Head and Neck Pathology 

The Head and Neck Pathology Division (HNPD), directed by Dr. Peter Sadow, is a vibrant clinical service at the Massachusetts General Hospital and one of the highest volume divisions of the MGH Pathology Service. This subspecialty division is responsible for providing surgical pathology services for Massachusetts General Hospital as well as for the Department of Otolaryngology (ENT) at Massachusetts Eye and Ear (MEE). Our greatest service volume comes from our ENT colleagues at MEE, who subspecialize in ENT oncology, otology (and neurootology), rhinology (sinus center), laryngology, thyroid/parathyroid surgery, pediatric otolaryngology and facial plastic surgery. At MGH, most cases come from the Division of Endocrine Surgery (thyroid/parathyroid), as well as the MGH Voice Center (larynx), Neurosurgery (skull-based tumors typically done alongside MEE-based otolaryngologists) and our distinguished Oral Maxillofacial Surgery colleagues.


The MGH Head & Neck Pathology Division provides consultative diagnostic services to partner institutions, including Martha’s Vineyard Hospital, Nantucket Hospital, Newton-Wellesley Hospital, North Shore Medical Center, Cambridge Health Alliance, and Cooley Dickinson Health. More broadly, our pathologists provide consultative services for colleagues and patients who are local, national and international.

Faculty

The faculty of the HNPD is diverse. Three of the faculty are primarily head and neck pathologists, Drs. Sadow, Faquin and Nosé. The other faculty, Drs. Wu and Martinez-Lage, primarily sign out in other pathology divisions and secondarily in the HNPD. Dr. Sadow also signs out genitourinary pathology. Dr. Faquin signs out cytology and is a world expert in thyroid cytology, also currently leading the development of a new cytology classification of salivary gland neoplasia (The Milan System). Dr. Nosé is a world-renowned endocrine pathologist who also signs out gastrointestinal pathology. Dr. Wu, the Director of the Genitourinary Pathology Division, is a prominent expert in prostate and kidney pathology. Dr. Martinez-Lage, our most recently acquired faculty member, is primarily a neuropathologist with research interests in neoplasia of the central nervous syndrome.

Clinical Program

The Head and Neck Pathology Division is among the most generalized of the surgical pathology services, as it encompasses the diversity of organs and tissue-types within a compact geographical space (head & neck), including the middle and external ear, sinonasal tract/nasopharynx, oral cavity, oropharynx, larynx and hypopharynx, salivary glands, thyroid and parathyroid glands, soft tissue and bones of the head and neck, lymph nodes, and skin. In addition to sign-out of surgical specimens, the HNPD also provides intraoperative subspecialty consultation (frozen section) services for MGH and the MEE. Intraoperative consultation for MEE is provided in the Max Goodman Frozen Section Laboratory, providing services for both Otolaryngology and Ophthalmology, the two surgical arms of the MEE.


The Head and Neck Pathology Division typically sees greater than 10,000 surgical cases per year and accounts for over 10% of the MGH Pathology Service case volume.

Academic and Research Accomplishments

Our Head and Neck Pathology Division has a broad educational and research mission, including a clinical fellowship program, whose graduates are providing the next generation of academic leadership across the country and around the globe. The Division has the responsibility for training approximately 40 resident physicians per year in pathology, as well as the MEE ENT surgery residents, and one to three clinical and research fellows. Our Division Faculty participate in formal lectures at both MGH and MEE, with clinical fellows having opportunities to participate in the teaching of resident trainees and clinical colleagues in formal and informal settings. Our HNPD faculty have authored over 500 manuscripts in the past five years, both primarily and in collaboration.

Teaching and Educational Activities

Fellowship
The HNPD supports a one year clinical fellowship program funded by Pathology Associates, the pathology arm of the MGH Physicians Organization. This is a sign out fellowship offered to Boards-eligible, fully licensed (in MA) physicians. Clinical fellows, also appointed as clinical fellows at Harvard Medical School, serve as mentored adjunct faculty and perform with guided independence at a 70% service effort. Clinical fellows often work on clinical research projects with HNPD faculty and collaborators on route to careers within the field in academia or as subject matter experts within other settings. Recent graduates have joined the faculty at the University of Chicago, Dartmouth, University of Miami, Vanderbilt University, UCLA, Mt. Sinai, Harvard Medical School, the University of Wisconsin and the University of the Western Cape (South Africa).


In addition to the sign out fellowship position, applicants might alternatively be interested in participation in the MGH Pathology Service Surgical Pathology Fellowship as part of the ACGME. Participation in the non-sign out ACGME fellowship incorporates subspecialty training in head & neck pathology supplemented by other surgical pathology subspecialty areas. Applicants to the MGH Pathology Surgical Pathology ACGME-sponsored fellowship may indicate a special interest in head & neck pathology among the thirteen surgical pathology subspecialties.

Residency

MGH Pathology residents rotate through over thirteen surgical pathology subspecialty divisions as part of their training in anatomic pathology. While rotating in the HNPD, residents have daily activities that involve performing gross pathology assessment and dictation of complex head & neck specimens as well as daily microscopic sign out with faculty and graduate assistants (clinical fellows).

The HNPD is unique among MGH Pathology Service Divisions in that it participates simultaneously in the residency training programs of three different departments at three institutions, primarily the Anatomic Pathology Residency Training Program at MGH and, on a more limited basis, the Otolaryngology Residency Training Program at MEE and the Oral Maxillofacial Pathology Training Program at Harvard School of Dental Medicine. This gives MGH Pathology residents the opportunity to train side by side on occasion with ENT surgery residents and dental residents who offer an indispensable clinical perspective. Additionally, while on service, ENT surgery residents and dental residents sign out in the Goodman Frozen Section Laboratory at MEE and learn the importance of providing proper clinical information and the critical value of communication while patients are under anesthesia during intraoperative consultation.

Medical School

Members of the HNPD are faculty at Harvard Medical School. They are variably involved in the training of Harvard Medical School students through formal course work at the undergraduate medical education level along with clinically for students rotating through Anatomic Pathology, either as an advanced clinical elective or as part of their surgery clerkship.

Postgraduate Courses, Invited Major Lectures

MGH HNPD faculty participate in several local, national and international continuing medical education courses. In addition to playing a prominent role in the annual MGH Surgical Pathology course, “Current Concepts in Surgical Pathology”, Drs. Faquin and Sadow initiated a “Current Concepts in Head & Neck Pathology” course in 2012, and following two successful years, expanded with the addition of Dr. Nosé, to “Current Concepts in Head & Neck and Endocrine Pathology”, a four day CME course, the largest of its kind, now given every other year in Boston.

Each year, our HNPD faculty are prominently featured in courses and lectures, at international meetings/congresses, state and national pathology societies and as institutionally invited speakers.

Research

Faculty of the HNPD are extensively involved in a robust clinical research as part of our academic mission. Research projects involve division-initiated projects or those in collaboration with clinical colleagues (intramurally and extramurally) or basic scientists. Funding sources involve grants to individual faculty through the department or extramural foundation awards. Internal funding sources also include funds from HNPD educational courses through Harvard Medical School or the MGH Cancer Center with funds slated for MGH Pathology.

Many HNPD projects investigate the molecular basis of head and neck-related neoplasia, developing ancillary markers for testing and/or treatment. Most projects within the division are faculty-initiated and involve mentorship of MGH Pathology residents and fellows as primary authors. Areas of current investigation involve follicular neoplasms of the thyroid, salivary gland tumors, and oropharyngeal squamous cell carcinomas among several others.

The MGH Pathology HNPD is highly collaborative with our pathology colleagues at academic institutions locally (Brigham and Women’s) and across the globe, especially in cases of rare tumors. Additionally, the HNPD faculty serve as faculty mentors and pathology collaborators for our clinical colleagues and their trainees in clinically-initiated, pathology-related projects, especially in otolaryngology, endocrine surgery and oral maxillofacial surgery.

For more detailed information regarding specific research interests, please view links associated with individual faculty (listed above).

Institutional Conferences

There are several institutional conferences with participation from faculty and fellows of the HNPD. Within the department, we have a weekly Head & Neck Pathology Staff Conference during which we discuss and show interesting and/or challenging cases or discuss any pressing administrative issues. There is a weekly Head & Neck Tumor Board, attended by faculty and fellows of the HNPD as well as surgeons and radiologists from MEE, along with oncologists and radiation oncologists from MGH. We attend a monthly Oral Maxillofacial Surgery Pathology Teaching Conference for faculty and residents of the OMFS division. We also participate in the monthly Endocrine Oncology Conference, including MGH Pathology, Endocrine Surgery, Endocrinology, and Radiology along with MEE Endocrine Surgery and remote participation via video link with colleagues in Maine. In addition, we participate as needed in several conferences at MGH and MEE, including clinical pathological conferences and morbidity and mortality conferences.

 

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