The Division of Women’s and Perinatal Pathology within the Pathology Department at Brigham and Women’s Hospital 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 Women’s and Perinatal Pathology 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, with 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, 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, and Hirsch).
The Division trains – and recruits many of its fellows from – a BWH Department of Pathology pool of residents, 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 Women’s and Perinatal Pathology Division has training and research advantages unmatched elsewhere. Our 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 as well as 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 work 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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