an Istanbul breeze

1. an Istanbulbreeze

2. İSTANBUL İZMİT, KOCAELİ NADİR PAKSOY, MD, MIAC Professor of Pathology & Cytopathologist, Kocaeli University – TURKEY

3. A voyage through the past pages of cyto-pathology

4. TOPIC 1; STORY OF HEMATOXYLIN Hematoxylin (HE) is a key stain in pathology and cytology.

5. Origin of HE is a tree, called logwood in English and Haematoxylum in Latin; which means “bloodwood” (“haima”being Greek for blood and “xulon” for wood).

6. HE Tree is native tree to southern Mexico and Central America. HE tree was used for a long time as natural source of textile dye for Mayas and Aztecs.

7. Dye is extracted from the chips of the wood It’s called ‘tree with blood colored wood’.

8. By the late 1500, European textile industry recognized the value of the tree as natural source of textile dye. Then the importance of the tree suddenly increased and even caused war between Spanish and English ships.

9. Around 1865, German scientist Boehmer whowas inspired by theuse of HEMATOXYLIN in textile industry had used it in combination with mordant (chemical procedure to increase dyeing effect), andpublished itsusage in histology.

10. Hematoxylingaineditspopularity in the late 1800’s. Eosin is a syntheticanalinedye, andcombination of H. witheosinwasfirstproposed in 1871 byPoole. Since then H&E has been an indispensable stain for us.

11. Here comes the first question! Today, one country in the American continent is using Hematoxylin tree as asymbol on hernational flag. Whichoneof the following countries is this? • Mexico • Brazil • Belize (British Honduras) • Panama

12. The correct answer is “C – Belize (British Honduras)”.

13. The British logwood cutters (baymen) found a river mouth with dense jungle containing hematoxylin trees; settled and formed a colony (British Honduras) in mid 1600’s.This is how hematoxylin tree caused the emergence of a new country (Belize). H. tree; a blackand a whitecutterarethenational amblem of Belize.

14. TOPIC 2;TROY AND THE PATHOLOGIST

15. TROY is an ancient city in Turkey, known as the center of many civilizations. TROY is located in south of the strait of the DARDANELLES (called Canakkale in Turkish).

16. The history of Troy dates back to 3000 B.C. Trojan war was described in the Greek Epic Iliad by Homer. Troy, the film, (2004) with starring Brad Pitt created worldwide publicity and revoked the interest to Troy again.

17. German businessman and archeologist Schliemann began excavating the Troy area in two different campaigns at 1868 and again after 1878. Schliemann’s excavation revealed some ancient cities. Meanwhile he and his wife claimed that they have already found the Troy’s LOST TREASURE (Priam’s treasure) in 1873. 

18. They smuggled the treasure to Berlin and donated to German people. The treasure was also on display for a time in Pergamon Museum. After the WW II Russians took the treasure to Moscow. Today, it is kept in the PushkinMuseumin Moscow. However some artifacts are kept at the Istanbul Archeology Museum as well as at theNeues Museum in Berlin.

19. Later Schliemann traded some treasures to the government of Turkish Empire (Ottoman Empire) in exchange for permission to dig at Troy again in 1878.

20. Here comes the question 2! A well known pathologist joined Schliemann’s second campaign of Troy excavations as a site/camp doctor. Do you know who this pathologist was? • Carl Rokitansky • Paul Langerhans • Lauren Ackerman • Rudolph Virchow • Gustav Giemsa

21. The correct answer is “D – Rudolph Virchow(1821-1905)” German pathologist, considered as the founder of cellular pathology was also a anthropologist, prehistorian and politician (political antagonist of Bismarck).He was credited with the interest of social medicine and public health.

22. TOPIC 3;ALMOST THE NEAR DEATH BIOPSY AND SURGICAL PATHOLOGY Towardsthe end of 19th century,the notion that microscopic examination of tissues from living patients has just began at the European medical community.

23. Carl Rokitansky (1804 – 1878): Bohemian (Czech/Austria) Pathologist. Perfomed 30.000 autopsies during his career. Large numbers of doctors were against biopsy because, for them, a diagnosis of malignancy can only be obtained from the autopsy. Between the pro/anti discussions on the use of biopsy an unfortunate event happened. This was nearly a death sentence for biopsy & microscopic diagnosis of malignancy.

24. Let’s have a look at this unfortunate event for pathologists. In Germany the newly appointed 55 years old Emperor Frederick III developed a throat lesion in 1887. German doctors clinically diagnosed as laryngeal carcinoma.

25. Emperor’s wife was a daughter of Queen Victoria of the United Kingdom. Probably because of this connection, the eminent British otolaryngologist Dr Morell McKenzie came to Berlin and biopsied the laryngeal lesion.

26. Here comes the question3! This was one of the first uses of biopsy technique; since microscopical evaluation of tissue from living patients in those years had been largely unheard of.   The pathologist interpreted the biopsy as benign. Who was the pathologist? • Paul Langerhans • Carl Rokitansky • Ludwig Aschoff • Rudolf Virchow

27. The correct answer is “D – Rudolf Virchow (1821-1905)” Despite Virchow’s “benign” diagnosis the Emperor’s condition became worse. Within a few months the Emperor died from laryngeal carcinoma.

28.  The consequences of the discrepancy in diagnosis caused shock waves in the medical community in Germany and Britain.

29. From the detailed description of the actual biopsies published by Vircow himself in British Medical Journal (1887), removed tissue may well have been free from malignancy. Unfortunately, blocks and slides are no longer available. (Underwood: Introduction to Biopsy Interpretation/Surgical Pathology. Springer Verlag, 1981)

30. Both McKenzie and Virchow were blamed. Virchow remained largely unaffected but McKenzie received many professional attacks, he was expelled from Royal College of Physicians. His reputation collapsed.  From the point of pathology, this unfortunate event reinforced the opinion of the anti-biopsy opponents that biopsy for diagnosing cancer was not a reliable method.

31. TOPIC 4;PRESIDENT & PATHOLOGIST Virchow was an eminent pathologist and politician as well but never became a president of the state. However in the recent history of politics, there was a head of state who was also a medical doctor and pathologist.

32. Here comes the question 4! Do you have any idea who this president was? • Salvador Allende– Chile • Javier Arias Stella – Peru • Ernesto Che Guevara – Cuba • BesarEsad– Syria

33. The correct answer is A – SalvadorAllende, Chilean president in 1970-1973 was a pathologist. He is known as the first Marxist president to gain power in a free democratic election.

34. On 11th September 1973, a military coup removed Allende’s government from power. Allende died in the fighting in the presidential palace in Santiago, the capital city of Chile. (Possibly committed suicide). General Pinochet’s military dictatorship governed Chile until 1990. Virchow’s followers established pathology depertmant in Latin America and initiated Cources in Social medicine Allende’s experiences as a doctor,pathologist and politician were shaped under such educational model. (B.Friedmann. Salvador Allende: Pathologist, Populist, and President. Lab Soft News, March22,2006).

35. TOPIC 5;NOBEL PRIZE & PATHOLOGISTS Nobel prizes are awarded for outstanding contribution in Physiology or Medicine by Swedish Academy since 1901. First Nobel Prize winner (Laureate) in Medicine is Behring in 1901 for discovering diphtheria vaccine. Since 1901 until 2010, in 109 years almost 100 winners received Nobel Prize in Medicine. (WW I, WW II no prize was given)

36. Here comes the question 5! Among more than 100 Nobel winners in medicine were there any pathologists? • Yes • No

37. The correct answer is “A” There were 3 pathologists who won the Prize: • 1906 Ramon Cajal(Spain), • 1934 George Whipple (USA), • 2005 Robin Warren (Australia).

38. 2005 Robin Warren (Australian Pathologist 1937-) Nobel Laureate who is credited with the be discovery of the bacterium Helicobacter Pylori (1979), together with Barry Marshall (microbiologist). Warren proved that HP is the cause of stomach ulcers and helped develop urea breath-test for detecting HP in ulcer patients.

39. 1934 George Whipple (1878 – 1976) American pathologist. Duodenal bx: Whipple’s disease; foamy macrophages Whipple won the Nobel Prize with 2 other non-pathologist doctors “for their discoveries concerning liver therapy in cases of anemia” Whipple’s main research was concern with anemia and pathology of liver which led to liver treatment of “pernicious anemia”. He also describedWhipple’s disease (malabsorption + weight loss + diarrhea + joint pain). He is not related to surgeon Allen Whipple who described the Whipple procedure. The two were life long friends.

40. 1906 Ramon Cajal(1852 – 1934)Spanish pathologist, neuroscientist, Nobel laureate together with Italian histologist Camillo Golgi (1843 - 1926) “in recognition of their work on the structure of the nervoussystem”.

41. TOPIC 6; SOME “FIRSTS” IN CYTOLOGY From Dr. JC Prolla, Brazil

42. Here comes the question 6! The usefulness of fine needle aspiration is todaywidelyaccepted. Do you have any idea who first applied FNA? • Franzen – Zajicek • Hajdu • Frable • Paget

43. The correct answer is “D – Paget” British surgeon Sir James Paget (1814 – 1879 ) applied the first recorded FNA in 1853. He prepared smears from needle aspirate of a breast carcinoma [Paget J. Lectures on surgical pathology Langman, Lerden, 1853].

44. In this context, I would like to mention a few other “firsts” in cytology. First Imprint Cytology: Johannes Müller (1801 – 1853) German pathologist in Berlin, made smears from tumors in 1838. Müller showed cancer cells in the microscope on scrapings from the cut surface of surgically excised tumors.

45. First FNA in USA breast FNA one of the first in USA (from: Rosai and Ackerman) James Ewing (1866 – 1943), pathologist working at the Memorial Hospital for Cancer in New York, introduced aspiration cytology in USA in 1920’s.

46. First pioneers of FNA in Europe,Swedish hematologist and pathologists(Zajicek, Franzen and Lowhagen) pioneered for widespread use of FNA. With their efforts FNA began to recieve international attention in 1980’s. Franzen 2008

47. Herecomesanotherquestionon thistopic: Question 7! Who is thefirstcytopathologistdescribedkoilocytoticatypia? • Dr. Papanicolaou • Dr. Leopold Koss • Dr. BernardNaylor • Dr. George Wied

48. Thecorrectanswer is “B – Dr. Leopold Koss” The term of koilocytoticatypia was first introduced by Leopold Koss in 1956 (two decades later, association between HPV and koilocytosis was first reported by Meissels & Purola).

49. TOPIC 7; DR PAP Needless to saywe all know aboutthe Pap test and itsinventorDr. Papanicolaou.

50. Here comes the question 8! What is the speciality of Dr Papanicolaou? • Pathologist • Gynecologist • Microbiologist • Anatomy