ENT (Head and Neck)

OVERVIEW

The Head and Neck (H&N or ENT) group, led by Dr. Ben Pilch, is an active clinical service at the MGH. This service is responsible for providing surgical pathology services for the otolaryngology department of the Massachusetts Eye and Ear Infirmary (MEEI). In addition, it signs out the surgical pathology of the head and neck region (excluding neuropathology and some dermatopathology) of MGH cases, e.g. thyroid and parathyroid surgery and oral/maxillofacial surgery. In addition, consultative diagnostic services are provided to other clinicians, pathologists, and institutions. The service participates in teaching conferences at the MEEI and MGH. Clinical research projects are ongoing, involving clinicopathologic studies of diseases affecting the head and neck region, including studies relating to fine needle aspiration cytology of this area.

FACULTY

Ben Z. Pilch, M.D., Associate Professor of Pathology, Chief of Otolaryngologic Pathologist MEEI.

William C. Faquin, M.D., PhD., Associate Professor of Pathology

Chin-Lee Wu, M.D., PhD., Assistant Professor of Pathology

Artur Zembowicz, M.D., PhD., Assistant Professor of Pathology

CLINICAL PROGRAM

Diagnostic activities, volume, case mix: Since surgical pathology at the MGH went to a totally subspecialized sign-out format, the H&N service has emerged as possibly the most generalized of the surgical pathology services. Thus, the H&N service is responsible for the signout of all the surgical pathology cases from the MEEI. As there are otolaryngologists, plastic surgeons, as well as a dermatologist/Mohs’ micrographic dermatologic surgeon operating out of the MEEI, the signout mix is eclectic. It involves tissues and organs of the head and neck, including sinonasal tract/nasopharynx, oral cavity, oropharynx, larynx and hypopharynx, salivary glands, thyroid and parathyroid glands, bones of the head and neck, lymph nodes of the head and neck, and skin of the head and neck and elsewhere. In addition, the H&N division provides frozen section services for MEEI in the latter institution’s frozen section laboratory, for both the Otolaryngology and Ophthalmology services. Further, our division provides surgical pathology services for head and neck tissues removed by MGH staff at the MGH, notably the oral/maxillofacial service and the general surgical service for thyroid, parathyroid, and salivary gland specimens. Our service maintains consultative relationships with other MGH subspecialty services, such as dermatopathology, hematopathology, and bone/soft tissue pathology, to assist us in our signout responsibilities. The pathology departmental records indicate that the ENT (H&N) service has had volumes of 5615, 6185, 7037, 7241, and 7393 cases for fiscal years 1997-2001 respectively, representing about 10% of the departmental caseload. None of our faculty signs out ENT/H&N exclusively; thus Dr. Pilch also signs out genitourinary pathology and MGH frozen sections, Dr. Faquin signs out cytopathology and MGH frozen sections, Dr. Wu signs out genitourinary pathology, and Dr. Zembowicz signs out dermatopathology. The division provides consultative services for H&N cases from the Cambridge Hospital as well as for occasional World Care and Telemedicine international cases. Private consultations for diagnostic opinions are also received.

Innovations: A longstanding practice in ENT pathology has been for otolaryngology residents at the MEEI to rotate formally through the ENT pathology service. Although no longer responsible for actually being prosectors of the large surgical specimens from the MEEI, the ENT residents sit at our divisional signout together with the senior pathologist and the pathology resident on service. This active participation by clinical residents as rotators on the pathology service is not, to my knowledge, widely practiced elsewhere in the US. It has proven to be beneficial both for the pathologists and the clinical residents and is well received by the MEEI ENT department.

While our use of diagnostic molecular pathology services is in its infancy, we do have access to in situ hybridization studies for Epstein-Barr encoded RNA (EBER) for diagnostic help with lymphoproliferative lesions and possible nasopharyngeal carcinomas. If and when the molecular diagnostic services for translocations in soft tissue tumors gets up and running, we hope to be able to use these facilities for soft tissue tumor specimens in the head and neck. Hopefully, we will one day also have access to viral molecular diagnostic studies, such as for subtyping human papillomaviruses (HPV) in various head and neck lesions.


ACADEMIC AND RESEARCH ACCOMPLISHMENTS 1997-2001

Members of the H&N group have participated and are participating in a number of research projects, primarily in the clinical research arena. Several projects involve the cytopathology of head and neck lesions, including salivary gland tumors (myoepithelial-rich, basaloid, and oncocytic), jaw lesions including odontogenic keratocysts, and thyroid neoplasms including the use of cytokeratin 19 in the cytologic diagnosis of papillary carcinomas and the cytopathology of Hürthle cell neoplasms. Other clinical research projects involve histochemical and immunohistochemical studies of intestinal-type sinonasal adenocarcinomas, cell proliferation markers in mucoepidermoid carcinomas of salivary glands, DNA topoisomerase II alpha levels in thyroid Hürthle cell neoplasms, clear cell-containing neoplasms of the jaw, confocal microscopy in parathyroid surgery, sinonasal lymphomas, and studies on nasopharyngeal carcinoma (NPC), including the presence of EBV and HPV in Western patients with the keratinizing subtype, and in vivo studies of interleukin-1 in NPC. These various studies involve collaboration with other members of the MGH pathology department, members of other MGH departments (e.g. endocrine and oral/maxillofacial surgery), members of our corresponding Partners pathology department at the Brigham and Women’s Hospital (BWH), members of other domestic institutions, such as the Medical College of Virginia, as well as international collaboration with a department in Germany. Currently, no extramural grant funding or space specifically committed to research for the division exists.

Other academic accomplishments include the publication of a textbook of the surgical pathology of the head and neck (Pilch BZ, ed., Head and neck surgical pathology. Philadelphia, Lippincott Williams & Wilkins, 2001), in which past and present members of the MGH pathology department contributed chapters. In addition, chapters to two other textbooks have been written by division members.

TEACHING AND EDUCATIONAL ACTIVITIES 1997-2001

Clinical Services: The H&N division participates actively in several clinical conferences at the MEEI and/or MGH, including presenting pathology at the clinicopathologic conferences (CPCs), or grand rounds, of the otolaryngology department at MEEI, and running the monthly head and neck tumor pathology conferences, whose audience includes representatives from both the MGH and MEEI. The division is represented at the monthly morbidity and mortality conference of the otolaryngology department at MEEI. Occasional participation at the MGH oral/maxillofacial surgery departmental conferences also occurs. In addition, the H&N division participates actively in the MGH departmental surgical pathology conference.

Residents: The division is unique in the MGH pathology department in that it participates simultaneously in the residency training programs of two different departments at two institutions, namely the pathology residency training program at MGH and the otolaryngology residency training program at MEEI. Thus, as mentioned above, residents from both programs rotate through the head and neck pathology service, participating in surgical signout and in frozen section examination (otolaryngology and ophthalmology) at MEEI. In addition, the MGH pathology residents serve as prosectors for large and/or complex head and neck surgical specimens, whether originating from MGH or MEEI, under the supervision of the division faculty. Furthermore, ophthalmology residents at MEEI rotate through eye pathology and often seek consultation and teaching from the head and neck service faculty.

Fellows: The head and neck pathology service currently has no current ongoing fellowship program; however, the eye pathology fellow frequently receives informal teaching from the division.

Medical students: Members of the division participate (or participated) in the teaching of several courses at HMS, including the second year Pathology course, physiology of the skin, and Endocrine pathophysiology. In addition, medical students from HMS and other schools occasionally spend clerkships in the MGH pathology department, in which head and neck pathology service faculty participate.

Post graduate courses, Invited major lectures: The head and neck service faculty have participated in various post graduate courses, including the annual course “Current Concepts in Surgical Pathology” given by the MGH pathology department. In addition, members of the H&N faculty have participated in MGH-sponsored postgraduate courses in dermatopathology and cytopathology. The H&N staff has been represented in the last USCAP evening session on cytopathology of the head and neck as well as at an American Society of Cytopathology-sponsored workshop on the difficult thyroid aspirate. One of our faculty members was invited to give the annual Merlin L. Trumbull Lecture in Pathology at the Baptist College of Health Sciences in Memphis, TN in 1998. The faculty member also lectured at the Brazil Pathology Conference in Curitiba Brazil in 1999 and at the course and workshop entitled Update in Surgical Pathology in Würzburg, Germany in 2000, jointly sponsored by the MGH pathology department and the pathology department of the University of Würzburg.