5:10 p.m., Tuesday, March 4, 2008
Convention Center Korbel Ballroom
Christopher D.M. Fletcher, M.D.
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Dr. Christopher D.M. Fletcher was born in Huddersfield, England. Educated in his native England,
Christopher Fletcher attended Winchester College in Hampshire, England, then took his MB BS (medical
degree) from St. Thomas's Hospital Medical School in London in 1981 and received his MD degree (by
thesis) from the University of London in 1991. Following internships in general medicine (Queen Mary's
Hospital in Sidcup) and surgery (Kingston General Hospital, Surrey), Dr. Fletcher returned to St.
Thomas's for a residency in pathology as well as senior residency and a research fellowship in
histopathology. He was to remain affiliated with the latter institution for the next decade, rising
rapidly to appointment as Consultant Histopathologist and Director of the Soft Tissue Tumor Unit
(19891995) and to the rank of Professor of Surgical Pathology in The University of London (1995). At the
age of 37, Dr. Fletcher was recruited to the United States by Dr. Ramzi Cotran and others in 1995,
serving as Director of Surgical Pathology at Brigham and Women's Hospital in Boston and being appointed
Professor of Pathology in the Harvard Medical School. He has also held appointment as Chief of
Onco-Pathology at the Dana Farber Cancer Institute since 2000.
Dr. Fletcher has received a great many awards and honors including those as an undergraduate from St.
Thomas's Hospital Medical School and the University of London, to those, for example,
from the Belgian and Austrian Societies of Pathology, and from virtually every place he has been!
(see below). Dr. Christopher Fletcher received the 1997 USCAP Young Investigator Award admirably
fulfilling the criteria for that major award; by age 38, he had already contributed a very substantial
body of work, including over 200 publications, which has had a considerable influence worldwide on the
diagnosis and understanding of human soft tissue tumors. He has been one of the most innovative and
creative of surgical pathologists, his work being characterized by an incisive, critical and even
iconoclastic approach to the subject of soft tissue tumors. His peer-reviewed publications now number
over 450 (at the time of this writing but rapidly increasing!) in the major pathology and oncology
Dr. Fletcher is the author/co-author of major monographs used by pathologists the world over in their
evaluation of soft tissue lesions. He is a co-author of the 3rd series Armed
Forces Institute of Pathology/American Registry of Pathology Fascicle, Tumors of the Soft Tissues
and, as Chairman of the World Health Organization Working Group for the Classification of Tumors
of Soft Tissue and Bone, taking the lead editorship of the authoritative new "blue book" in this area
(Pathology and Genetics of Tumours of Soft Tissue and Bone, 2002). An
oncologic pathologist of broad talents, Chris Fletcher is also editor of the masterful Diagnostic Histopathology of Tumors, which recently went into a 3rd
edition. This received the United Kingdom's Royal Society of Medicine/ Society of Authors Prize for Best
Illustrated Medical Textbook (1996) and its successor received from this society Best Subsequent Edition
of a Medical Textbook. Dr. Fletcher has delivered a great many invited lectureships that have taken him
across the United States, Canada, South America, Europe, Australia, and Asia. He is devoted to his
annual Diagnostic Histopathology of Soft Tissue Tumors course and to Harvard's pathologists-in-training,
for whom he serves as a very active mentor.
Major recognitions include the major awards of: the European Community Oswald Van Der Veken Prize for
research on musculoskeletal system tumors, the title of M.A. Honoris Causa from Harvard University, the
Henry L. Jaffe Award from the Hospital for Joint Diseases in New York City, the McAllister Memorial
Lectureship from Yale, the Elson Helwig Memorial Lectureship from the American Society of
Dermatopathology, the William Shelley Memorial Lectureship from Johns Hopkins, and the Eleanor Humphreys
Visiting Professor from the University of Chicago, as well as Honorary Fellowships in the College of
American Pathologists and Austrian Society of Pathology to name just a few.
He has served on the editorial boards of 17 leading periodicals (possibly a record!) including the
American Journal of Surgical Pathology, Virchows Archiv, Modern Pathology, Applied
Immunohistochemistry, American Journal of Clinical Pathology, Histopathology, the Journal of Pathology, Human Pathology and the Journal of
Clinical Oncology (to name just a few). Dr. Fletcher also served as a very active (Immediate
Past-) President of the Association of Directors of Anatomic and Surgical Pathology for two terms. He
has served a great many professional societies and memberships and is President-elect of the
International Society of Bone and Soft Tissue Pathology.
Dr. Fletcher's work falls broadly into three main categories centered upon the reassessment of
established diagnostic concepts, the description or validation of formerly unrecognized or inadequately
documented tumor types and the incorporation of modern molecular genetic techniques to enhance basic
understanding of the biology of soft tissue tumors.
Dr. Fletcher has provided convincing data that the diagnosis of prototypical pleomorphic malignant
fibrous histiocytoma (formerly regarded as the most common adult sarcoma), as generally used, subsumes a
heterogeneous but non-cohesive group of poorly differentiated neoplasms which usually can be classified
more specifically. Such reclassification has already proved to have significant therapeutic and
prognostic implications. He has carried this work forward by critically reassessing the validity of
`MFH' variants. More recently he has presented data to suggest that hemangiopericytoma is an
over-diagnosed neoplasm which again subsumes a variety of tumor types among which specific subsets can be
Dr. Fletcher has provided the first formal descriptions of a variety of previously unrecognized
tumors, many of which were mistaken for lesions of different biologic potential. Examples include
epithelioid angiosarcoma in soft tissue, angiomyofibroblastoma, cellular angiofibroma, retiform
hemangioendothelioma and spindle cell liposarcoma. He also validated and formally documented a variety
of tumors, such as the cellular and deep variants of benign fibrous histiocytoma, the prior existence of
which was not clearly defined.
Dr. Fletcher's incorporation of molecular genetic techniques into his research has been notable for
its attempts both to focus on specific histologic tumor types and to retain clinical relevance. With his
collaborators, he has shown that p53 mutations in atypical fibroxanthoma are U-V induced, that different
sarcoma types have very different molecular mechanisms and cell cycle pathways, that karyotype correlates
reliability with morphologic phenotype in adipose tissue tumors and he has provided conclusive proof at
the molecular genetic level that myxoid and round cell liposarcoma are a single tumor type.
Dr. Christopher D.M. Fletcher was the 2005 recipient of the Fred Waldorf Stewart Award, bestowed
annually by the Department of Pathology, Memorial Sloan-Kettering Cancer Center, on an individual deemed
to have contributed significantly to our understanding of human neoplasia. As Cristina R. Antonescu and
Marc K. Rosenblum stated in their Special Announcement in the American Journal of
Surgical Pathology (30: 400-401 March 2006):
"The international visibility and acclaim now enjoyed by Christopher Fletcher reflect his demonstrated
gifts as a microscopist, his creative intellect, pedagogical talents, and remarkable academic industry as
applied to the difficult area of soft tissue tumors. His original contributions to the literature (some
320 at the time of this writing) include over 280 studies devoted to neoplastic growths arising in the
soft tissues or to allied lesions presenting in visceral sites. These works include definitive
morphologic, immunophenotypic, and clinical characterizations of various established entities as well as
accounts (in surprising number) describing previously unrecognized tumors of distinctive aspect. A
sampling of the latter would include spindle cell liposarcoma, cellular angiofibroma,
angiomyofibroblastoma, proximal-type epithelioid sarcoma, the cellular variant of cutaneous fibrous
histiocytoma, reticular perineurioma, retiform hemangioendothelioma, myoepithelial tumors of soft tissue,
and a novel type of prepubertal vulvar fibroma. A busy consultation practice has facilitated Dr.
Fletcher's researches, enabling him to comment with unusual authority on even the rarest entities. Some
recent evidences (and these culled from the pages of this Journal alone) of the experience this man
brings to bear on problems of soft tissue neoplasia include sizable series addressing
radiation-associated vascular lesions of the skin (42 cases), cellular angiofibromas (51 cases), soft
tissue perineuriomas (81 cases), and soft tissue myoepitheliomas (101 cases). Dr. Fletcher has also
engaged, with others,
in developing new prognostic indices based on morphologic or genetic parameters, and he was
instrumental in generating the now widely used consensus system for predicting risk of metastasis in
gastrointestinal stromal tumors.
Noteworthy of Christopher Fletcher's scholarly efforts have been the critical eye he has turned on
certain traditional concepts of tumor classification and the enthusiasm with which he has lent his
expertise to studies aimed at extending our knowledge of soft tissue neoplasia to the genetic level. Dr.
Fletcher has argued persuasively for the unity of so-called infantile hemangiopericytoma and
myofibromatosis of infancy. He has also made a compelling case for the allied nature of adult-onset
myofibromatosis, myopericytoma, and glomangiopericytoma as
members of a tumor family (``myopericytomas'') deriving from modified perivascular smooth
muscle cells. Skeptical of wisdom in ready-to-wear form and a trenchant polemicist, Chris has questioned
the existence of hemangiopericytoma as a distinct entity (the teasing out of solitary fibrous tumors and
giant cell angiofibromas, among other lesions, now leaving precious little territory for believers), and
he may yet force the habitually abused term malignant fibrous histiocytoma (once the most commonly
invoked designation for sarcomas of adulthood) into retirement. A founding member of the Chromosomes and
Morphology Collaborative Study Group, Dr. Fletcher has partnered in the cytogenetic and molecular
genomic characterization of clear cell sarcoma/melanoma of soft parts, lipomatous tumors and liposarcoma
variants, leiomyosarcomas, synovial sarcomas, gastrointestinal stromal tumors, inflammatory
myofibroblastic tumors, extraskeletal myxoid chondrosarcomas, fibromyxoid sarcomas, desmoid tumors, and a
unique t(7;12)-associated pericytoma."
Significantly, Dr. Fletcher also has been one of the international members of the USCAP who has made
an important commitment to its many varied programs. Even when working in England, he regularly
contributed scientific abstracts, lectured in Companion Society meetings, Specialty Conferences, and the
Long Course on Soft Tissue Tumors and he enriched formal and informal discussions. His selection as the
USCAP awardee is not only well deserved on its own merit but reflects the international nature and
stature of USCAP. Dr. Fletcher has continued to serve the USCAP as an Abstract Reviewer and a member of
the Benjamin Castleman Award Committee, while also contributing to numerous Companion Society meetings
and Specialty Conferences. He presently serves as the Moderator of the USCAP evening Specialty
Conference in Surgical Pathology.
Dr. Christopher Fletcher is certainly a "man for all seasons" and we honor ourselves and our great
profession by recognizing this extraordinarily outstanding individual as the 2008 Maude Abbott Lecturer.
Maude would be proud.