Chapter  Surgical Pathology Eugene J. Mark, David N. Louis, and Robert H. Young

urgical pathology as a discipline distinct subspecialties of neuropathology and dermatopa- Sfrom autopsy pathology stems from approxi- thology in chapters 17 and 18, respectively. Over- mately the 1870s, when the microscope began views of four areas of MGH Surgical Pathology to be brought to bear to a signifi cant degree on are presented here: examination of tissue specimens for patient care. 1. Th e early years and prominent surgical pathol- As it did at many other institutions, it took some ogists before subspecialization time for the advance to bear fruit at Massachu- setts General Hospital (MGH)—but once it did, 2. Technical developments that have advanced a proud and successful tradition took root. Th at the practice of surgical pathology, in chrono- surgical pathology could ascend so quickly in logical order: frozen sections, electron micros- the early years was based in part on the large and copy, immunohistochemistry and immuno- innovative MGH Surgical Services; indeed, the fl uorescence, and molecular diagnostics hospital has often been called a “surgeon’s hos- 3. Th e interface of clinical service and teaching: pital.” Th e tradition continues today, with about sign-out activities and intramural conferences, 70 active operating rooms. extramural teaching, and interactions with Th e contributions of those who have handled other MGH departments tissue biopsies and resection specimens over the years could be the basis for an entire book. 4. Th e later years of subspecialty pathology, Unfortunately, space limitations preclude a covering each of the major subspecialties, complete account of all who have been (or are in alphabetical order: bone and soft tissue, currently) engaged in surgical pathology at the breast, cardiac, endocrine, ear, nose, and MGH because of their large number and to some throat (ENT) and eye, gastrointestinal, gyne- degree a lack of adequate information. Th is chap- cologic and obstetric, hematologic, medical ter therefore focuses primarily on those before renal, pulmonary, and urologic. the current era and on those who have led, or currently lead, surgical pathology and its sub- The “General” Surgical specialty groups at the MGH or have gone else- Pathologists where to prominent careers in surgical pathol- Surgical pathology made a very early appear- ogy subspecialties. Th e basic features of surgical ance at the MGH. In 1837 one of the cofound- pathology (e.g., laboratories, volumes of cases, ers of the hospital, the surgeon Dr. John Collins and so on) are covered in the sections on surgical Warren (chapter 1), published a book on tumors pathology in chapters 1, 3, 5, 7, and 13 and the (Surgical Observations on Tumours, with Cases

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and Operations, Boston, 1837), which, as it was translucent tumor within the tunica vaginalis tes- written in the premicroscopic age, focuses only tis, or tunica albuginea.” on surgical and gross aspects of neoplasms. Th e Th ose who practiced surgical pathology on the book (fi gure 16.1) is impressive, 607 pages long basis of gross appearances in the early years—such and containing 16 plates, most in color. Th ere are as Dr. J. B. S. Jackson—and who probably also 14 sections dealing with various types of tumors, practiced microscopic evaluation of specimens to and Warren concluded with a section entitled some degree in the years circa 1870–1890—Drs. “Distinguishing Characters of the Most Com- Ellis, Fitz, and Warren, for example—are consid- mon Tumours.” In that section he presented a ered in chapters 1 and 2. Mention of Dr. J. Collins series of defi nitions, many of which use now- Warren, the grandson of Dr. John Collins War- antiquated terminology but some of which have ren, is made here because the title of his 1895 book, not changed at all, such as hydrocele and osteo- Surgical Pathology and Th erapeutics, contains the sarcoma. His defi nition of hydrocele is as good term surgical pathology (see fi gure 1.8). He played today as then: “a rounded, smooth, undulating, a signifi cant role in bringing about biopsies for microscopic diagnosis, including those using the Mixter biopsy needle (fi gure 16.2), developed by another MGH surgeon, Dr. Samuel Mixter. Th e crucial role that pathology examination played in good patient care was clearly evident to J. Collins Warren. In the preface to his book he writes: “No young practitioner can be regarded as thoroughly equipped for surgical pathology who is not both a good pathologist and an expert bacteriologist. Th e confi dence born of a knowledge of pathol- ogy and bacteriology enables him to assume grave responsibilities and to grapple successfully with the most complicated problems. It is from men thus equipped that we have a right to hope that the future masters of surgery are to be evolved.” Although Warren used the words surgical pathology in his book, none of the early practi- tioners styled themselves as “surgical patholo- gists” until Dr. William Fiske Whitney (chapters 1 and 3; see fi gure 3.6) at the end of the nine- teenth century. In those days diagnostic (surgi- cal) pathology was under the aegis of the Surgery Services, and Dr. Whitney thus worked in that division, initially as Assistant Pathologist from 1888 to 1892, as Pathologist from 1893 to 1901, and then as Surgical Pathologist until his retirement in 1916. During most of this time he appears to Figure 16.1 Title page of a book by John Collins have been the one responsible for the evaluation Warren, one of the founders of the MGH, on the gross of all biopsies and resection specimens. Although appearances of tumors he was initially working solely under Surgery, Dr.

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to a separate status for surgical pathology. Th e title “surgical pathologist” seems, however, to indicate that the diagnostic work was considered at least somewhat separate from the research, microbiology, and autopsy pathology that were clearly in the bailiwick of Pathology. In his 1934 book Tumors of the Female Pelvic Organs, Dr. Joe Figure 16.2 An illustration of a Mixter biopsy needle, V. Meigs, then Chief of Gynecology (see fi gure which would have been used by J. Collins Warren to 19.2), acknowledged the help of three members sample tumors at the end of the nineteenth century of MGH Pathology, but he gave precedence to Dr. Hartwell when he commented, “His advice, Whitney’s work came partly within the domain help and patience made a diffi cult and painstak- of Pathology sometime after Dr. Wright became ing work a decided pleasure, and without him it the Chief of Pathology, probably circa 1900. James Homer Wright (chapter 4) practiced surgical pathology to some extent throughout his tenure as chief, but his interests in microbiology and research restricted the time he had available for evaluation of routine specimens (fi gure 16.3). As a result, the daily load of surgical pathology was handled by Dr. Whitney as well as Drs. Oscar Richardson and Harry F. Hartwell (from 1911). Dr. Whitney had originally worked in the fi rst Allen Street House, which had an amphitheater, morgue, and small laboratory that had been built in 1874. After the new laboratories were fi tted out under Dr. Wright’s supervision, Dr. Whit- ney, Dr. Richardson, and ultimately Dr. Hartwell (who did surgical pathology in the department until 1937) worked with Dr. Wright in the new quarters as well as in the various laboratories off the operating theaters. Th e practice of surgi- cal pathology in those days diff ered signifi cantly from how it is performed today; for example, the eminent surgeon Dr. Maurice H. Richardson vis- ited the homes of the more well-to-do to oper- ate on them, often at their kitchen tables, with Dr. Whitney in tow, presumably so that he could give an opinion based solely on the gross charac- teristics of the neoplasm to be removed. In 1916 Dr. Hartwell succeeded Dr. Whitney, and surgical pathology gradually became amal- gamated with general pathology; annual reports Figure 16.3 Consultation report between Richard C. of Drs. Wright and Mallory do not make reference Cabot and James Homer Wright, 1916

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could have not been accomplished.” Dr. Meigs the endocrine glands in the department. Th e next indicated that in preparing the illustrations for his year Dr. Bradley resigned as Assistant Pathologist, book he consulted Dr. Hartwell most frequently, and Dr. Castleman (chapter 8) was appointed in but he also thanked Dr. Mallory and his assistant his place. Dr. John I. Bradley. Th ose who practiced surgical A trainee under Dr. Mallory’s tenure who pathology were probably busy; even though the had an illustrious career was Dr. Edward A. Gall volume was relatively small, there was not a sin- (1906–1979). Dr. Gall graduated from Tulane gle house offi cer or resident during Dr. Wright’s University School of Medicine. As Dr. Castleman entire tenure, so presumably all the gross descrip- recounted many years later, he had met Dr. Gall tions and cutting of specimens were done by the when Dr. Gall was a district physician at the Bos- small attending staff . ton Dispensary. One evening, on a double date, Th e invention of the rotary paraffi n micro- Dr. Castleman asked Dr. Gall if he knew any- tome in 1899 was an important development, one interested in a pathology residency, because brought about through the eff orts of Francis Dr. Castleman was about to fi nish his. Dr. Gall Blake, a Trustee of the hospital, working with inquired about the salary. Th e fi gure of $500 per Dr. George Minot and with Dr. Wright’s input. year did not dissuade him; a few days later he Another important development was the advent applied for the position and was accepted. Dr. of microscopic photography, enabled by the head Gall already had some background in hematol- technician and photographer, Louis Brown, who ogy, and this led to an interest in lymph node joined the department in 1896 and served in this pathology and papers with Dr. Mallory on the capacity for 24 years (chapter 3). Brown’s talents classifi cations of lymphomas (chapter 6) and with were known beyond the walls of the MGH, and Dr. H. A. Stout on infectious mononucleosis. others came to MGH Pathology in the early years Dr. Gall left the MGH in 1940 to go into private of the twentieth century to use the photographic practice in Cincinnati, but he returned to aca- equipment. In a 1908 Festschrift honoring Dr. demic medicine and ultimately became Professor Fitz, an essay on multiple myeloma by Dr. Henry and Chairman of the Department of Pathology at A. Christian, fi rst Chief of Medicine at Peter the University of Cincinnati. He was also a father Bent Brigham Hospital, acknowledged Brown’s fi gure for pathologists in training and practice assistance in obtaining the high-quality photo- in southern Ohio and Kentucky for decades. He graphs used therein. was an international leader in pathology and held In 1928, two years after Tracy B. Mallory a number of prestigious positions in national and became Chief of Pathology, a new position of international societies. He wrote over 160 papers, Assistant Pathologist (distinct from the positions among which were seminal works on liver dis- occupied by Drs. Whitney and Hartwell) was ease. He remained Dr. Castleman’s close personal created, and Dr. John Bradley was appointed. friend throughout his life. In 1929 the Allen Street House was “completely An important addition to the staff in the mid- gutted,” according to Dr. Mallory. Th e autopsy dle years of Dr. Mallory’s tenure was Dr. Ron- room was remodeled and reequipped, and a ald C. Sniff en (1912–1966) (see fi gures 5.7, 7.7, room for photography and a small research labo- and 7.8). He was born in Pittsfi eld, Massachu- ratory were constructed on the second fl oor. In setts, went to medical school at the University of 1935 Dr. Mallory and Dr. Benjamin Castleman Toronto, and did his internship at St. Michael’s published their seminal paper on the pathology Hospital, Toronto. He then did a fellowship of the parathyroid glands in hyperparathyroid- with Sir Frederick Banting, followed by a year ism, heralding the long interest in pathology of as a junior assistant in pathology at the British

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Postgraduate Medical School in London. He Freiman had done an internship and residency then returned to the University of Toronto for six in pathology at Montefi ore Hospital in New months of further training in pathology and came York. He served on the MGH faculty until 1950 to the MGH in 1940 to continue his training. (see fi gure 5.8), and then worked with Dr. Gall Dr. Gall left three months later, and Dr. Sniff en at Cincinnati General Hospital before returning was appointed Assistant Pathologist, despite the to Boston in 1956 as Chief of Pathology at Beth fact that he had not yet completed his residency. Israel Hospital, a position he held until 1979. Dr. In a letter some years later, Dr. Castleman noted Freiman played a major role in medical student that during World War II, while Dr. Mallory was teaching at HMS and had a number of research away, Dr. Sniff en “carried a tremendous load of interests, including histochemistry, and wrote the routine—both autopsy and surgical pathol- major papers on sarcoidosis and beryllium dis- ogy. In fact, while I was out sick for two months, ease as well as on the pathogenesis of vascular he ran the entire department.” Dr. Sniff en had a thrombi. major interest in nonneoplastic testicular pathol- Near the end of Dr. Mallory’s tenure, Dr. Leon- ogy and wrote a number of papers in this area, ard Atkins (see fi gures 7.6, 7.16, and 13.2) joined and the observations made in those papers are the department. Dr. Atkins was born in Newark, a foundation for our knowledge of the normal New Jersey, in 1922 and received a bachelor of histology of the testis. In 1949, Dr. Sniff en left science degree from Yale University in 1942. He the MGH to become Director of Laboratories at then volunteered for the U.S. Army and served Memorial Hospital in Worcester, but he kept a with distinction in World War II, receiving the close association with MGH Pathology, where he Silver Star for extraordinary courage under fi re. came every Friday for the rest of his career until After returning home, Dr. Atkins obtained his his untimely death. medical degree from Johns Hopkins in 1950. He Th ree years after Dr. Sniff en joined the faculty, volunteered at the MGH in the summer of 1951 another person with major interest in genitouri- and shortly thereafter was appointed Assistant nary pathology joined the staff . Dr. Fathollah Resident in Pathology. Dr. Atkins quickly devel- (Kash) Mostofi (1911–2003) was from Iran and oped an interest in the new fi eld of chromosomal had trained from 1940 to 1943 in pathology at analysis (chapters 7 and 13). On being asked in the Peter Bent Brigham Hospital, Lying-In Hos- 1957 by the Commonwealth of Massachusetts to pital, Free Hospital for Women, and Children’s appoint a pathologist living in Suff olk County Hospital, all in Boston. In the summer of 1943, to succeed Dr. William Brickley as county medi- he was recruited to the MGH staff by Dr. Mal- cal examiner, Dr. Castleman chose Dr. Atkins. lory but he left in October of the next year for Th e job was to consume approximately one-half military service. Dr. Mostofi went on to a distin- of his time thereafter. In 1966–1967, Dr. Atkins guished career focusing on genitourinary pathol- became Acting Head of Legal Medicine at HMS. ogy. He was a major fi gure in the U.S.–Cana- Th roughout his long career at the MGH, Dr. dian Division of the International Academy of Atkins took his routine turn signing out surgi- Pathology. Although his time at MGH was short, cal pathology specimens in addition to his other Dr. Mostofi remembered his 15 months in the obligations as medical examiner and cytogeneti- department fondly and continued his connection cist. Dr. Atkins retired from the MGH in 2001 through MGH reunions held in conjunction with for health reasons. the annual United States and Canadian Academy Dr. Mallory’s last two recruits to the faculty, of Pathology (USCAP) meetings. Drs. Austin L. Vickery Jr. and Robert E. Scully, Dr. David G. Freiman (1911–2003) was were to be the two most dominant fi gures in MGH recruited the year after Dr. Mostofi , 1944. Dr. surgical pathology for the next 50 years (chapters

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9 and 10). Upon Dr. Castleman’s retirement in to 40 MGH operating rooms. A histotechnolo- 1974, Drs. Vickery and Scully became Co-direc- gist was devoted to cutting the frozen sections; tors of Surgical Pathology, stepping down from for many years this was Mertice Currier; later it those positions only late in their careers. It is also was Sven Holder. A resident and staff patholo- noteworthy that their relationship was more than gist were assigned to the area on a daily rotation. cordial, it was symbiotic (chapter 7); they helped Th is practice continues in the current, expanded each other with various hospital duties like two Surgical Pathology Laboratory on Blake 3, which soldiers in a single foxhole, and their contribu- was constructed in the early 1990s in conjunction tions to the daily fl ow of diagnoses were more with the new main Histology Laboratory imme- than the sum of their respective parts. diately across the corridor. Th e Blake 3 laboratory Another individual who trained at the MGH has two cryostats and three multiheaded micro- and served for a time on the faculty during Dr. scopes, one of which is connected to a camera Mallory’s tenure was Dr. Robert H. (Hank) Fen- that can be accessed electronically for review of nell (see fi gures 5.8, 7.6, and 19.6). He practiced slides elsewhere in the hospital or off -site. In this surgical pathology, but his most important con- laboratory the spatial proximity of frozen sec- tributions at the MGH concerned the develop- tions with specimen grossing has enabled more ment of cytopathology (chapter 19). effi cient and accurate setting aside of tissue sam- ples for specialized techniques such as immuno- Technical Advances in Surgical pathology, electron microscopy, fl ow cytometry, Pathology and Their and tissue banking, and for up-front dissections Implementation at MGH for research laboratories. Frozen Section Pathology Electron Microscopy Frozen section diagnosis began in Dr. Wright’s Electron microscopic examination for surgical era. In the 1950s and 1960s frozen sections were pathology began in the mid- to late 1960s, but performed in quarters adjacent to the gross- it had been used before for experimental work ing stations and formalin hoods, which in that by faculty such as Drs. David Spiro, Irwin Roth, era were situated in an alcove between the main James Caulfi eld, and Robert Trelstad (chapter 7). desk area for residents doing general pathology In 1975 the Electron Microscopy Unit was set up and a smaller desk area for residents doing neu- in Cox 5 and run by Dr. Ann Dvorak (chapter ropathology. Trainees and junior staff would cut 24). Th e unit included for the fi rst time a signifi - their own sections, whereas senior pathologists cant number of routine diagnostic cases, includ- were assisted by histotechnologists, who for the ing renal biopsies that were interpreted by Drs. most part were not specialized in the technique Robert McCluskey and Robert Colvin. In 1976, but were called upon on an ad hoc basis. In the when Dr. Ann Dvorak left the MGH for a posi- 1960s a self-contained cryostat was brought into tion at Beth Israel Hospital in Boston, Dr. G. service. Th is also was housed in the residents’ Richard Dickersin became director of the unit. laboratory, two feet from the nearest resident’s Dr. Dickersin (1927–) (see fi gures 7.7, 13.1, 13.2, desk and in a very busy area. One benefi t of this 23.5, 23.7, and 25.3) graduated from Johns Hop- positioning was that it was easy to fi nd many sets kins University and Jeff erson Medical College of of eyes in the immediate vicinity for consultation Philadelphia and did his training at Pennsylvania and instruction, but it was a noisy environment. Hospital in Philadelphia and the MGH. After In the 1970s the handling of surgical pathology additional time at the National Cancer Insti- specimens from the operating room was moved to tute and at the MGH, he was the head of the its own quarters on Gray 3, immediately adjacent Department of Pathology at the nearby Brockton

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Hospital from 1959 to 1971. Following an addi- research. For most of the existence of the depart- tional four years as a pathologist at Tufts–New ment, and for the most part still, the cases have England Medical Center, he returned to MGH been handled by a team of two individuals, the to direct Diagnostic Electron Microscopy. He staff pathologist and the resident. Th is time-hon- was the fi rst speaker at the New England Society ored system has served well by making sure that of Pathologists to lecture on electron microscopy most cases are seen fi rst by a resident but then by and published an outstanding atlas on diagnostic a staff pathologist. Junior faculty generally sign electron microscopy. Dr. Dickersin also did sur- out in a “sign-out booth” in the residents’ room, gical pathology until his retirement in 1999. but senior faculty juggling multiple responsibili- Upon Dr. Dickersin’s retirement, Dr. G. Petur ties on any one day often sign out in their offi ces. Nielsen, one of the bone and soft tissue patholo- Th e expectation that the resident will study gists (see below), became head of Diagnostic all the cases means that residents regularly work Electron Microscopy. To this day, the Electron late into the evening, which has resulted in the Microscopy Unit remains clinically very active, reputation of the department as demanding of its emphases on kidney, nerve/muscle, metabolic residents’ time and eff orts—but with the benefi t disease, and tumor diagnosis. that most of the trainees emerge at the end ready to be leaders in diagnostic pathology. Th e pairing Immunohistochemistry and also means that most of the cases are utilized for Immunofl uorescence teaching. From about the mid-1990s, a subset of Th e advent of immunohistochemistry and immu- cases has been handled only by a staff patholo- nofl uorescence has had a tremendous eff ect on gist, usually with the help of a pathology assistant the fi eld of surgical pathology over the past three in the case of large resection specimens, because decades. MGH Pathology was well positioned to the volume has become so great that it is imprac- take advantage of these advances because of its tical for every case to be seen by a resident. Th e successful Immunopathology Unit. Th is unit and sign-out of the cases has traditionally begun at its introduction of immunohistochemical and 8:00 every morning, which allows the resident immunofl uorescence assays for clinical diagnosis the previous afternoon or early evening to review are covered in detail in chapter 23. the cases on his or her own. Th is practice con- tinues, although with some modifi cations neces- Molecular Diagnostic Pathology sitated by recent resident work-hour rules. Molecular diagnostic pathology has also begun to Fellowships have been an important part of make major contributions to surgical pathology, the program over the years for both residents and primarily over the past 10 to 15 years. Advances in visitors desiring more clinical and research experi- this area at MGH are covered primarily in chap- ence. During the past 20 years, one- and two-year ter 25. fellowships in general surgical pathology and in some specialties have increased in number. As the The Interface of Clinical demands in anatomic pathology have increased, Service and Education: the fellowships have become increasingly popu- Sign-Out and Teaching lar and competitive. Since about the mid-1990s, named fellowships have existed, honoring dis- Sign-Out Activities and the Outs Conference tinguished former members of the department, Th e activities of those who have practiced sur- specifi cally Drs. Castleman, McCluskey, Vickery, gical pathology over the years have had three Scully, Wright, and Mallory, in addition to Drs. components: diagnostic service, teaching, and Priscilla and Edgar Taft, jointly. Th ere is also the

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Figure 16.4 A surgical pathology conference, 1950s. Benjamin Castleman is in the center. At the far left is E. P. Richardson Jr.; Winfi eld Morgan is between Drs. Richardson and Castleman.

Gillette Fellow in Women’s Cancers, focusing on Every afternoon from 2 to 3, I personally check breast pathology. More numerous than the spe- the interesting and problem microscopic slides cifi c fellowship positions have been visiting fel- of the surgical pathology specimens that have lows from all points of the globe. Th ese fellows come through that day. Th ese two hours [one have often been paid by their home institution hour autopsy in the morning and this hour in with the expectation that they would return after the afternoon] each day give me an opportu- a year at the MGH to take a leading role in their nity to actually know what is going on in the own institutions. Many, if not most, of these department and also give an opportunity to individuals have risen to the professorial rank, the various members of the department, who and several have become departmental chairman. are working on research problems or who are Although the fundamental teaching of resi- assigned to bacteriology, hematology, or chem- dents has been the one-on-one sign-out with the istry to return to the laboratory each day in the staff pathologist, the service has prided itself over morning before they start their regular work decades on the daily surgical pathology teaching and right after lunch before they start their conference, referred to as the Outs Conference afternoon’s work. (fi gures 16.4, 16.5, and 16.6). Th is term evolved Upon Dr. Castleman’s retirement, Dr. Aus- because cases were simply left out in the labora- tin Vickery took over primary responsibility for tory for the residents to review before the con- the Outs Conference. Increasing subspecializa- ference. For many years this conference was tion slowly aff ected the conference, the result conducted at 2:00 p.m. by Dr. Castleman. He being that certain days were devoted to specifi c refl ected on the Outs Conference: areas of surgical pathology, initially gynecologic

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pathology and dermatopathology. Nonetheless, the conference remained largely a session devoted to a mixture of “general surgical pathology” cases until complete subspecialization was instituted on July 1, 1995. At that time several of the one-hour conferences became split into two half-hour ses- sions; time is apportioned roughly to the respec- tive volumes of the subspecialty services. In some specialties the cases are mainly routine MGH ones, whereas in others they are consultation cases from around the world. At these sessions the resi- dents present their descriptions and opinions of a case, and the staff pathologist then makes his or her own remarks. Th e department has been proud of the continuance of this exercise for so many years, since it provides an educational benefi t for Figure 16.5 A surgical pathology conference, 1980s. the trainees. Th e downside has been that special- Robert Fienberg (left) and Eugene Mark are shown ists attend only their own conferences, and the with the “fl amethrower,” a device used to project interaction of senior pathologists commenting microscopic slides onto a screen. outside their specialty has been lost.

Figure 16.6 Surgical pathology conference, 2010. Ben Pilch (right) and William Faquin are at the currently used microscope, which features a digital camera.

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For many years, Dr. Walter Putschar (chapter 12) sat in the front row at the conferences, and his many insights will be remembered by many. Another who had a role somewhat similar to Dr. Putschar’s though on a part-time basis was Dr. Rob- ert Fienberg (1906–1998) (fi gure 16.5). Dr. Fienberg represented a unique blend of academic pathol- ogy with community practice. He graduated from HMS and trained with Dr. Lauren Acker- man at Pondville State Hospital under Dr. Shields Warren. Although he spent most of his career as Chief of Pathology at Beverly Hospital, Dr. Fienberg had particular interests in gynecologic and pulmonary pathology, especially Wegener’s granulomatosis, which he liked to term “pather- Figure 16.7 Booklet covers for the “Pathology of the gic granulomatosis.” He had met with Friedrich Endocrine Glands” course from 1964, and the “Current Wegener, who reportedly preferred Dr. Fienberg’s Concepts in Surgical Pathology” course from 2009 term. For decades while practicing at Beverly Hospital, he regularly attended the CPCs and pathology; both are still ongoing, the “fl agship came weekly to the Outs Conference. Dr. Fien- course” on surgical pathology having been given berg worked with Dr. McCluskey and Dr. Mark every November since 1978 (fi gures 16.7 and on granulomatous diseases. In later years he had 16.8). It has been off ered at a nearby hotel and a consultant position similar to Dr. Putschar’s, attended each year by 150 to 220 pathologists, with whom he shared an offi ce. primarily from North America, but signifi cant numbers from abroad also attend. Recently, Extramural Teaching small group slide tutorials and informal evening In addition to the many invited lectures and seminars have been added. Th e lectures are now seminars given locally, nationally, and interna- broadcast to the department by closed-circuit tionally by MGH surgical pathologists and their television so that residents who are on service can frequent participation in the CPCs (chapter 24), still profi t. Th e most recent course was “oversold” MGH surgical pathologists have played key roles by 25 attendees, some having registered for the in postgraduate medical education. Th e initial next course a year in advance. postgraduate course run by the department was At the time of this writing, postgraduate on endocrine pathology (fi gure 16.7). It was fi rst courses are also given annually on dermatopa- given in 1960 and directed by Drs. Castleman, thology, gastrointestinal pathology, thoracic Vickery, and Scully. Th e course was successful, pathology, and urologic surgical pathology. For but it was labor-intensive, requiring the prepara- several years a highly regarded course on breast tion of slide sets for study by the participants; it pathology was held in collaboration with pathol- was ultimately discontinued. Quickly, however, ogists from Memorial Sloan-Kettering Cancer it was replaced by a number of other courses, all Center, the site of the course alternating between under the auspices of Harvard Medical School Boston and New York. In addition, a workshop Department of Continuing Education. In the has been given in the fall for several years on pla- mid-1970s courses were instituted on gyneco- cental pathology. Beyond these exercises, begin- logic-obstetric pathology and on general surgical ning in the late 1990s, the department has given

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postgraduate courses at various off -site locations, classifi cations: Drs. Scully, Harris, and Louis (see current off erings being on general surgical pathol- Appendix). ogy in Scottsdale, Arizona, every January and Fort Myers, Florida, every March. Th e department has Participation of Surgical Pathology in cosponsored three separate courses in Italy, codi- Other MGH Departments rected by Drs. Robert H. Young and Juan Rosai. Most clinical services have a weekly, bimonthly, or Th ese have been given in Milan (2003), Florence monthly conference relating to surgical pathology (2006), and Riva del Garda (2009). Th ey have that goes back many decades. Perhaps most nota- all been most successful, the most recent draw- ble has been the weekly Surgical Grand Rounds, ing a record 511 registrants. For some years Dr. held every Th ursday at 8:30 a.m. in the Bigelow Rosai had the honorary title of visiting profes- Amphitheater. A staff pathologist generally repre- sor of pathology at Harvard Medical School in sents the department, although, sadly, pathology recognition not only of his remarkable contribu- is not called on now as frequently as it was earlier. tions to pathology but also of his close ties to the Th e Medical Service has held a weekly medical department. morbidity and mortality conference, usually Fri- An additional activity in Surgical Pathology day at noon and attended by senior and junior going back to the 1950s is participation by staff medical attending staff , house offi cers, and medi- and residents in pathology societies, particu- cal students. Th e chief resident or a senior resident larly the United States–Canadian division of the in pathology generally represents the department. International Academy of Pathology. In the ear- Each oncologic service has its own conference, lier years contributors focused on traditional sur- the longest-running ones being in gynecology gical and autopsy pathology and gradually pro- and orthopedics. Pediatrics has its own share of ceeded to incorporate histochemistry, electron conferences, usually one or two a month, includ- microscopy, immunochemistry, and molecular ing new specialty conferences for pediatricians in pathology. gastrointestinal and pulmonary diseases, where Many staff or alumni have served as President pathology plays an important role. of the New England Society of Pathology, whose meeting usually has taken place at the nearby The “Subspecialist” Surgical Museum of Science in Boston. Th e list of past Pathologists Presidents with MGH ties includes Drs. Vick- Over the past few decades surgical pathology has ery, Scully, McCluskey, Fienberg, Flax, and Bell; become subspecialized; MGH Pathology on July Dr. David Louis is scheduled to begin serving as 1, 1995, became the fi rst hospital department to President in 2011. A relationship has existed over achieve complete subspecialization. Th e follow- the decades with the Armed Forces Institute of ing sections cover the major areas of subspecialty Pathology (AFIP). Dr. Putschar served as a con- surgical pathology at MGH in alphabetical order, sultant in orthopedic pathology and anthropol- except for neuropathology and dermatopathol- ogy to the AFIP. Dr. Mark, in his role as a pathol- ogy, which are covered in chapters 17 and 18, ogist in the U.S. Army Reserve, served during respectively. In addition, although the current summer intervals at the AFIP. Several members department does not have a specifi c subspecialty of the department have also been authors of the in endocrine pathology (endocrine cases being AFIP fascicles: Drs. Castleman, Roth, Scully, covered according to the location of the organ), Young, Clement, DeLellis, Pitman, Louis, and endocrine pathology is covered separately below Lauwers (see Appendix). Faculty have also played because of the strengths in that area over the prominent roles in World Health Organization years. On the other hand, although obstetric

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Figure 16.8 Course directors and distinguished lecturers, “Current Concepts in Surgical Pathology,” early 2000s. Left to right: Andrew Rosenberg, Robert Young, Robert Scully, Juan Rosai, Judith Ferry, Eugene Mark.

and perinatal pathology is now a separate unit, C. Bloodgood of Johns Hopkins Hospital and it is handled under gynecologic pathology below. Dr. James Ewing of Memorial Hospital in New (Many of the individuals mentioned below are York City. Th e collection of tumors in the regis- pictured throughout this book, particularly in try was later given to the AFIP. fi gures 16.8, 16.9, and 16.10 and in chapters 5, 7, Another who contributed signifi cantly in the 13, and 25.) overall fi eld of musculoskeletal pathology was Dr. Granville A. (“Red”) Bennett (1901–1986). Bone and Soft Tissue Pathology He trained under Dr. S. Burt Wolbach, Shat- Dr. Ernest A. Codman (1869–1940) began the tuck Professor of Pathology at HMS and Chief MGH legacy of work in bone and joint pathol- of Pathology at Peter Bent Brigham Hospital. Dr. ogy. Dr. Codman, a surgeon, described the Bennett was recruited by Dr. Walter Bauer, Chief radiological and microscopic features of chon- of the Arthritis Unit, to be the unit histopatholo- droblastoma of the shoulder and wrote books on gist. Dr. Bennett wrote important papers on the the shoulder and on bone sarcomas. In 1920 he pathology of joint diseases and both rheumatic founded the fi rst tumor registry in the world, the and rheumatoid nodules, coauthored a book on Bone Sarcoma Registry, together with Dr. Joseph the pathology of the knee joint, and wrote the

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Figure 16.9 Robert Scully and some of his trainees and coauthors, 1990s. Left to right: Judith Ferry, Silvestro Carinelli, Debra Bell, Philip Clement, Jaime Prat, Robert Young, Robert Scully, Pascasio Aguirre, Richard Dickersin, John Eichhorn, William Welch, Dwayne Lawrence, Cynthia Flynn, Takako Kiyokawa, Esther Oliva, George Kleinman, Mahpareh Mostoufi zadeh. chapters on the bones and joints in Anderson’s York, a position from which he retired in 2010. Pathology. He later became Chief of Pathology at Dr. A. Kevin Raymond (1950–) trained in the Tulane Medical School and then at the Univer- department from 1976 to 1980 and from an early sity of Illinois College of Medicine at Chicago, stage in his training took a special interest in where he also served as Dean from 1954 to 1967. musculoskeletal pathology. Dr. Raymond subse- Beginning in the late 1950s this area was domi- quently served as the senior attending staff with nated by Walter Putschar. A physician infl uenced special interest in bone pathology at the M. D. by Dr. Putschar in the late 1960s was Dr. Alan L. Anderson Cancer Center in Houston. Schiller (1943–), a native of Brooklyn, New York, Dr. Andrew E. Rosenberg (1953–) succeeded who graduated from Chicago Medical School in Dr. Schiller as the senior orthopedic pathologist in 1967. He trained in pathology at the MGH and 1986. A native of Philadelphia, he attended Tem- took a special interest in orthopedic pathology as ple University School of Medicine and trained at well as autopsy pathology (chapter 15). Dr. Schil- the MGH as a resident in the early 1980s and ler was a dynamic speaker and received numerous was the last orthopedic pathologist to have the awards for teaching. He left the MGH in 1986 to good fortune to come under Dr. Putschar’s infl u- become Chairman of the Department of Pathol- ence. Dr. Rosenberg’s diagnostic skills were evi- ogy at Booth Memorial Medical Center in New dent from an early stage in his training, and his York and in 1988 became the Irene Heinz Given alert eye has led to his being widely recognized, and John LaPorte Given Professor and Chairman both locally and internationally, as an outstand- of Pathology at Mount Sinai Hospital in New ing microscopist. He has written extensively in

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both bone and soft tissue pathology, his particu- in the late 1980s and a fellowship in bone and lar interests being in skull-base tumors, epitheli- soft tissue pathology. Dr. O’Connell moved to oid vascular tumors of the skeleton, chordomas, Vancouver General Hospital at the University and the immunohistochemistry of soft tissue and of British Columbia and has contributed signifi - bone tumors. Dr. Rosenberg has given many cantly to the literature. Another recent graduate courses under the auspices of various societies of the program with special interest in muscu- and has lectured around the world. loskeletal pathology is Dr. Justin M. M. Cates Dr. G. Petur Nielsen (1962–) is a native of (1967–). Cates did a residency and a fellowship Iceland, where he did his initial training before year focusing on bone and soft tissue pathol- coming to the MGH in 1991 to complete his ogy in the late 1990s. He is currently the faculty training. He took an interest in bone and soft tis- member with senior responsibility for bone and sue disease from an early stage and has recently soft tissue pathology at Vanderbilt University. succeeded Dr. Rosenberg as head of the subspe- cialty. He has a wide range of interests within the Breast Pathology fi eld, but particularly noteworthy are his papers As the surgical department has always had an on mesenchymal tumors of the female genital active program in breast tumors, pathologists tract. Dr. Nielsen has also signed out in the uro- have gained considerable experience in this area. logic pathology group in the past and currently is Drs. Castleman, Scully, Vickery, and A. Jane also a member of the ENT group. Lingeman were all experts in this discipline. Dr. Dr. John X. O’Connell (1962–), originally Lingeman (1931–2003) was on the staff from 1974 from Dublin, did a residency in the department to 1985 and was a remarkably talented general

Figure 16.10 MGH surgical pathologists in the MGH Trustees Room, 2010 (not all pictured). Seated, left to right: Drucilla Roberts, Peter Sadow, Esther Oliva, Gregory Lauwers, Judith Ferry, Mari Mino-Kenudsen, Andrew Rosenberg. Standing: Eugene Mark, Chin-Lee Wu, Petur Nielsen, Melinda Lerwill, Kamran Badizadegan, Richard Kradin, Frederick Koerner, James Stone, Dennis Sgroi, Nancy Lee Harris, Robert Young.

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surgical pathologist. She had trained in part at fellowship in breast pathology and has authored Memorial Hospital in New York and had also a recent book on pathology of the breast. spent time in the hematopathology division of Since the early 2000s Dr. Dennis Sgroi (1961–), the AFIP. an MGH trainee, has directed the breast pathol- Dr. David L. Page (1941–), who became an ogy section while maintaining an active research internationally known expert in breast pathol- laboratory in molecular breast pathology. His ogy, trained at the MGH from 1967 to 1969. After laboratory has played a leading role in employ- leaving the MGH, Dr. Page spent time at Johns ing advanced gene expression and proteomic Hopkins Hospital and the National Institutes technologies to study breast cancer, and he has of Health before accepting a faculty position at identifi ed a gene expression signature that is both Vanderbilt University in Tennessee, ultimately prognostic and predictive of therapeutic response becoming Professor. His study of long-term to adjuvant tamoxifen. follow-up of patients with breast cancer and Other members of the breast sign-out team the categorization of early lesions and correlat- at the current time are Drs. Melinda F. Lerwill, ing them with therapy was a major contribution Elena F. Brachtel, John H. Eichhorn, Th omas to the fi eld, as was his textbook on breast cancer Gudewicz, and David C. Wilbur. Dr. Lerwill pathology. codirected the postgraduate course taught by In the 1970s through early 1980s, Dr. Karl Drs. Koerner and Brogi and has lectured exten- Proppe (1941–), from Iceland, worked in breast sively at other HMS courses because of her excel- pathology and other areas, including soft tissue, lent teaching skills. urologic, and infectious disease pathology. Dr. Proppe had trained in Iceland under Dr. Jónas Cardiac Pathology Hallgrímsson (chapter 7) and then done a resi- In the early years, cardiac pathology was mostly dency at MGH from 1970 to 1975. He joined the a facet of autopsy pathology, whereas diagnos- MGH faculty in 1975 and for many years was tic surgical pathology generally reviewed heart the Pathology representative at regular confer- valves, aneurysms, atherosclerosis, blood clots, ences with the breast surgeons. Dr. Proppe left and the rare tumor. Dr. Robert Scully maintained to become Chief of Pathology at Salem Hospital an interest in the fi eld for many years, and, with (now North Shore Medical Center), Salem, Mas- Benjamin Castleman, he ensured that cardiac sachusetts, and later established a private labora- cases with autopsies formed a prominent role in tory specializing in dermatopathology in Cam- the published CPCs (chapter 24). bridge, Massachusetts. Dr. John T. Fallon (1946–) was a resident and Th e role of senior breast pathologist passed in fellow in the department. He graduated from 1984 to Dr. Frederick (“Fritz”) Koerner (1948–). Albany Medical College in 1974 and trained Dr. Koerner, a native of Vermont, trained in part at MGH from 1974 to 1978 before joining the with Dr. Merle Legg at New England Deaconess faculty. He was the Chief of Pathology at the Hospital. He was the director of breast pathol- nearby Shriners Burns Institute for 10 years and ogy through much of the 1990s, and he has been one of the fi rst in the department to specialize active in teaching, participating in postgradu- almost entirely in cardiac pathology. In 1994 he ate courses in breast pathology, one of which was recruited by Alan Schiller to Mount Sinai was a conjoint course with another graduate School of Medicine, and has recently moved of the department, Dr. Edi Brogi, currently at to chair the Department of Pathology at New the Memorial Sloan-Kettering Cancer Center. York Medical College. Dr. Fallon has per- Dr. Koerner was instrumental in developing a formed important work in the progression of

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atherosclerosis, using magnetic resonance imag- ing and digital imaging. Endocrine Pathology Dr. James Southern (1947–) (chapter 15), who Th e department has long had expertise in the trained at the University of Oklahoma, directed pathology of the endocrine organs, namely para- cardiac pathology from 1986 to 1996. With the thyroids (Drs. Castleman and Roth), thyroid advent of heart transplantation at the MGH, Dr. (Drs. Vickery and Wolfe), adrenal (Dr. Cohen), Southern was in place to evaluate the subtleties of thyroid and adrenal (Dr. DeLellis), ovary (Dr. cardiac rejection. Scully), and testis (Drs. Sniff en and Scully). As Dr. H. Th omas Aretz (1948–), originally from a result, all but the most mundane cases in these Germany, became Director of Cardiac Pathology areas have been evaluated by one or more of these in 1996. Dr. Aretz had trained at the MGH in experts; this was the case even before offi cial sub- the late 1970s and then did a one-year fellowship specialization began. Comments are made here in cardiovascular pathology. After spending some only on those who do not receive coverage else- years at the Lahey Clinic and New England Dea- where in this book. coness Hospital, he returned to the MGH and Dr. Richard Cohen (1923–2006) (chapter 7) served as leader of the Cardiac Pathology Service trained in pathology initially at Beth Israel Hos- until late 2003, when he took a position as Vice pital in New York from 1948 to 1951 and then President for Education of the Harvard Medical moved to the MGH for further training, acting as International Group. He remains a consultant in both chief resident and research fellow in pathol- Pathology at the MGH. ogy from 1951 to 1954. He then joined the faculty Dr. Stuart Houser (1944–) joined the depart- at the MGH and was regarded as an outstanding ment in 1996 after a career in cardiothoracic sur- diagnostic surgical pathologist in many areas but gery at Saint Francis Hospital in Hartford, Con- with particular interest in the adrenal gland. His necticut. He trained in pathology at the MGH, investigative eff orts focused on histochemistry, did a three-year fellowship in cardiovascular and he wrote many original papers in that area, pathology, and then joined the staff in 2001. As a in regard to both the adrenal gland and to a lesser surgeon he had a superior knowledge of the anat- extent the ovary. Apart from this diagnostic and omy of the heart and of the surgery and surgical research activity, Dr. Cohen was an enthusiastic complications of heart disease, and this led to his and outstanding teacher at both the resident and single-authored treatise, Pathology of the Operated postgraduate level, the latter as a member of the Heart. He retired from pathology in 2008. faculty of the endocrine pathology course. He During the late 1990s and early 2000s Drs. remained on the staff of MGH until 1969, when Richard Kradin, Eugene Mark, Stuart Houser, he moved to Beth Israel Hospital in Boston to and Rex Neal Smith were the specialists for sur- become Codirector of Surgical Pathology. gical cardiac pathology. Dr. E. Dillwyn Williams (1929–) was a visit- Dr. James Stone (1967–), who obtained his ing fellow in the department from 1962 to 1963. medical and graduate degrees from the Univer- Dr. Williams was already known for his work in sity of Michigan, joined the department in 2003 endocrine pathology at that time, having worked after training at Brigham and Women’s Hospi- with the eminent British expert Professor Israel tal in anatomic and cardiac pathology. For the Doniach at London Hospital. Dr. Williams last six years he has headed the Cardiovascular became internationally renowned for his exper- Pathology section and has a special interest in tise in endocrine pathology, particularly thyroid amyloidosis and atherosclerosis, as well as endo- pathology, including seminal observations on thelial cell biology. medullary carcinoma. He subsequently became

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Professor of Pathology at the National University Medical Corps and staff pathologist in the Skin of Wales in Cardiff and thereafter was Professor and Gastrointestinal Branch of the AFIP in Wash- of Pathology at Cambridge University. Dr. Wil- ington, D.C. He returned to the MGH in 1962, liams served as President of the Royal College of rising to the rank of Associate Pathologist, before Pathologists and was knighted for his services to leaving in 1975 to become Professor and Chair- pathology. For many years he was a member of man of Pathology of the University of Arkansas the faculty of the endocrine pathology course Medical Center in Little Rock. At MGH he did and had a lifelong close friendship with both Drs. important work in the pathology of the para- Scully and Vickery. thyroid glands and coauthored the second series Dr. Ronald DeLellis (1941–) was a research fel- AFIP fascicle on the parathyroid glands with low and intern in MGH Pathology from 1966 to Benjamin Castleman. In 1981 he joined the fac- 1967. His experience with endocrine pathology ulty of Northwestern Memorial Hospital in Chi- stimulated his contributions to the fi eld over the cago. In 2000 he became Professor Emeritus at years, fi rst at Tufts–New England Medical Cen- Northwestern, and he returned to the MGH as a ter, then as Vice Chairman and Director of Ana- consultant in Pathology. tomic Pathology at New York Hospital, Cornell Currently, those surgical pathologists with Medical Center from 1998 to 2001, and then as interests in endocrine pathology are in the ENT Pathologist-in-Chief at Rhode Island Hospital in group (see below). Providence. He has written extensively on thy- roid diseases, particularly issues related to C-cell ENT and Eye Pathology hyperplasia and medullary carcinoma, and coau- Th e strong tradition of the study of head and thored the third series AFIP fascicle on the thy- neck pathology dates back to the early days of Dr. roid gland. His interests have extended to para- James Homer Wright’s tenure when Dr. Joseph thyroid disease and disorders of the adrenal gland. Lincoln Goodale (an otolaryngologist at MGH With Dr. Hugh Wolfe (see below) and others he from 1895 to 1907) wrote a series of papers on also wrote extensively on immunohistochemistry ENT pathology, many of which are still available in many endocrine conditions. as bound reprints in the offi ce of the Chief of Dr. Hugh Wolfe (1934–2001) had a career that Pathology. (Dr. J. L. Goodale was a cousin of Dr. to some degree paralleled Dr. DeLellis’s, as the Fairfi eld Goodale; see chapters 7 and 15). two were good friends and colleagues at Tufts– Surgical pathology at Massachusetts Eye and New England Medical Center and at MGH. Dr. Ear Infi rmary (MEEI) has been a close relative of Wolfe was a graduate of the University of Louis- the main department for approximately a century. ville. After an internship in pathology at the Mal- Dr. Harris P. Mosher (1867–1954) was Chief of lory Institute of Pathology at Boston City Hos- Otolaryngology at MEEI and Professor of Otolar- pital, he trained at MGH from 1960 to 1964 and yngology at HMS from 1922 until 1939. He gave then stayed on the faculty until moving with Dr. an annual postgraduate course in head and neck DeLellis to Tufts when Dr. Martin Flax assumed anatomy beginning in 1922. He established the the chairmanship there. Dr. Wolfe played an Mosher Pathology Laboratory at MEEI, where active role in academic aff airs at Tufts and also in histologic slides were prepared for his course and the International Academy of Pathology. biopsies were processed and interpreted. Subse- Dr. Irwin Roth (1932–) graduated from HMS quently, Dr. Werner Mueller (1892–1965) ran the in 1956 and completed his residency in pathol- laboratory and consulted on cases. ENT pathol- ogy in 1960. He then entered the U.S. Army and ogy had been physically separated from general served two years as a captain in the U.S. Army surgical pathology at MGH because the operating

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rooms at MEEI were in a diff erent building with a in 1955. He spoke with a soft southern gentility separate facility for frozen sections. and a modest twang. He trained in pathology Upon Dr. Mueller’s retirement in 1962, the fi rst at the City of Memphis Hospital and then new Chief of Otolaryngology, Dr. Harold F. at the Mallory Institute of Pathology at Boston Schuknecht (1917–1996), asked Dr. Castleman to City Hospital from 1958 to 1961. For a brief time recommend a board-certifi ed pathologist to take after completion of his training, Dr. Goodman on the leadership of the pathology department was on the faculty at Emory University Medi- and be director of ENT pathology. Th is position cal School, serving for a time as Acting Chair- was off ered to Dr. Karoly Balogh (1930–). Dr. man, but he returned in 1962 to Boston Univer- Balogh, a native of Budapest, had immigrated to sity School of Medicine, where he stayed until the United States in 1956. After being a Rock- joining the MGH faculty. Dr. Goodman’s offi ce efeller Fellow at the Department of Pathology was at MEEI, but he was a constant presence in at Tulane University in New Orleans, he joined MGH Pathology. He suff ered a fatal stroke while MGH Pathology as a clinical research fellow in on a fi shing excursion; his sudden death was a 1958. While at MGH he published many papers great blow to the department not just because of relating to general surgical pathology, enzyme his- his diagnostic acumen but because of his genial tochemistry, and ENT pathology with a research personality. Few have been as popular with staff focus on the inner ear. Dr. Balogh moved to and residents over the years. Even 15 years later, Boston University Hospital in 1968, where he those who fondly remember him miss discussing became Professor, and he subsequently moved the weekend sporting events with him on Mon- in the mid-1970s to Deaconess Hospital in Bos- day mornings. ton and was then on the staff of the merged Beth Dr. Benjamin Pilch (1944–) succeeded Dr. Israel Deaconess Medical Center. Goodman as Chief of Pathology at MEEI. Dr. During these years the Pathology Laboratory Pilch had trained for a brief time in surgery in was initially on the third fl oor of MEEI and Michigan and came to MGH in 1973 as a resi- included two large rooms, one for the secretary dent. At the conclusion of his residency, having and another for histochemical research. Speci- worked closely with Dr. Goodman, he specialized mens were processed at MGH, and MEEI paid in ENT pathology and later edited a textbook for the processing. In this manner the specimens on the subject that Dr. Goodman had initially could be used for training purposes at MGH. undertaken. Dr. Pilch had a Broadway-caliber Th e separation of MGH Pathology from MEEI showmanship when talking at staff meetings or Pathology continued through the 1970s. Th ere giving lectures, and he was always able to lighten was a separate accessioning system: MGH speci- up any topic. He was a renowned diagnostician mens began with the letter S and MEEI speci- and consultant to many members of the depart- mens began with the letter E. Th e E slides were ment on numerous issues. ENT surgeons often stored at MEEI. called him to review frozen sections even when Dr. Max L. Goodman (1932–1996) succeeded he was not on duty for frozen sections, and he Dr. Balogh. He had been recruited by Dr. Castle- always gracefully accepted the duty. He retired in man in 1968 from Boston University to be Direc- 2009. tor of ENT Pathology at MEEI. He published Dr. William C. Faquin (1959–), an HMS grad- over 100 papers. His knowledge of ENT pathol- uate, became chief of MEEI Pathology in 2009. ogy was great, and he was regarded as an excel- He had trained in pathology at Brigham and lent teacher. Dr. Goodman was from Tennessee Women’s Hospital and had already made signifi - and graduated from the University of Tennessee cant strides in diagnostic service, research, and

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teaching before succeeding as chief. He also has during which years he was considered an out- a major interest in cytology and has coauthored standing resident. He went on to have a dis- books on the cytopathology of the thyroid and tinguished career focusing on gastrointestinal salivary glands. pathology. After leaving the MGH, Dr. Ming More recent recruits to the faculty in ENT was a surgical pathologist at Beth Israel Hos- pathology are Drs. Peter Sadow and Jennifer L. pital, Boston, until 1967. He then spent sev- Hunt. Dr. Sadow trained at Brigham and Wom- eral years at the University of Maryland before en’s Hospital and focuses on thyroid diseases. Dr. being recruited in 1971 as Professor of Pathology Hunt came to the MGH from the Cleveland at Temple University Medical School, where he Clinic, where she had risen to prominence in remained for the rest of his career. Dr. Ming con- anatomic pathology because of her work in ENT tributed signifi cantly to the literature on gastro- pathology. As noted earlier, Dr. Petur Nielsen intestinal pathology and also had a major interest also is part of the ENT group. in autopsy pathology. He was the senior author MEEI has separate ENT and Ophthalmol- of the second series AFIP fascicle on tumors of ogy departments, and the Eye Pathology group the esophagus and stomach. Dr. David Freiman has not had as close a relationship with MGH (see above and chapter 5), who was Dr. Ming’s Pathology as has the ENT Department; the chief at Beth Israel Hospital, described him as the Cogan Laboratory for Ophthalmic Pathology has best surgical pathologist he had ever seen. always been a separate entity in the Department Dr. David L. Gang (1946–) was a staff pathol- of Ophthalmology. Over the years, prominent ogist from 1976 to 1985 and during those years ophthalmic pathologists have been primarily took special interest in gastrointestinal and pedi- ophthalmologists and have included Drs. Daniel atric pathology as well as doing routine general Albert, Th addeus Dryja, and Frederick Jakobiec. surgical pathology. He was highly regarded by In recent years Dr. Anat O. Stemmer-Rachami- his colleagues from both pathology and the clini- mov, a neuropathologist (chapter 17), has also cal staff , the latter appreciating his conducting covered the Eye Pathology Service. Over the past many conferences for them. Dr. Gang left for the decade, MGH Pathology has undertaken the University of Massachusetts in 1985 and is cur- processing of all eye pathology specimens for the rently at Baystate Medical Center in Springfi eld, ophthalmic pathologists. Massachusetts. Dr. Carolyn Compton (1947–) joined the MGH Gastrointestinal Pathology Pathology faculty in 1985 as the fi rst formally des- Drs. Edward Gall (see above and chapter 5) and ignated Director of Gastrointestinal Pathology. Austin L. Vickery (chapter 9) were authorities She was an HMS graduate who had trained at in gastrointestinal pathology; Dr. Gall was par- Brigham and Women’s Hospital, then worked at ticularly interested in the liver. Cooperating with the University of Massachusetts Medical School Dr. Vickery as the gastrointestinal pathology spe- in Worcester. She was interested in colonic and cialist in the 1970s was Dr. James J. Galdabini pancreatic neoplasia, among other issues, and had (chapter 7), who had trained at the MGH in the a research program focusing on skin regeneration late 1960s and was considered one of the best all- after burns. With this latter interest, she served around surgical pathologists of his era. He was as Chief of Pathology at Shriners Burns Institute. also particularly interested in liver disease. Dr. She was active in teaching HMS students and, in Galdabini left the MGH in 1981. conjunction with Dr. Robert Odze of Brigham Dr. Si-Chun Ming (1922–), originally from and Women’s Hospital, initiated a successful post- China, trained at the MGH from 1952 to 1956, graduate course on gastrointestinal pathology that

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continues to this day. Dr. Compton became Chair Beginning in the mid-1970s the gynecologic and of Pathology at McGill University in Montreal in testicular specimens were evaluated separately. 2000 and moved from there to become Director Th e story of gynecologic pathology at the MGH of the National Cancer Institute Offi ce of Biore- is dominated by the contributions of Dr. Robert positories and Biospecimen Research in 2005. Scully (chapter 10), but many others have also With Dr. Compton’s departure in 2000, Dr. contributed signifi cantly. Gregory Y. Lauwers (1958–) was recruited to head Th e fi rst major work in gynecologic pathology the division. Dr. Lauwers, originally from Paris, at MGH came from a surgeon, Dr. Joe Vincent had been working at the University of Florida in Meigs (1892–1970) (see fi gure 19.2). He was a 1919 Gainesville after training at Lenox Hill Hospital HMS graduate and initially trained in surgery and Memorial Sloan-Kettering Cancer Center in under the leading Harvard gynecologist of that New York. Over the past 10 years he has brought era, Dr. Wilbur P. Graves of the Free Hospital together a large and academically productive for Women. In the early 1920s Dr. Meigs became group of gastrointestinal pathologists. Dr. Lau- an assistant to Dr. George Brewster of the MGH wers’s interests center on neoplasia of the upper and soon became greatly interested in gyneco- gastrointestinal tract, but he has published exten- logic cancer. Dr. Meigs was appointed Chief of sively in other areas of gastrointestinal pathology Gynecology at the Pondville State Cancer Hospi- and is coauthor of the latest AFIP fascicle on the tal in Norfolk, Massachusetts, in 1927, a position stomach. He was appointed Director of Surgical he held for thirty years. He became Chief of the Pathology in 2008 and Vice Chair of the depart- Vincent Memorial Hospital Service of the MGH ment in 2011. in 1931 and reviewed all the pathology material Dr. Rhonda K. Yantiss (1969–) did a residency of his cases and incorporated his experience into and then fellowship in the department in the late his well-received 1934 book, Tumors of the Female 1990s and has become known for her work in Pelvic Organs. Dr. Meigs maintained his inter- gastrointestinal pathology, which began during est in gynecologic pathology throughout his life. her training at the MGH. She is currently on the When Robert Scully came to the hospital in the faculty of Weill Cornell Medical College in New early 1950s and became the consultant in gyne- York City, where she focuses on gastrointestinal cologic pathology, he frequently interacted with pathology. Dr. Meigs and his colleagues, who often came to Other current members of the gastrointestinal Pathology to review unusual cases and to discuss pathology faculty (and their academic emphases) their management. Dr. Meigs also was an early are Dr. Vikram Deshpande (pancreas), Dr. Fiona proponent of cytology in the MGH and beyond Graeme-Cook (who serves in a consultant capac- (chapter 19). He is immortalized in the eponym ity, with expertise in the liver), Dr. Joseph Misdraji “Meigs syndrome” (ascites and hydrothorax due (liver and appendix), Dr. Mari Mino-Kenudson to a fi bromatous ovarian tumor), even though (pancreas), Dr. Martha B. Pitman (pancreas), Dr. he acknowledged he was not the fi rst to note the Kamran Badizadegan (pediatrics), and Dr. Law- association. rence Zukerberg (general gastrointestinal). Many of Dr. Scully’s residents and fellows have gone on to make signifi cant contributions to the Gynecologic and Obstetric Pathology fi eld of gynecological pathology (fi gure 16.9). For most of the history of the department, speci- Dr. Robert J. Kurman (1943–), after graduating mens from the female and male reproductive from Upstate Medical Center in Syracuse, came system and obstetric pathology were handled under the infl uence of Dr. William B. Ober of by the general surgical pathology sign-out staff . Beth Israel Hospital in New York, an eminent

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gynecologic pathologist and medical historian. of the College of Pathologists, a leader in the After further training at Peter Bent Brigham development of the systemized nomenclature Hospital in Boston, Dr. Kurman became, in of medicine (SNOMED) for pathology. In 1984 1971, the second American Cancer Society Fel- Dr. Robboy left the MGH to become Professor low under Dr. Scully’s direction. Dr. Kurman of Pathology and Chief of Pathology at the Col- subsequently completed his training as one of lege of Medicine and Dentistry of New Jersey in the small number of physicians board-certifi ed Newark. A few years later he became Professor in both pathology and obstetrics and gynecol- of Pathology and Chief of Anatomic Pathology ogy. In the late 1980s Dr. Kurman was Professor at Duke University Medical Center. In 2010 he of Pathology and Obstetrics and Gynecology at was elected President of the College of American Georgetown University School of Medicine, but Pathologists. he was then recruited to Johns Hopkins Univer- Another trainee of Dr. Scully’s who has attained sity Medical School to become the Richard W. international eminence because of his contribu- TeLinde Distinguished Professor of Pathology tions in gynecologic pathology is Dr. Philip B. and Obstetrics and Gynecology. Dr. Kurman’s Clement (1946–), a native of British Columbia, interests have resulted in seminal observations where he attended medical school. Dr. Clement concerning trophoblastic disease, ovarian tumor was a resident at the MGH from 1970 to 1974 pathology, and cervical neoplasia. Dr. Kurman and then did a one-year fellowship in gynecologic succeeded Dr. Ancel Blaustein as the Editor of pathology with Dr. Scully. Dr. Clement then the well-known text Blaustein’s Pathology of the returned to his home city of Vancouver, where Female Genital Tract and was President of the he has served at Vancouver General Hospital as International Society of Gynecological Patholo- Professor of Pathology. Dr. Clement has writ- gists from 2006 to 2008. ten many original papers in gynecologic pathol- Another individual who came under Dr. Scul- ogy and has a particular interest in mesenchymal ly’s infl uence at around the same time as Dr. Kur- and mixed tumors of the uterus, nonneoplastic man was Dr. Stanley J. Robboy (1941–). A 1965 lesions of the ovary, and peritoneal lesions. He graduate of the University of Michigan Medi- was a coauthor of the third series AFIP fascicle, cal School, Dr. Robboy became a resident at the Tumors of the Ovary, Maldeveloped Gonads, Fal- MGH in 1966. He was the fi rst American Cancer lopian Tube and Broad Ligament, and served a Society Fellow under Dr. Scully in 1967 and, with record 10 years as Editor in Chief of the Interna- the exception of two years in the Army as Chief tional Journal of Gynecological Pathology. of Pathology at the Army hospital in Fort Knox, Dr. Jaime Prat (1944–) joined the faculty in Kentucky, was on the staff at the MGH until 1976 after initial training in his home country 1984. Dr. Robboy has made many contributions of Spain and as a fellow at Memorial Sloan- to gynecologic pathology. During his MGH years Kettering Cancer Center. Dr. Prat remained on Dr. Robboy was active in the study of the eff ects the MGH faculty until 1981, when he returned to on the female genital tract of prenatal exposure Spain, initially in Alicante and since 1986 as Pro- to diethylstilbestrol (DES) and was a founding fessor and Chairman at the Hospital de la Santa codirector of the continuing postgraduate course Creu i Sant Pau of the autonomous University of on gynecological and obstetrical pathology. He Barcelona. He served as President of the Interna- was one of the fi rst pathologists to actively pursue tional Society of Gynecological Pathologists from the computerization of surgical pathology (chap- 2008 to 2010 and has held many other prestigious ter 13), and he has long maintained an interest positions in academic pathology. His contribu- in this area as well as being, under the auspices tions to the literature have spanned many areas

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of gynecologic pathology and have included both University of Alabama. Dr. Lawrence joined the conventional morphologic interpretation as well faculty in 1982 and remained at MGH until 1985, as translational research. when he left to take up the position of Direc- Dr. William R. Welch (1944–) joined the tor of Anatomic Pathology at Hutzel Hospital department in 1974 as a clinical fellow funded in Detroit, where he remained until 2000. He partly by the American Cancer Society and was then appointed Chief of Pathology at the remained on staff for three years as a faculty Women and Infants Hospital in Providence, member in gynecologic pathology. Dr. Welch Rhode Island, where he currently practices. Dr. obtained his medical degree from Duke Univer- Lawrence has made many contributions to the sity and trained at the Upstate Medical Center literature and is a highly regarded teacher. in Syracuse, New York. He was one of the group Dr. Debra A. Bell (1953–), a 1976 graduate of under Dr. Scully’s direction who worked exten- Albany Medical College, joined the department sively on the DES-induced lesions in the vagina after training in pathology at New York Univer- and on endometrial hyperplasia. In 1979, Dr. sity Medical Center and undertaking a fellowship Welch moved to Brigham and Women’s Hospi- in cytopathology at Memorial Sloan-Kettering tal, where he still serves as a senior member of the Cancer Center. She was on the faculty at MGH faculty in gynecologic pathology. from 1982 to 2008 before being recruited to the Dr. Robert H. Young (1950–), a native of Mayo Clinic in Rochester, Minnesota, where she Northern Ireland and graduate of Dublin Uni- is currently Professor in Laboratory Medicine versity, joined the department in 1977 as a resi- and Pathology. Dr. Bell has particular expertise dent, was subsequently a fellow in gynecologic in gynecologic pathology and cytopathology and pathology, and since 1981 has been a member has written extensively, including a number of of the faculty. Dr. Young specialized initially in seminal papers on surface epithelial neoplasms. gynecologic pathology with Dr. Scully and sub- She is renowned both as a diagnostician and as sequently also took a major interest in urologic a teacher. pathology. He has written extensively in both Dr. Joanne K. L. Rutgers (1955–) was an Amer- areas and, in addition to coauthoring three AFIP ican Cancer Society Clinical Fellow in gyneco- fascicles, has written books on the testis, bladder, logic pathology from 1986 to 1988. Her academic and uterus and served on senior editorial boards productivity continued after she left the MGH to of many pathology journals. Dr. Young also has practice in California. She was a member of the a major interest in the history of pathology and World Health Organization group on the classi- in 1996 instituted a series of historical essays that fi cation of breast and female genital tract tumors. appear in the International Journal of Gynecologi- Th e other faculty specializing in gynecologic cal Pathology. For some years Dr. Young served as pathology at this time are Drs. W. Stephen Director of Surgical Pathology and then Director Black-Schaff er, John H. Eichhorn, Melinda F. of Anatomic Pathology at MGH, and at this writ- Lerwill, Esther Oliva, Drucilla J. Roberts, Rose- ing he is the leader of the Gynecologic Pathology mary Tambouret, and David C. Wilbur (chapter and Urologic Pathology subspecialty groups. Dr. 19), who directs the annual HMS postgradu- Young serves as the inaugural Robert E. Scully ate course on gynecological pathology with Dr. Professor of Pathology at HMS. Young. Dr. Eichhorn trained at the MGH and Dr. Dwayne Lawrence (1947–) trained in ana- has written on ovarian tumors. Dr. Lerwill (see tomic pathology at MGH from 1979 to 1982 above, under “Breast Pathology”) has coauthored and had an early interest in gynecologic pathol- the chapter on metastatic tumors to the ovary in ogy prompted by his postgraduate work at the the Blaustein textbook. Dr. Oliva, originally from

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Barcelona, Spain, trained under Drs. Scully and in 1980 and was one of the fi rst in the United Young. She has made widely recognized contri- States to utilize the application of immunohisto- butions to the gynecologic pathology literature, chemistry to the diagnosis and subclassifi cation relating particularly to uterine neoplasia, and lec- of malignant lymphomas. She has contributed tures throughout the world. numerous original reports to the literature and In the late 1990s MGH reestablished its played a crucial role in arriving at the modern Obstetrics Service (which had been closed classifi cation of malignant lymphomas, serving decades earlier), which necessitated hiring a spe- on many important groups that have advanced cialist in obstetric and perinatal pathology and that area, such as the Revised European-Amer- the separate evaluation of those specimens. In ican Lymphoid (REAL) Classifi cation and the 1994 Dr. Drucilla J. Roberts (1955–), a 1985 HMS current World Health Organization Classifi ca- graduate, was recruited from Brigham and Wom- tion of Hematologic Neoplasms. She has edited en’s Hospital to MGH. She had trained initially or written a number of books, including one as an obstetrician-gynecologist at Brigham and with her colleague Dr. Judith Ferry. In addition Women’s but then changed course to complete to her academic contributions, Dr. Harris has training in pathology. She has been a dynamic served the department in a number of leadership leader in developing an obstetrical and perinatal capacities: Director of Hematopathology; Direc- pathology group and over recent years has had tor of Surgical Pathology for seven years; Direc- the assistance of Drs. Esther Oliva and Rosemary tor of Anatomic Pathology for almost as long; Tambouret. Dr. Roberts is also involved in global and director of all pathology training programs. health initiatives in underdeveloped countries, In 2002 she succeeded Dr. Robert Scully as the emphasizing maternal health and the role of Editor of the MGH Case Records (chapter 24) pathology in this eff ort. and is the inaugural Austin L. Vickery, Jr. Profes- sor of Pathology at HMS. Hematopathology In 2010 Dr. Harris relinquished her position as Th e tradition of hematopathology dates back to Director of Hematopathology so that she could the seminal observations of James Homer Wright spend more time on the Case Records; she was (chapter 3) and Drs. Gall and Mallory’s impor- succeeded by Dr. Judith A. Ferry (1957–). Dr. tant paper on malignant lymphoma (chapter Ferry had obtained her medical degree from New 6). Many general surgical pathologists practiced York University and trained in pathology at the hematopathology at a high level over the years, MGH in the mid-1980s. After a two-year fellow- particularly Dr. A. Jane Lingeman, who played ship, sponsored partly by the American Cancer an important role in this area in the late 1970s Society, she joined the faculty in 1986. Dr. Ferry’s and early 1980s. Dr. John C. Long was the fi rst to teaching skills, diagnostic acumen, and wonder- focus solely on this area but was dismissed from ful personal qualities have made her one of the the institution (chapter 13). mainstays of the staff for almost a quarter of a Th e current high standing of this discipline century, and she is widely known for her work in within the department is due in signifi cant mea- hematopathology, having a particular interest in sure to the contributions of Dr. Nancy Lee Har- extranodal lymphomas, on which she has com- ris (1943–), who has headed the unit for most of pleted a book, Extranodal Lymphomas: A Site- the last quarter century. Dr. Harris trained in Specifi c Approach to Diagnosis. pathology at Beth Israel Hospital, Boston, from Other faculty members specializing in hema- 1974 to 1978 before coming to MGH to serve topathology are Drs. Robert Hasserjian (who has as a fellow for two years. She joined the faculty particular interest in leukemias and thymomas

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and directs the hematopathology fellowship), Institute in Sussex. He became Professor and Abner Louissaint, Aliyah Sohani, and Lawrence Head of Pathology at the University of Manitoba Zukerberg. in Winnipeg in 1975, where he remained for fi ve years. He completed his academic career at the Medical Renal Pathology University of British Columbia, as he contin- Th e degree of sophistication of renal biopsy inter- ued in his investigations into airway resistance pretation paralleled the developments in that until his death. Dr. Th urlbeck devised quantita- fi eld in the 1960s, specifi cally in the incorpora- tive measurements of the bronchus that led to tion of immunologic techniques and ultrastruc- understanding of the anatomy and function of tural evaluation. Dr. Robert T. McCluskey had the airways and small airways disease. He was his primary clinical and research interest in this an infl uential member of the College of Chest area (chapters 14 and 23), and Dr. Robert Colvin Physicians and edited a book entitled Pathology of (chapters 23 and 25) had an interest in the subject the Lung through two editions; the third edition from his early training days and is the current was named in his honor posthumously. He was head of the MGH renal subspecialty group. Drs. known for his ribald sense of humor and eff er- McCluskey and Colvin have been the mainstays vescence. He never turned down an invitation: of the diagnostic service for the last few decades, when asked if he would be willing to give a talk, and in recent years they have been assisted by his answer was “I am setting up a folder for that Drs. Eveline Schneeberger and R. Neal Smith. right now.” MGH trainees who have gone on to careers in Dr. James Hogg (1935–) graduated from the academic renal pathology include Drs. Vivian University of Manitoba in 1962 and then earned a Pinn (see chapters 7 and 23), Shane Meehan at Ph.D. at McGill University. He was a resident at the University of Chicago, and Volker Nickeleit the MGH from 1969 to 1970 and then returned at the University of North Carolina. to McGill to complete his residency training, after which he joined the faculty there for sev- Pulmonary Pathology eral years. His academic interests have been in A number of MGH graduates have gone on to the pathophysiology of obstructive lung disease academic careers centered on lung pathology, and its anatomic basis. For most of his career he including Drs. William (“Whitey”) Th urlbeck, has been Professor of Pathology at the Univer- James Hogg, Mario Saldana, and Gerald Nash. sity of British Columbia, where he is currently an Dr. Th urlbeck (1929–1997), a South African, emeritus professor. received his medical degree from the University Dr. Mario Saldana (1933–) served as a fellow in of Cape Town. He came to the MGH in 1955 to surgical pathology in the department from 1969 train in anatomic pathology and was chief resi- to 1970. Dr. Saldana, a native of Peru, came to dent from 1957 to 1958 (see fi gure 7.19). He then the United States in 1963 and worked initially at became a postdoctoral fellow in the laboratory Yale University with Dr. Averill Liebow, one of of Dr. Lynne Reid, fi rst at Brompton Hospital the authorities in pulmonary disease. After leav- in London and then at Children’s Hospital in ing the MGH, Dr. Saldana fi rst went to the Uni- Boston, where Dr. Reid was Chair of Pathology. versity of Pennsylvania and then served for many Dr. Th urlbeck left HMS for a position at McGill years on the faculty of the University of Miami University in 1961, where he stayed for 10 years Medical School, rising to the rank of Professor. before spending a year on sabbatical at the Nuf- His interests in hematopathology, pulmonary fi eld Department of Surgery at Oxford. He then disease, and infectious disease led him to write spent fi ve years at the Midhurst Medical Research often-quoted articles on lymphoproliferative

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diseases in the lung and the interpretation of interests have centered on Wegener’s granulo- vasculitis. matosis (stimulated by Dr. Fienberg; see above) Dr. Gerald Nash (1937–) trained in the depart- and malignant mesothelioma, and he is a colonel ment from 1964 to 1968 and was then called to (retired) in the U.S. Army. active duty at the U.S. Army Institute of Surgi- Dr. Douglas Flieder (1965–), who gradu- cal Research, Fort Sam Houston, San Antonio, ated from the University of Rochester School of Texas. On the basis of that experience he stud- Medicine and Dentistry in 1992, trained in gen- ied and wrote on the lung in severely burned eral pathology at the MGH and worked closely patients, including diff use alveolar damage and with Dr. Mark in pulmonary pathology. He fi rst infections. After his military service, he returned went to the pulmonary and mediastinal branch to MGH Pathology in 1971 and became the pul- of the Armed Forces Institute of Pathology for monary pathologist for three years before taking two years, then to Cornell University, and is now a position at Cedars-Sinai Medical Center in Los Director of Surgical Pathology at Fox Chase Can- Angeles and the UCLA Medical Center. He then cer Center in Philadelphia. practiced at Baystate Medical Center in Spring- Current faculty doing pulmonary pathology fi eld, Massachusetts, and more recently at Mercy in addition to Dr. Mark are Drs. Richard Kradin Hospital in that city. and Mari Mino-Kenudson. Dr. Kradin trained in Dr. Eugene J. Mark (1942–) succeeded Dr. medicine at the University of Pennsylvania, and Nash as Director of Pulmonary Pathology. A then as a pulmonary fellow at MGH. He worked native of Ohio and a 1967 HMS graduate who with Dr. Robert McCluskey on immunopathol- had done a year in pathology at the University ogy, including immunopathology of the lung. He of Zurich, Dr. Mark trained as a medical intern has edited a recent textbook, Diagnostic Pathology at Stanford University and did his pathology of Infectious Disease. Dr. Mino-Kenudson trained training at MGH. Having studied under Mar- as a pulmonologist in Kyoto, Japan, and then tin Mihm and later becoming board-certifi ed studied with Dr. Mark. Her research focuses on in dermatopathology, he joined the staff to do molecular aspects of carcinomas of the lung and dermatopathology. In the interval between his pancreas, the latter related to her practice in gas- departure from active duty with the U.S. Army trointesintal pathology. in Landstuhl, Germany, and his return, how- ever, Dr. McCluskey told him that a more press- Urologic Pathology ing need was for director of the nascent Pulmo- Until 1996 urologic pathology was not separately nary Pathology and that he would be given that subspecialized and fell within the domain of gen- responsibility until a substitute could be found, eral surgical pathology. Th ere had in previous after which he could return full-time to dermato- years been individuals with special expertise in pathology; no substitute was ever appointed. Dr. this area of pathology, however, including Drs. Mark’s work in pulmonary pathology increased Ronald Sniff en and Robert Scully, who both over the next few years, while his obligations in wrote on the pathology of the testis (see above dermatopathology diminished. Dr. Mark was and chapter 10). Dr. Austin Vickery also had a the single author of the 1984 book Lung Biopsy signifi cant interest in urologic pathology and Interpretation, which came to be known as “Th e wrote a number of important papers on prostate Little Red Book” and which was widely used at a pathology. time when there were not as many lung pathol- Dr. James J. Daly (1938–), originally from ogy books as there are today. Dr. Mark also Dublin, Ireland, trained at the MGH from 1965 instituted the fi rst pulmonary pathology post- to 1972, and then served on the faculty from 1973 graduate course in North America. His academic to 1978 and as a consultant until 1995. Dr. Daly

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had a great interest in urological pathology and around the world, the diverse academic origins worked closely with the urologists, collaborating and training of its faculty, the excellence of the on studies of pathologic and biologic aspects of clinicians in the hospital for clinicopathologi- bladder cancer with Dr. George Prout, the Chief cal collaborations, the effi ciency engendered by of Urology at the time. specialization, the far-fl ung distribution of its Dr. Robert H. Young is now the leader of this accomplished alumni, and the benefi ts accruing group and has authored the third series AFIP to the department by its plethora of postgraduate fascicle, Tumors of the Prostate Gland, Seminal courses. Th e future of surgical pathology depends Vesicles, Male Urethra, and Penis, and has writ- on maintenance of its traditions of clinicopatho- ten widely on nonneoplastic bladder lesions, logical correlation and careful gross and micro- variants of bladder cancer, and testicular tumors. scopic evaluation, coupled with techniques such Th e other faculty in the group currently are Drs. as immunopathology and molecular pathology Esther Oliva, Peter Sadow, and Chin-Lee Wu, that can bring powerful new tools to decipher who runs a research laboratory in Urology study- the pathological features of surgically sampled ing the biology of prostate cancer. human tissues. Conclusion Note: Many of the MGH surgical pathology faculty Th e surgical pathology group at MGH has been and alumni have published excellent textbooks, but at the vanguard of the specialty, aided by a large space limitations prevent our listing what would be a volume of cases, referrals of complex cases from long and probably incomplete list.

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