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Head and Neck Pathology
The Head and Neck service, led by Dr. Bill Faquin, is an active clinical service at the Massachusetts General Hospital. This subspecialty division is responsible for providing surgical pathology services for the Otolaryngology Department of the Massachusetts Eye and Ear Infirmary (MEEI), as well as surgical pathology of the head and neck region (excluding neuropathology and some dermatopathology) of Mass General (e.g. thyroid and parathyroid, oral/maxillofacial, and otolaryngologic). 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 oropharyngeal squamous cell carcinoma, salivary glands, thyroid, and fine needle aspiration (FNA) cytology of this area.
Diagnostic activities, volume, case mix: The Head and Neck subspecialty service is among the most generalized of the surgical pathology services since it encompasses a wide range of tissues and organs of the head and neck, including 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 HHead and Neck subspecialty also provides frozen section services for the MEEI at the latter institution's Max Goodman Frozen Section Laboratory, for both the Otolaryngology and Ophthalmology services.
Further, our division provides surgical pathology services for head and neck tissues removed by Mass General staff at the Mass General, notably the Oral/Maxillofacial Service and the general surgical service for thyroid, parathyroid, and salivary gland specimens. Our service maintains consultative relationships with other Mass General subspecialty services, such as Dermatopathology, Hematopathology, and Bone and Soft Tissue pathology, to assist us in our sign-out responsibilities. The Head and Neck service has had volumes of over 11,000 cases for 2009, representing about 10% of the departmental caseload.
None of our faculty signs out ENT/Head and Neck cases exclusively; thus Dr. Faquin also signs out Cytopathology and covers the Pathology Fine Needle Aspiration Clinic; Dr. Nielsen signs out Electron Micrscopy and Bone and Soft Tissue Pathology (and is Director of those subspecialties), and frozen sections; and Dr. Sadow also signs out Genitourinary Pathology, and Frozen Sections and has a specialty interest in endocrine pathology. The division provides consultative services for Head and Neck cases from several local hospitals as well as for occasional World Care and Telemedicine international cases. Many private consultations for diagnostic opinions are also received.
A longstanding practice in Head and Neck pathology has been for otolaryngology residents at the MEEI to rotate formally through the Head and Neck pathology service. Although no longer responsible for actually being prosectors of the large surgical specimens from the MEEI, the Head and Neck (ENT) surgical residents spend a portion of their training rotating through our Head and Neck service subspecialty by sitting at our divisional sign-out together with the attending pathologist and the pathology resident on service. This active participation by clinical residents as rotators on the pathology service is not widely practiced elsewhere in the US, but it has proven to be beneficial both for the pathologists and the clinical residents, and is well received by the MEEI Otolaryngology Department.
Academic and Research Accomplishments
Members of the Head and Neck group have participated and are participating in a number of research projects, primarily in the clinical research arena. Several projects involve molecular characterization and development of ancillary markers for head and neck neoplasms including salivary gland tumors, oropharyngeal squamous cell carcinomas, and thyroid neoplasms such as papillary carcinoma, medullary carcinoma, and poorly differentiated carcinoma. Application of FNA to the detection and diagnosis of head and neck tumors is also a focus of some of our subspecialty's pathologists.
Other clinical research projects involve a combination of molecular, histochemical, and immunohistochemical studies of giant cell lesions of the jaw, papillary carcinomas arising in follicular adenomas, thyroid Hürthle cell neoplasms, clear cell-containing neoplasms of the jaw, and lymphomas of the oropharynx. 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. Members of the Head and Neck subspecialty have published books and numerous chapters pertaining to this field.
For more detailed information regarding specific research interests and links to Pubmed, see individual faculty pages (listed above under Faculty).
Teaching and Educational Activities
Clinical ServicesThe Head and Neck division participates actively in several clinical conferences at the MEEI and at Mass General, including presenting pathology at the clinicopathologic conferences (CPCs) of the Otolaryngology Department at MEEI. The division is represented at the monthly Morbidity and Mortality conference of the Otolaryngology Department at MEEI, presents pathology at the weekly Pediatric ENT Oncology Conference, presents monthly clinicopathologic conferences for the Oral and Maxillofacial Surgery Department, and occasionally presents pathology for the joint Head and Neck Oncology Service. In addition, the Head and Neck division participates actively in the MGH departmental surgical pathology conference.
ResidentsThe 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.
FellowsThe head and neck pathology service does not have a formally funded fellowship, but the division often has visiting fellows rotating in our subspecialty for one to six months. In addition, senior residents and surgical pathology fellows, sometimes elect to participate as "junior attending pathologists" in the sign-out of Head and Neck cases.
Medical StudentsMembers of the division participate (or participated) in the teaching of several courses at Harvard Medical School (HMS), including the second year Pathology course, Endocrine Pathophysiology. In addition, medical students from HMS and other schools occasionally spend clerkships in the Pathology Department, in which head and neck pathology service faculty participate.
Postgraduate Courses, Invited Major LecturesThe 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 Head and Neck faculty have participated in numerous Mass General-sponsored postgraduate courses in surgical pathology, and cytopathology. Our Head and Neck faculty presented lectures this past year at the World Thyroid Congress (Toronto, ON), the European Congress of Cytology (Lisbon, Portugal), and the USCAP among others.
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