Pathways to Excellence | Spring 2019

Pathways to Excellence URMC DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE

|

WWW.PATHOLOGY.URMC.EDU

Drs. Philip Katzman (left) and Leon Metlay comprise the pediatric pathology service at URMC. While they are already involved in teaching residents, they look forward to welcoming their first fellow in 2020.

A $1 million gift from Milton Finegold, M.D., an alumnus of the University of Rochester School of Medicine and Dentistry, will support a new pediatric pathology fellowship.

The fellowship will be the first of its kind offered in New York State and one of just 26 ACGME approved pediatric fellowships in the U.S. URMC looks forward to enrolling its first pediatric pathology fellow in the fall of 2020.

“Having a fellowship in our institution may help to retain some of our own residents who are interested in this subspecialty,” said Philip Katzman, M.D., a pediatric pathologist at URMC. “The presence of a fellowship program also helps with providing more teaching opportunities in the medical school and in clinical services that the pediatric pathology subspecialty serves,” he said.

Finegold is a native of New York City and studied at U of R from 1955-60 as a medical student and a year-out pathology student fellow. He went on to a long and successful career as a pediatric pathologist. He is now Professor Emeritus of Pathology & Immunology at Baylor College of Medicine.

|

SPRING 2019

Alumni Gift to Fund New Pediatric Pathology Fellowship

His original intention as a trainee was to become a hand surgeon. When he decided surgery “wasn’t for him,” he was thankful for the mentorship he received from UR Pathology faculty, especially the late chairman, Dr. Lowell Orbison.

Over the course of his training, he developed a passion for learning about how children become ill and how to determine what causes these illnesses. While at NYU and then Baylor, he served as the director of a pediatric pathology fellowship. Looking back to his own days as a student and fellow, Finegold says that sponsoring this educational opportunity is one way he wants to give back.

“Like anybody in academic medicine, your greatest satisfaction is getting to see the progress of your students,” said Finegold. “It’s Milton Finegold, M.D.

IN THIS ISSUE From the Chair.................................................................. 2

Focus on Faculty ............................................................... 4

Award Winner .................................................................. 3

USCAP Recap ................................................................... 5

June Symposium............................................................... 3

Research Study.................................................................. 6

CHAIR’S COLUMN

G

Bruce Smoller, M.D.

“A lot of hard work and creative thinking will be required of the entire team to make this next phase a success.”

reetings from the Chair’s office! Spring is just around the corner (or within the next few months) and with it, the annual rituals of closing out one academic year and bringing in the next. Match day is a week from now, as I write this, and with it, the excitement (and anxiety) about discovering the names of our new class of trainees. The faculty are finalizing their decisions about offers for various fellowship positions and faculty recruiting continues with its usual fervor.

We have successfully recruited Dr. Tony Yeung from Vanderbilt University to join our hematopathology unit. He will be arriving in the late summer and we will introduce him more fully at that point.

We are also excited to have Dr. Sachica Cheris, one of our recent residency graduates, returning to us from Duke University, having just completed fellowship training in both surgical pathology and cytopathology. This summer we will also welcome Tanupriya Agrawal, M.D. to our Cytopathology service after she completes her fellowship at NIH. The most exciting news within the department is that we are now the occupants of a new laboratory building on Bailey Road.

We are moving office furniture and laboratory equipment into the building and beginning the validation procedures. The plan is that we will start generating patient test results from the new facility on June 24. Our faculty and staff have been busily preparing for this move for the past several years and all seems to be progressing as well as could be hoped for. Alas, this is just the beginning.

Our automated hematology and chemistry laboratories, as well as the Blood Bank, are now beginning the process of planning for their moves from their current locations to the 2100 Tower of the main hospital, creating space for enlarging the Emergency Department. This on-site relocation is expected to be completed by the end of 2019. A lot of hard work and creative thinking will be required of the entire team to make this next phase a success.

Thereafter, various additional laboratories will move into the Bailey Road facility, hopefully within the next couple of years and we will be able to enter a period with less upheaval.

Many of our faculty, fellows and residents attended the USCAP meeting in Washington, D.C. later this month. The department was responsible for 31 abstract presentations at the annual meeting and was represented by a very large team. I am proud of the academic work that our team is generating. We held our usual reception for URMC members, alumni and friends and hope you will plan to join us again at next year’s conference.

Finally, on June 1, 2019, our department will host its first annual “Updates in Pathology” conference (see page 3 for details).

Dr. Mark Stoler, a URMC alumnus will be the keynote speaker and a panel of distinguished faculty members will present a full day of CME-generating lectures. Please plan to attend the conference which will be open to pathologists and trainees throughout the state and neighboring communities. We are excited about this new event.

2 URMC DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE

Sachica Cheris, M.D.

Tony Yeung, M.D.

Tanupriya Agrawal, M.D..

PEDIATRIC PATHOLOGY FELLOWSHIP (CONT.) wonderful to witness what they become and what they do.”

He noted that pathology is generally low on the list of attractive areas of study among especially for medical students. Pediatric pathology is an even rarer program, forced to compete with more popular subspecialties like forensic pathology or surgical and neuropathology.

“In order to get people interested in pediatric pathology you want to generate an opportunity in the area of children’s disease, and you have to do whatever you can to make it attractive,” said Finegold.

Bruce Smoller, M.D., chairman of Pathology & Laboratory Medicine at URMC said the gift will expand the department’s offerings for potential trainees.

“This prestigious new fellowship opportunity enhances the range of training opportunities that our department provides,

increasing our national visibility and improving what is already a very strong educational program,” said Smoller.

“Like anybody in academic medicine, your greatest satisfaction is getting to see the progress of your students.”

- Milton Finegold, M.D. Dr. Finegold lives in Houston with his wife, Jan GoddardFinegold, M.D., and their dachshund, Trixie. They have three children and two grandchildren.

VANDEWALLE WINS MELIORA AWARD Congratulations to Vicki VanDeWalle, director of process improvement and projects for Pathology and Laboratory Medicine, for being named a winner of the prestigious University of Rochester Meliora Award.

This honor recognizes a select number of staff members whose work performance and dedication during the preceding few years exemplify the University’s motto, Meliora (“ever better”).

Vicki has played a key role in many quality and patient care initiatives for the department, including the current relocation and consolidation of clinical laboratory operations to Bailey Road.

According to the nomination statement, “Her expertise and consistent professionalism have made her an invaluable resource to

her colleagues and all those involved.”

This, together with her years of work leading and coaching those who spearhead various projects in the laboratory, earned her an enthusiastic endorsement.

VanDeWalle will be honored in April along with other award recipients.

SAVE THE DATE! WHAT WHEN WHERE COST

REGISTER: CME

QUESTIONS

The first annual Updates in Pathology Regional Symposium Saturday, June 1, 2019 Hilton Garden Inn, 30 Celebration Drive, Rochester, NY 14620 $150 for pathologists (early registration), $175 regular registration, free for URMC trainees.

Non-URMC residents or fellows may attend for meal cost only.

Online at www.Pathology.urmc.edu 7.5 hours Email Bethany_bushen@urmc.rochester.edu

3 URMC DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE

FOCUS ON FACULTY: CAROLINE DIGNAN, M.D. From a young age, Dr. Caroline Dignan was curious about life and death.

Her career as a chief medical examiner, and today as the head of Autopsy at URMC was foreshadowed by moments like when she heard that a person on TV died and asked her mom how.

“My mother would say, ‘They just died. Their heart stopped,’” Dignan recalls. “And I would say, ‘No, Mom. How did they really die?’”

This desire to know the truth has been a constant throughout her career. Dignan grew up in Alexandria, Va. and went to the University of Virginia for medical school. There, she developed her interest in becoming a pediatrician. But in her third year, she read a book that changed the course of her life. The book was Unnatural Death: Confessions of a Medical Examiner by Michael Baden, M.D. By the time Dignan started her residency at the University of Michigan she had decided forensic pathology was what she wanted to do.

“For me it’s all about understanding,” she said. “I always loved to learn and putting it all together is what really appeals to me about medicine in general – trying to make sense of everything.

Autopsy pathology is about working to get the ultimate understanding of what has happened.”

After residency, she did her fellowship at the University of New Mexico where she and husband, Jim, pondered their next move. Their family moved to Syracuse where there was a part-time opening in the Onondaga County Medical Examiner’s Office (where they were geographically halfway between their respective families). Ultimately, her job became full-time and she rose to the role of deputy chief medical examiner. In 2002 Dignan began working for the Monroe County ME’s office where she would later become the chief medical examiner – a role she held for 10 years.

During that time, she oversaw thousands of cases and testified in many criminal court cases. She was still giving testimony almost two years after leaving to take her current position as director of Autopsy at URMC in 2016.

The main differences between autopsies conducted at a medical examiner’s office versus a hospital, she explained, have to do with the law and type of death that occurs. In general terms, ME offices investigate deaths where the cause is unknown, or “unnatural.” Hospitals perform autopsies on deceased patients when the family requests it – either to learn more about the cause of death, confirm or refute a diagnosis, or learn whether the death was linked to something genetic.

Under Dignan’s leadership, the Autopsy service has been very open about encouraging clinicians to tell patients and their families to take advantage of this option. Hospital autopsies have since continued to climb, with 220 in 2018, up from just 186 in 2016. This year, they are on track to do at least 250 autopsies at SMH. She attributes the rise in autopsies to a simple desire for families to get answers about the factors that led to their loved one’s death, especially if it means learning something about their own health in the case of diseases that can be passed down genetically.

“Like so many other things, it’s important for people to feel like they have as much information as they can and that they are making an informed decision,” said Dignan. “I think finding answers that help others is what I really love.”

While getting these answers is a process she finds rewarding, she acknowledges that like many clinical professions, the daily work can take an emotional toll due to its difficult nature. She

“I think finding answers that help others is what I really love.“ - Caroline Dignan, M.D. openly shared that she regularly sees a therapist to develop techniques for processing the weight of her work.

“I think that mental health is really important and that having a professional or somebody you can talk to is important for everybody,” she said.

Having a strong family support system is critical for striking that balance, she said. Dignan and her husband have two daughters, Sarah, 21, and Anna, 17. They live in the village of Fairport. In her free time, she enjoys crochet, gardening and walking along the Erie Canal near home.

THANK YOU FOR GIVING BACK We are grateful for philanthropic support that allows us to maintain and accelerate clinical, educational, and research initiatives.

To make a tax-deductible gift today or as part of your estate plans, please visit www.pathology.urmc.edu and click the “Make a Gift” button, or contact Matt Haag at (585) 276-3638 or matthew.haag@rochester.edu.

4

CATCHING UP AT USCAP Department faculty and trainees had another strong showing at USCAP 2019, held in Washington, D.C. in March. In addition to giving poster and oral presentations, more than 60 people attended our annual reception for alumni and friends.

5

Department of Pathology and Laboratory Medicine University of Rochester Medical Center 601 Elmwood Avenue, Box 626 Rochester, NY 14642

RESEARCH OFFERS NOVEL INSIGHTS INTO TREATMENT OF RHEUMATOID ARTHRITIS It has been known for years that B cells, immune cells that originate in bone marrow, play a role in Rheumatoid Arthritis (RA). A recent Nature Communications publication from co-senior authors Lianping Xing, Ph.D., and Jennifer Anolik, M.D, Ph.D., suggests that the accumulation of B cells close to areas of arthritic bone loss inhibit the formation of new bone – a discovery that may help drive the development of new RA treatments.

Until now, the connection between B cells and bone damage was not clear. In healthy people, bones undergo constant break-down and rebuilding. Xing and Anolik’s work suggests that a subgroup of B cells inhibit bone regrowth and furthermore, that B cells secrete specific molecules that can be targeted pharmacologically.

Unlike palliative treatments that managed the symptoms of the disease, current therapies include targeted biologics that aims to slow disease progression. Eliminating B cells through B Cell Depletion Therapy (BCDT) has

been shown to do so, though this paper is the first to provide a possible answer why.

“Our study discovered a subgroup of B cells that affect bone cell functions in RA and support the development of therapies targeting specific pathogenic B cells and key inhibitors of osteoblasts, the bone contributing cells,” said Xing.

-Heather Natola

Lianping Xing, Ph.D.

URMC DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE 6