Pathology At The Speed Of Thought

Excerpts from the Robert E. Scully Collection

A Journey through Diagnostically Challenging Areas in Gynecologic Pathology

A Journey through Diagnostically Challenging Areas in Gynecologic Pathology

September 28 - 30, 2018

Physicians Can Earn A Maximum Of 15 AMA PRA Category 1 Credits
Physicians Can Earn A Maximum Of 15 SAM Credit Hours

Mentoring is a core value of USCAP, and Dr. Robert E. Scully is one of the legendary and iconic pathologists who inculcated this concept in his colleagues and students. His empathic, gentle, and kind nature, his indomitable spirit and gifted diagnostic skills suffused the inspiration he radiated. His spirit prevails in the contributions of the pathologists he influenced, an excellent example of which is the mentoring relationship between Drs. Robert H. Young and Jennifer Stall, reinforced by their experience with the Scully archive. Together, they bring to next generation learning the diagnostic principles and wisdom of the Scully approach.

Robert E. Scully (RES) was one of the most influential anatomic pathologists of the last sixty years; his work in gynecologic pathology is seminal and his contributions to testicular pathology and the pathology of disorders of sexual development attained great stature.

RES, a native of Pittsfield in western Massachusetts, was born in 1921. The early death of his father resulted in his being raised by his mother, a teacher, to whom he credited his great knowledge of English and love for writing. He graduated from the College of the Holy Cross in Worcester, Massachusetts in 1941 and then attended Harvard Medical School. He subsequently was a resident in pathology at the Peter Bent Brigham Hospital, also spending time at the gynecologic and obstetric hospitals affiliated with Harvard Medical School, the Free Hospital for Women and Boston Lying-In Hospital where he came under the influence of Dr. Arthur Hertig, which led to an interest in gynecologic pathology.

His aptitude for academic contributions was shown (when he was a resident) in the form of a comprehensive review of all testicular tumors seen at the Brigham hospital. This led to two early publications on that topic upon which he maintained a life-long interest. Gynecologic pathology was nonetheless his “first love.” A seminal description of the remarkable disorder “gonadoblastoma” in 1953 heralded his interest in disorders of sexual development, the latter a subject on which he was a master. RES was recruited to join the staff of the Massachusetts General Hospital (MGH) in 1950, by Dr. Tracy Mallory, one of the three eminent pathologists of a legendary Boston medical family. RES remained at the MGH for his entire fifty five-year career, save for relatively frequent trips to lecture in North America and abroad, undertakings which he greatly enjoyed as they represented a respite from an exceedingly busy hospital and consultation practice and also satisfied his curiosity about distant parts.

Although best known for his work in the fields already noted it should be remarked that RES was a superb all round anatomic pathologist, having a great interest, particularly in his early years, in cardiac pathology. Throughout his entire career he was an excellent expert consultant on essentially all areas of diagnostic pathology. An important early contribution was his 1958 book with Dr. Jack Morris, a gynecologist, entitled “Endocrine Pathology of the Ovary” which showcased an early interest in unusual ovarian tumors and resulted in their being sent to him for a second opinion at an ever-accelerating pace.

These were accompanied, as the years went by, with cases from the entire field of gynecologic pathology as well as his noted other areas of interest and even included a modest number of cases of miscellaneous surgical pathology natures. The collection of cases sent to him was maintained by him in his office and still remains for review at the MGH; study of them by numerous trainees and visitors is a remarkable educational experience because of the wealth of material and the opportunity to read the accompanying letter of consultation sent by RES which often amounted to a small treatise on the matter at hand.

The contributions of RES to what we know about ovarian tumor pathology merits particular emphasis. He was the main guiding light behind the first World Health Organization (WHO) classification of ovarian neoplasms published in 1973 and the old adage “bringing order out of chaos” is never more appropriately used than in reference to that work. His many original contributions include clarification of the nature of clear cell carcinoma of the ovary (still widely considered mesonephric before his paper on the topic), original descriptions of many entities, sclerosing stromal tumor, small cell carcinoma of hypercalcemic type, juvenile granulosa cell tumor, retiform Sertoli-Leydig cell tumor, to name just a few, and his body of papers on categories such as metastatic tumors and sex cord-stromal tumors in general represent the framework for most discussions of these tumors in standard texts to this day and likely for years to come.

His contributions to other areas of gynecologic pathology should not, however, be overlooked and include seminal contributions (with Philip B. Clement, M.D.) on Müllerian adenosarcoma and the unusual so-called uterine tumor resembling an ovarian sex cord tumor. Work in non-ovarian fields included his playing a major role in describing the neoplasms and non-neoplastic abnormalities that afflicted young women exposed in utero to diethylstilbestrol (DES); indeed, it was likely that his noting a spike in hospital cases of vaginal clear cell carcinoma in young females led to the DES story coming to light.

Original contributions in testicular pathology include descriptions of the large cell calcifying Sertoli cell tumor and the largest series of cases of juvenile granulosa cell tumor. By writing the first English language paper on spermatocytic seminoma, he also highlighted that remarkable neoplasm. He was always alert to the clinical background being relevant, often times, to the interpretation of a pathologic specimen and perhaps nowhere was this shown better than his appreciating the remarkable pseudotumor named “postoperative spindle cell nodule,” an entity co-recognized by Dr. Juan Rosai. The remarkable length of the career of RES is noted in many ways, including being the first speaker at a postgraduate course co-organized by Dr. Rosai when RES was no less than 81 years of age!

Dr. Scully’s character and expertise were acknowledged by USCAP when he was invited to present the prestigious Maude Abbott Lecture and was bestowed the Board’s Distinguished Pathologist Award.

RES remained largely free of major health issues until his 9th decade when various afflictions unfortunately hindered his participation in routine work activities and resulted in his spending most of his time in his apartment overlooking Boston Common. He still remained in frequent touch with many colleagues and friends and did so until his death in October, 2012.

RES, who attained the rank of Professor of Pathology at Harvard Medical School was survived by his two nieces and a nephew, children of his only sibling, a brother, and they were a source of great joy to him throughout his life.

Although RES is remembered from the academic viewpoint for his remarkable diagnostic skills and numerous contributions, all who interfaced with him remember him equally for his humble, kind nature. Despite a great workload and numerous obligations he always remained a gentle, considerate colleague and advisor to numerous individuals who had the good fortune to collaborate with him and train under him. His legacy will remain because of that, his remarkable spectrum of contributions, and his great collection of cases. Excerpts from those cases will be presented by Drs. Young and Stall at this remarkable interactive microscopy course.