Pulmonary
OVERVIEW
The pulmonary pathology service provides
clinical, teaching and research for all surgical specimens
in pulmonary pathology. This includes biopsies and
resections of lung, trachea, bronchi, pleura, mediastinal
lymph nodes (non-lymphoma), and chest wall. The pulmonary
service also functions as a consultant in infectious
disease pathology for other units in the department.
The pulmonary pathology service handles approximately
1,100 cases per year. There has been an increase of
approximately ten percent over the past five years.
Special expertise in surgical pathology exists in
lung transplant pathology, thoracic oncology including
mesotheliomas, tracheal pathology, pulmonary hypertension,
vasculitis, granulomatous diseases, and pediatric
pulmonary pathology.
FACULTY
Eugene J. Mark, M.D., Director, Associate
Professor
H. Thomas Aretz, M.D., Associate Professor
Richard L. Kradin, M.D., Associate Professor
Stuart Houser, M.D., Assistant Professor
R. Neal Smith, M.D.,Ph.D. Assistant Professor
CLINICAL PROGRAM
Residents have three rotations for
a total of seven weeks through pulmonary pathology
during their first two years of training in surgical
pathology. The rotations combine pulmonary and cardiac
pathology. The rotations include reviewing difficult
frozen sections in pulmonary disease on an average
of two per day. The rotations also include the material
coming from this hospital as well as a sign-out of
complicated extramural referral cases with Dr. Mark
at eleven o’clock every morning.
ACADEMIC ACCOMPLISHMENTS
Dr. Mark is interested in the clinicopathological
correlations of pulmonary vascular disease. This has
included particularly biopsy diagnosis of early stages
of Wegener’s granulomatosis and treated stages
of Wegener’s granulomatosis, pulmonary hypertension,
cholesterol embolization in the lung, and giant cell
arteritis. Clinicopathological correlations of thoracic
oncology include descriptions of variant forms of
pulmonary carcinomas, sarcomas, and mesotheliomas.
In conjunction with the Armed Forces Institute of
Pathology, the department was part of the largest
series of the pleural manifestations of endometriosis.
In collaboration with David Christiani and other members
of the Harvard School of Public Health, Dr. Mark works
on genetic mutations associated with adenocarcinomas
in patients exposed to cigarette smoke and asbestos.
Dr. Mark is currently working with Al Head on the
effects of nitrous oxide in pulmonary vasculature.
This work resolves around the passage of silicon spherules
of microscopic size through the vessels with and without
treatment.
Dr. Kradin is director of pulmonary
transplantation pathology. His major interest is immunopathology
of the lung. He has a long-standing focus on pulmonary
inflammation and the role of stress on pulmonary and
immune function. His research activities include both
basic and applied clinical research. Recent published
findings include role of pulmonary dendritic cells
in pulmonary inflammation, effects of immune cytokines
on pulmonary inflammation and fibrosis, the effects
of nitric oxide and catecholamines on pulmonary immune
function and the effects of stress on pulmonary function.
Dr. Kradin is the editor of the textbook “Immunopathology
of Lung Disease.”
Dr. Kradin has supervised six research
fellows during the last five years: Amit Anand, M.D.
(1994-96) Staff: Beth Israel Hospital, Boston; Hong-Wen
Liu, M.D. (1996-97) Staff: University of Taiwan; Atul
Malhotra, M.D. (1997) Staff: Massachusetts General
Hospital; James MacLean, M.D. (1995) Staff: Massachusetts
General Hospital; Gisele Manfro, M.D . (1996-1998)
Staff: University of Brazil; Hideo Sakamoto, Ph.D.
(1997-2000) Staff University of Kyoto, Japan.
Dr. Kradin’s research collaborators
include the following physicians: Andrew Luster, M.D.
MGH Arthritis Unit.Andre; Tager, M.D. MGH Pulmonary
Unit; Barbara Cockrill, MGH Pulmonary Unit; Randall
Zussman, M.D. MGH Cardiology Unit; Alan Fishman, M.D.
MGH Radiology Department; Mark Pollack, M.D. MGH Psychiatry
Department; Patricia Hibberd, M.D. Public Health,
Childrens’ Hospital, Boston; Nadia Nathan, M.D.
Department of Anesthesiology, Brigham and Women’s
Hospital; Herbert Benson, M.D. Department of Medicine,
Beth-Israel Deaconess Medical Center; Ary Goldberger,
M.D. Department of Medicine, Beth-Israel Deaconess
Medical Center; George Stefano, Ph.D, Neuroimmunobiology
Unit, State University of New York, Old Westbury
Dr. Houser is defining the immunologic
mechanisms and possible treatments for chronic lung
allograft rejection using a model in miniature swine.
Extramural support for this study is pending He is
currently applying an immunohistochemical technique
to define experssion of MHC class II in the allografts
and to compare it to that seen in human, mouse, rat
and porcine lung. The study is based on previous findings
in the laboratory that class II expression in porcine
and human coronary endothelium is constitutive, whereas
in rodents it is not. In surgical pathology, Dr. Houser
and Dr. Mark have investigated the phenomenon of bronchogenic
granulomatosis associated with pulmonary carcinomas
and reported on this novel observation.
Dr. Smith focuses on the transplantation
pathology of the lung, heart, pancreatic islets, and
blood vessels in collaboration with several other
groups of investigators. He is particularly interested
in how the acute and chronic rejection of allografts
and xenografts develop. These studies emphasize manipulation
of the rejection using protocols to attenuate immunologically
the rejection itself or to affect how an organ mitigates
the pathological damage that its rejection may cause.
He is also involved in collaborative ongoing studies
of the pathological correlations in asthma models
of various transgenic and knockout mice and in pulmonary
hypertension in end-stage human disease.
Dr. Javad Beheshti has been working
with Dr. Matthew Myerson at Dana-Farber Cancer Institute
for the past year as a research associate. Their work
involves the classifications of human lung carcinomas
by mRNA expression profiling, which reveals distinct
adenocarcinoma subclasses. He is also working in the
same laboratory on single nucleotide polymorphism
array hybridization in pulmonary adenocarcinomas,
and bronchioloalveolar carcinomas using computational
DNA subtraction, a novel method of discovery of human
pathogens. Dr. Beheshti and Dr. Mark have recently
completed a major treatise on pathology of tracheal
tumors for a textbook on the trachea and anticipate
publishing in a separate atlas after the work is completed.
Dr. Beheshti has been working with Dr. Mark on several
studies during this period including the following:
1. the chronic eosinophilic pneumonia/ bronchiolitis
obliterans organizing pneumonia overlap syndrome;
2. clinicopathological and surgical and prognostic
features for fibrous tumors of the pleura, working
with Dr. Douglas Mathisen, chief of thoracic surgery;
3. three dimensional refractile characteristics of
atypical adenomatous hyperplasia and pulmonary eosinophilic
granuloma, working with Dr. David Christiani of the
Harvard School of Public Health; 4. cytokine profile
in bronchiolitis obliterans organizing pneumonia,
working with Dr. Bernard Kinane, director of pediatric
pulmonology.
Dr. Houser and Dr. Mark in collaboration
with Dr. Balis have recently completed a computerized
version of a teaching module entitled “Consultations
in Pulmonary Pathology: A Twenty Year Perspective.”
This is a novel teaching atlas of 250 provocative
cases selected from Dr. Mark’s comprehensive
personal consultation file of 7500 cases of medical
and surgical lung disease. The final CD/DVD will contain
images of pertinent histology relating to the cases
and hyperlinked to the text of the letters sent to
the referring pathologists, where histologic findings
and their significance are described. The atlas will
be available in digital format within the next year.
TEACHING ACTIVITIES
The pulmonary pathology service contributes
to the weekly Pulmonary Medicine Grand Rounds, the
weekly Medical and Morbidity Conference, and the weekly
Interhospital Pediatric Pulmonary Rounds. This includes
description of pathology and also radiologic and clinical
correlations and recommendations for further diagnosis
and/or treatment.
Dr. Houser and Dr. Smith are both active
in teaching laboratory sections in lung disease during
the pathophysiology course for second year students
at Harvard Medical School. Dr. Houser presents autopsy
pathology and 30 minute lectures to physicians at
Spaulding Rehabilitation Hospital, a nearby affiliate
of the Massachusetts General Hospital, at their monthly
morbidity and mortality conference. Many case presentations
involve the lung. Dr. Houser presents pathology findings
at the biweekly lung transplant conference. This includes
patients being considered for or having had a lung
transplantation.
Two fellows from abroad have studied
pulmonary pathology in the department for a duration
of twelve months or more, and additional fellows have
studied for shorter intervals. Dr. Mari Mino came
as a fellow for one year from the Department of Pulmonary
Medicine, Tenri Hospital, Nara, Japan. After returning
to Japan for one year, she returned to the department
and is currently a senior resident. Dr. Javad Beheshti,
Assistant Professor at the National Research Institute
of Tuberculosis and Lung Disease, Shaheed Beheshti
University Medical Sciences and Health Services, Tehran,
Iran came to the department in 1999 and has been working
here for the last two years. He hopes to enter a residency
in pathology at this hospital.
The unit is a major sponsor of the
Boston Lung Pathology Group, a bimonthly meeting which
is held at Tufts University during the academic year.
This brings together pulmonary pathologists from eastern
Massachusetts to discuss particularly challenging
cases and concepts in pulmonary disease. A unique
aspect of the Group is study of lung disease in animals.
Dr. Joseph Alroy, member of the faculty of the Department
of Pathology at Tufts University Veterinary School
and Dr. Scott Schelling, chief of Pathology at the
Angell Memorial Animal Hospital are regular members.
Residents and fellows in pathology attend these meetings
when they are working in lung pathology.
Dr. Kradin lectures at the American
Thoracic Society Plenary Course on Lung Immunology.
Over the past five years, Dr Mark has served as a
visiting professor in Tehran, Iran and at the University
of Edmonton, Edmonton, Canada. He has lectured in
Tacoma, Washington; Nice, France; San Diego, California;
New York, New York; Atlanta, Georgia; Nagoya, Japan
as well as many hospitals in Massachusetts. |
