to determine the areas and extent of competency of oral pathologists on completion of training.

Oral cavity

Trainees will be expected to be able to diagnose disorders of the teeth and supporting structures and lesions derived from odontogenic tissues. They will be expected to be able to recognise structural abnormalities of the dental hard tissues of developmental origin, be able to diagnose the main types affecting dentine and to offer at least a differential diagnosis of rarer disorders including those of cementum. They will be expected to be aware of and be able to advise on developmental disorders of enamel but, since experience of these is likely to be limited and facilities for ground sections may not be routinely available, competency in the histopathological diagnosis on ground sections will not be expected. The ability to diagnose dental caries, pulpitis and its periapical sequelae will be expected.

Trainees will be expected to be able to diagnose all odontogenic and non-odontogenic cysts of the jaws and all odontogenic tumours (or to be able to offer at least a working or, in some cases, a differential diagnosis of rarer types). They will be expected to be able to diagnose all developmental, inflammatory, preneoplastic and neoplastic disorders of the oral mucosa (or at least give a working/differential diagnosis of rarer types including malignant lymphomas) and to be capable to providing accurate and complete reports on resection specimens for oral cancer, in accordance with relevant specialist reporting guidelines.

Major and minor salivary glands and other mucosal glands

Trainees will be expected to be able to diagnose all inflammatory and cystic disorders of the major and minor salivary glands and of sinonasal, pharyngeal and laryngeal minor glands. They will be expected to offer at least a working or differential diagnosis of lymphoid infiltration of the major and/or minor glands and of malignant lymphomas involving lymph nodes associated with the major glands.

They will be expected to be able to diagnose all primary epithelial neoplasms of these glands (or at least offer a working or differential diagnosis of rare types), developmental disorders relevant to histopathology and common mesenchymal tumours, (for example polycystic disease of the parotid; haemangiomas and lymphangiomas). At least a working or differential diagnosis of other mesenchymal tumours (including malignant lymphomas) and of metastatic tumours to the major glands will be expected.

An awareness and ability to advise on similar disease processes affecting the lacrimal gland will be required, but since experience of these is likely to be limited, competency in their diagnosis is not expected.

Jaws, craniofacial bones and temporomandibular joint

Trainees will be expected to be able to diagnose inflammatory and reactive lesions involving bone, bone marrow or periosteum and, in association with appropriate radiographic and biochemical data, fibro-osseous and cemento-osseous lesions of the jaws and craniofacial bones, Paget’s disease of bone and giant cell lesions of bone, including cherubism (in the absence of adequate radiographic/biochemical data, a working or differential diagnosis will be expected).

They will be expected to be able to diagnose benign neoplasms of bone and cartilage, to offer a working diagnosis of the main types of malignant neoplasms and to be able to offer at least a differential diagnosis of rarer types.

They will be expected to be able to offer a working or differential diagnosis of abnormal lymphoreticular or haemopoietic proliferation in the bone marrow and of Langerhans cell histiocytosis and metastatic malignant disease.

They will be expected to be aware of and be able to advise on other generalised disorders of bone that may involve the jaws, including developmental and acquired osteodystrophies, but diagnosis of these is not expected on biopsies from the jaws or craniofacial bones.

They will be expected to be able to diagnose or offer at least a working diagnosis of non-neoplastic disorders of the temporomandibular joint and at least a working or differential diagnosis of benign and malignant neoplasms involving the joint.

Ear, sinonasal tract and nasopharynx

Trainees will be expected to be able to diagnose inflammatory, reactive and neoplastic disorders of the skin (at levels of competency described under skin) and cartilage of the external ear, and of the external auditory meatus (or at least provide a working/differential diagnosis of rare types).

They will be expected to be able to diagnose or offer at least a working diagnosis of inflammatory disease of the middle ear and mastoid air cells, particularly cholesteatoma and aural polyps.

An awareness of other disorders and tumours of the middle ear will be required, but as experience of these is likely to be limited, competency in their diagnosis is not expected. Detailed knowledge of disorders of the inner ear is not expected.

Trainees will be expected to be able to diagnose all inflammatory and neoplastic diseases of the mucosa and associated minor glands of the sinonasal tract and nasopharynx (or at least offer a working or differential diagnosis in rarer cases) and to offer at least a working or differential diagnosis for malignant lymphomas, tumours of soft tissues and bone and other rare tumours of neuroectodermal/central nervous system origin such as neuroblastoma, chordoma, meningioma that may present in this area.

Pharynx and larynx

Trainees will be expected to be able to diagnose all inflammatory and neoplastic disorders arising from the pharyngeal mucosa and underlying glands and all inflammatory, reactive and other non-neoplastic disorders of tonsillar and other pharyngeal lymphoid tissue. They will be expected to be able to give at least a working or differential diagnosis of malignant lymphomas and other soft tissue tumours.

They will be expected to be able to diagnose all inflammatory, reactive and neoplastic disorders arising from laryngeal mucosa and underlying glands. They will be expected to be able to diagnose and interpret laryngeal epithelial dysplasia and to be able to provide accurate and complete reports on resection specimens for pharyngeal and laryngeal cancer, in accordance with relevant specialist reporting guidelines.

Trainees will be expected to offer at least a working or differential diagnoses of other neoplasms that may involve the laryngeal soft tissues and cartilages.

Facial and neck skin

Trainees will be expected to be able to diagnose neoplastic and preneoplastic lesions of keratinocyte origin (or at least offer a working or differential diagnosis in rarer cases) and to offer at least a working or differential diagnosis for benign melanocytic disorders and common benign adnexal tumours. A working or differential diagnosis only will be expected for malignant melanoma of skin and for malignant adnexal tumours.

They will be expected to be able to diagnose common dermal cysts and inflammatory lesions of pilosebaceous follicles. They will be expected to be aware of and recognise other inflammatory and neoplastic processes in the dermis and subcutaneous tissues, but since experience of these is likely to be limited, competence in their diagnosis is not expected.

Neck and thyroid gland

Trainees will be expected to be able to diagnose non-neoplastic disorders of lymph nodes (or at least offer a working or differential diagnosis in appropriate cases, such as granulomatous inflammation) and to offer at least a working or differential diagnosis of malignant lymphomas and of metastatic malignant disease. They will be expected to be capable of providing accurate and complete reports on cervical lymph node dissection specimens in accordance with relevant specialist reporting guidelines.

They will be expected to be able to diagnose all developmental cysts in the neck and to offer at least a working or differential diagnosis of soft tissue tumours.

They will be expected to be aware of disorders of the thyroid gland and to be able to distinguish between inflammatory and hyperplastic/neoplastic lesions. They will be expected to be able to offer at least a differential diagnosis of the main types of thyroid carcinomas, including their metastatic deposits. They will be expected, at least, to be aware of the principles of handling thyroidectomy specimens and of relevant specialist reporting guidelines. However, since experience of such specimens may be limited, competence in providing accurate and complete reports without further opinion is not expected.

Cytology, fine needle aspiration (FNA), core biopsies and frozen sections

It is expected that trainees will be familiar with these techniques, their applications and limitations. It is expected that they will be able to interpret such material from salivary tumours and cervical masses as a triage to identify the presence of carcinoma, or at least of squamous cell carcinoma, but it is not expected that they will be competent to offer differential or working diagnoses on such material from the head and neck, on the award of a CCST.