Selected reviews on topics in oncologic pathology related to tumors of the breast, gynecologic organs, and head and neck region.
Article Type: Report
Subject: Cancer (Diagnosis)
Cancer (Study and teaching)
Pathology (Study and teaching)
Pathology (Technology application)
Pathology (Practice)
Continuing medical education (Management)
Authors: Klimstra, David S.
Soslow, Robert A.
Ghossein, Ronald A.
Brogi, Edi
Pub Date: 05/01/2009
Publication: Name: Archives of Pathology & Laboratory Medicine Publisher: College of American Pathologists Audience: Academic; Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2009 College of American Pathologists ISSN: 1543-2165
Issue: Date: May, 2009 Source Volume: 133 Source Issue: 5
Topic: Event Code: 200 Management dynamics Computer Subject: Company business management; Technology application
Organization: Organization: Memorial Sloan-Kettering Cancer Center
Accession Number: 230151988
Full Text: The following 7 review articles are based upon selected lectures presented as part of the continuing medical education course, "The Surgical Pathology of Neoplastic Diseases," sponsored by Memorial Sloan-Kettering Cancer Center and held in New York City on May 12-16, 2008. The reviews were selected to reflect the variety of topics covered in the course with the hope that their publication in Archives of Pathology & Laboratory Medicine would bring this material to a wider audience.

The Department of Pathology at Memorial Hospital for Cancer and Allied Diseases (part of Memorial Sloan-Kettering Cancer Center) began hosting postgraduate review courses in the late 1970s. Under the direction of Dr Philip Lieberman, chief of the Surgical Pathology Service, the courses were intended to provide up-to-date information concerning the pathologic evaluation of specimens related to cancer, including the diagnosis, prognostication, and biology of neoplastic diseases. In the early years, the course was relatively informal and included both didactic lectures as well as sessions during which the participants each independently reviewed teaching slide sets at microscopes provided for their use. The course faculty consisted of the attending staff from Memorial Hospital. At that time, the department was not formally subspecialized, but each attending pathologist had his or her own area(s) of expertise, and the faculty was large enough that a week-long course could be held without the need for invited speakers. The course was organized along generalist lines, with most major subspecialties in tumor pathology being represented. Marc Rosenblum, MD, the current chairman of the department and for many years the sole neuropathologist on the staff, often lamented that the neuropathology lectures were commonly scheduled on the final afternoon of the course, allowing less enamored participants (ie, most attendees) to escape! Held in New York City annually each May for the first 16 years, "The Surgical Pathology of Neoplastic Diseases" attracted about 75 participants each year, largely from the surrounding regions.

In 1991, Juan Rosai, MD, joined the faculty as chairman of the Department of Pathology. Given Dr Rosai's wellknown interests in education and course organization, it is no surprise that the Memorial Hospital course was not only continued but also expanded. Although still a general tumor pathology course, there was added emphasis on molecular biology and newer techniques. After a few more years in Manhattan, Dr Rosai arranged for the course to go "on the road," leading to highly successful ventures in Florence (1995), Rome (1997), Granada (1999), and Copenhagen (2001), alternating with years back home in New York. As course participation grew, the microscopic sessions became impractical, and a fully didactic lecture format was adopted. An afternoon of case presentations was incorporated to provide variety and to challenge the participants.

The last year abroad (2001) marked the 24th year of the course, and under the chairmanship of Dr Rosenblum, the faculty planned a gala celebration in New York to mark the 25th anniversary course, scheduled for May 2002. Unforeseen events in Manhattan intervened on September 11, 2001. At a critical time in the planning of the event, there was great uncertainty as to whether New York City would be ready to host this sort of activity, and whether pathologists would be comfortable attending. Given these uncertainties, the course for 2002 was canceled, and courses were suspended for the next 5 years.

Since that time, dramatic changes have occurred in our department. The staff adopted a fully subspecialized practice model, abandoning more than a century of generalist practice. Additional faculty were recruited, and many illustrious, long-term members of the department retired. During 2006, the staff once again took up discussion about "the course." It was decided that, despite the proliferation of pathology courses nationwide, the Memorial Hospital course still filled a vital niche, and a new course organized along subspecialty lines was developed. The 25th anniversary course took place in New York in May 2007 and included lectures concentrated on 3 subspecialty areas (gastrointestinal, genitourinary, and thoracic pathology), a day of case presentations, and a special topics session. Digitized images were provided in lieu of glass slides for histologic assessment of the cases. Guest faculty were invited to supplement the attending staff. This course drew 150 pathologists from 35 states and 16 foreign countries. Our department is now once again committed to preparing a course each year.

The 2008 course, from which the following review ar ticles were derived, covered the subspecialty disciplines of breast, gynecologic, and head and neck pathology. This year, case presentations related to these topics were incorporated into the lecture schedule, and the notes from one such case are included in this issue. An additional facet of the 2008 course was the inclusion of more intimate evening sessions held around a projection microscope, in which smaller groups of pathologists reviewed slides related to one of the course topics with a senior diagnostician. Plans are already well underway for the 2009 course, to be held again in New York City (May 18-22). The subspecialty topics to be covered, determined in part by votes solicited from last year's participants, will include endocrine, bone and soft tissue, and gastrointestinal pathology. There will also be a special topics session on new technology in the practice of surgical pathology.

The dictates of good medical practice as well as the increasingly stringent regulatory climate in which we all work mandate that courses offering continuing medical education and self-assessment module credits be conducted for maintenance of competence and medical board recertification. Practical courses such as "The Surgical Pathology of Neoplastic Diseases" are designed to expose pathologists to new information of potential value in their assessment of patients' specimens. We hope that some of the information contained in the following review articles will be of interest to the broader readership of the ARCHIVES.

Accepted for publication January 26, 2009.

David S. Klimstra, MD; Robert A. Soslow, MD; Ronald A. Ghossein, MD; Edi Brogi, MD, PhD

From the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York.

The authors have no relevant financial interest in the products or companies described in this article.

Reprints: David S. Klimstra, MD, Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065 (e-mail: klimstrd@mskcc.org).

Robert A. Soslow, MD, received his MD degree from the University of Pennsylvania School of Medicine and did his residency and fellowship at Stanford University Medical Center. He is an internationally recognized expert in gynecologic pathology and has published more than 120 peer-reviewed articles. He is currently an attending pathologist at Memorial Sloan-Kettering Cancer Center and a professor of pathology and laboratory medicine at Weill Medical College of Cornell University. Dr Soslow is a section editor for gynecologic pathology for the Archives ofPathology & Laboratory Medicine.

Edi Brogi, MD, PhD, received her MD and PhD degrees from the University of Florence and completed her residency and fellowship at Massachusetts General Hospital. She is a world-renowned expert in breast pathology and cytology with more than 40 peer-reviewed published articles. Dr Brogi is a section editor for breast pathology for the Archives ofPathology & Laboratory Medicine.

David S. Klimstra, MD, is chief of the Surgical Pathology Service at Memorial Sloan-Kettering Cancer Center. Dr Klimstra received his MD degree from Yale University School of Medicine where he also completed his residency in anatomic pathology before completing a fellowship at Memorial Sloan-Kettering Cancer Center. He is the author of more than 225 peer-reviewed published articles and a legendary authority on gastrointestinal tumors, hepatobiliary tumors, and pulmonary pathology.

Ronald A. Ghossein, MD, received his MD degree from St Joseph University School of Medicine, Beirut, Lebanon, followed by residencies at Mallory Institute of Pathology and Tufts University School of Medicine and a fellowship at Memorial Sloan-Kettering Cancer Center. He is highly regarded as a specialist in thyroid pathology. He is the author of more than 70 peer-reviewed published articles.
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