Thoracic Pathology Center of Excellence
Extensive involvement of a neoplasm in pulmonary vessels
Mission StatementThe Thoracic Center of Excellence is based at UPMC Presbyterian and has a broad agenda focused on achieving excellence in clinical service, resident/fellow education, and translational research. The Center of Excellence supports diagnostic services at both Presbyterian and Shadyside Hospitals, offering skilled interpretation in the surgical pathology of thoracic, mediastinal, and cardiovascular diseases. This mission supports the focused efforts in thoracic oncology and interstitial lung disease of the Divisions of Thoracic Surgery and Pulmonary Medicine at the UPMCHS. The Thoracic Center of Excellence is active in housestaff education, with much of the educational efforts focused on training of residents through case analysis and discussion. A wealth of internal material is supplemented by an active consultation service, an extensive slide teaching collection and study sets in the pathology of lung transplantation. Housestaff officers are trained in the applications of histochemistry, immunohistochemistry, and molecular biological techniques in the evaluation of clinical and pathologic diagnostic problems as well as in the interpretation of radiologic images and functional studies. Our research focus is largely oriented toward utilizing our own and the resources of the Molecular Anatomic Pathology section of the Division of Anatomic Pathology for assessing the relationship of surgical pathology to molecular pathology to clinical outcome. Major focuses have been on clonality in unusual pulmonary proliferations, the relationship of molecular changes in non-small cell carcinoma to clinical outcome, and the utilization of histology and immunohistology in predicting acute and chronic rejection of lung allografts.
Clinical ServicesThoracic Pathology is a comprehensive area including all organs within the thoracic cavity including lungs, thymus, and heart. Four pathologists are committed to this Center of Excellence: Samuel A. Yousem, MD, Sanja Dacic, MD, PhD, Frank Schneider, MD, and N. Paul Ohori, MD. On this diagnostic bench, we handle all pulmonary specimens including all of the material from University of Pittsburgh Cancer Institute. This material however is supplemented by a huge volume of inflammatory lung disease derived from a very active interstitial lung disease program, from the world’s largest thoracic transplantation program, a brisk consultation service, and a very active cardiovascular group. Signout on the thoracic bench includes daily reviews of all biopsy and large resection specimens including over 150 native lungs. The wide array of materials that include neoplasms, inflammatory lung disease, thymic neoplasia, allograft lung biopsies, and cardiovascular pathology is a unique experience. Signout is associated with frozen section responsibilities although in the afternoons, housestaff officers are allowed protected time for both grossing specimens and reviewing glass slides of their cases.
Research ActivitiesWithin the Thoracic Pathology Center of Excellence are diverse investigative efforts that reflect our focus on inflammatory lung disease and thoracic neoplasia. Working with the Simmons Center for Interstitial Lung Disease, Drs. Yousem and Schneider have focused on describing and analyzing new models and forms of interstitial lung disease, particularly focused on rheumatologic conditions. Such an interest in inflammation readily extends to our analysis of allograft lungs and the pathology of lung transplantation where we are actively involved in studying antibody mediated rejection as it applies to lung allografts. Perhaps our greatest interest and international recognition is in thoracic oncology in an area lead by Sanja Dacic, MD, PhD. In this area we have utilized fluorescence in situ hybridization techniques and molecular techniques, in close collaborations with Yuri Nikiforov, MD, PhD and Marina Nikiforova, MD in the Molecular Anatomic Pathology Laboratory, to establish ourselves as the premiere clinical, diagnostic, and research thoracic pathology group in the country. Routine cases are typically submitted for molecular analysis and the results incorporated into our diagnostic surgical pathology reports. This work is the basis for very active collaborative discussions between our molecular analysis pathology division, our FISH group, and our diagnostic pathologists. Truly, there is no section of pathology in the world that is equivalent to this experience in pulmonary pathology.
Hürthle cell hyperplasia in folliclesIn addition to participating in the general department–wide teaching activities including a weekly research conference, anatomic pathology grand rounds, and multiheaded slide conference, the thoracic pathology Center of Excellence is involved in several clinicopathologic conferences each week: the thoracic oncology conference on Tuesday morning, a general pulmonary medicine conference with pulmonary medicine fellows and faculty at 11:00 AM on Tuesday, a consultation practice slide review conference at 11:00 AM on Wednesday, and the interstitial lung disease/rheumatology conference at 8:00 AM on Thursday. This core group of weekly conferences is supplemented by at least five other monthly conferences that encompass the entire vast array of pulmonary pathology including research conferences on pulmonary fibrosis, pulmonary vascular disease, and Lung SPORE meetings with Jill Siegfried, PhD focused on hormonal and tyrosine kinase receptor studies and lung carcinogenesis.