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The Women's and Perinatal Pathology Division at Brigham and performs
tissue diagnosis from gynecological and obstetrical surgeries and other
procedures related to high-risk pregnancy and disorders diagnosed prenatally.
Specialists offer expert consultative
services relative to rare disorders of the human female reproductive
organs, fetus and placenta.
The Division of Women’s and Perinatal Pathology is one of a few clinical
services in the United States in which gynecologic pathology is practiced as a
dedicated subspecialty with its own full time faculty, exclusive specimen
triaging, and distinct divisional infrastructure. Much more common is
intermingling of gynecologic and non-gynecologic specimens in a general
surgical pathology service staffed by generalists. This Divisional structure is
possible because of the scale of subspecialty work in our institution: the
W&P Division receives approximately 30 percent of the pathology specimen
volume of the entire Department of Pathology at BWH. It serves an active
Obstetrical and Gynecologic service, including over 20,000 specimens per
year, including papillomavirus testing. Approximately 400 new
gynecologic cancer cases are seen per year. The division is staffed by 12
faculty, including five who are occupied nearly full-time in the research
laboratory (Drs. Mutter,
Quade, Ince,
Drapkin, Dinulescu),
two who are strictly clinical investigators (Drs.
Lee, Welch),
and four who dovetail clinical activities with research laboratory expertise
(Drs. Crum,
Bieber, Nucci,
Hirsch, Kindelberger).
The Division trains, and recruits many of its fellows from, a BWH Department of
Pathology pool of 40 residents (10-12 annually, 40 total), approximately 70% of
whom have both MD and PhD degrees. The
Department of Pathology at BWH is one of the premier pathology
departments in the country in terms of research (currently $18 million direct
costs per year).
The subspecialty structure of the W&P Division has training
and research advantages unmatched elsewhere. A
critical mass of 12 faculty facilitates service scheduling to protect faculty
research effort. By narrowing the range of clinical activities, faculty are
easily able to develop experimental laboratory research programs which
complement, rather than compete with, their clinical activities. This provides
role models for future physician scientists, and an intellectual environment in
which scientific discussions are commonplace in the course of diagnostic
procedures, and discussions of clinical context are commonplace in the research
laboratory. Opportunities for projects in the laboratories of supportive
faculty succeed in drawing many previously clinical-only trainees into basic
laboratory experiences. A very broad range of expertise has been assembled in
the Division faculty under the leadership of
Dr. Crum. Faculty academic activities are defined in complementary,
rather than competing, areas. Thus,
Dr. Mutter and one other faculty member works on endometrium,
Dr. Crum cervix and lower genital tract,
Dr. Quade myometrium, and eight other faculty separately interested in
endometrial stroma, trophoblast, cervical glandular lesions, and ovary. All
staff pathologists are clinically competent and active in all areas of
gynecologic pathology, but these clear interests provide easy marks for a
trainee to seek advice or opportunities in an area of interest. There is a very
large amount of collaboration between Division Faculty,
many of whom share reagents, instrumentation, and technical expertise on a
daily basis within the Center For
Uterine Cancer at BWH. This expanded reservoir of shared expertise and
technical capability is freely available to any faculty or trainee member of
the W&P Division and their collaborators.
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