It is difficult to put into words my humble gratitude to you, my fellow colleagues of the Academy for this honor. I feel as though I am a surrogate for those distinguished pathologists who provided for me the path along which I have traveled these four decades. Two of these distinguished pathologists, Drs. John Kissane and Lauren V. Ackerman, one a pediatric pathologist and the other a surgical pathologist, became a part of my life when I was a second year medical student at Washington University School of Medicine. Was there any other direction that their respective influences upon me were to be manifested than for me to become a surgical pathologist whose core interest and scholarship has been focused upon the unique maladies of childhood? Other distinguished pathologists in my life have included Captain Bruce Smith, MC, USN, Drs. Walter C. Bauer, Ellis S. Benson, Juan Rosai and Michael Kyriakos. Each of these individuals was there at a critical juncture in my professional life.
My undergraduate and medical educations were obtained at Washington University in St. Louis. In fact, I was born in this medical center at the old St. Louis Maternity Hospital, and grew up in the community across the Mississippi River, East St Louis, IL where my father coached high school basketball and my mother taught English and literature at one of the junior high schools. My classmates sympathized with me since basketball practice in a sense never ended for me. My father was a former all-American basketball player at the University of Illinois, but he and I discovered that one son who was a mediocre athlete and a better student was bound to disappoint him at some level.
Upon the completion of my first year of residency in anatomic pathology at Barnes Hospital in June 1967, it became necessary to pay the piper as I had joined the U.S. Navy's Ensign 1915 program as a medical student in order to support my young family. We had been living in public housing in East St. Louis until my third year in medical school when I no longer had the time to travel across the River when I began my clinical clerkships. The terms of my contract with the Navy required me to report for active duty in July, 1967 and before the end of that month, I found myself as the "laboratory officer" at the U.S. Naval Support Activity Station Hospital, DaNang, Republic of Vietnam (RVN). Before I left St. Louis to report to Camp Pendleton, California, for Field Medical Service School, Dr. Ackerman called me into his office and told me that he was sorry that I had to go off to "that terrible war," but he wanted to let me know that there would be a fellowship position in surgical pathology waiting for me upon the completion of my service obligation. Dr. Ackerman provided one of few glimmers of hope about the future as I began a very dark period of my life when I left a wife, three sons and a daughter to be born in October, 1967.
The year (1967-1968) in RVN forever divided my life into the "before" and the "after" of that experience. I had the opportunity to work with some of the most dedicated, unselfish and compassionate physicians, nurses and corpsmen in the midst of the "gore of war" and "seeing the elephant" as it came to the perimeter of the hospital in the early hours of January 31, 1968 with the initiation of the Tet offensive which was the beginning of the end of our involvement in RVN.
Captain Bruce Smith was the Director of the Armed Forces Institute of Pathology (AFIP) in 1968 and agreed to accept me when there were no Navy billots at the AFIP after my year in RVN. The opportunity to attend sign-out conferences with Drs. Herbert Taylor, Henry (Jason) Norris and Kamal Ishak, and work on a number of projects for Captain Smith set me on the pathway of academic surgical pathology. Jason Norris taught me the essentials of writing a paper and Kamal Ishak the basics of hepatic pathology.
Following the completion of my military service, the transition to civilian life proved to be more difficult than anticipated as a piece of me never left RVN and may still be there on the DaNang peninsula 40 years later. However, true to his word, Dr. Ackerman had that fellowship position for me in July 1970. The year as a surgical pathology fellow remains in many respects my best year in surgical pathology in that every day there was something new. During the course of the day, Dr. Ackerman was constantly throwing the challenges our way, instilling that sense of inquiry and discovery and demonstrating to us how to reach beyond ourselves. Dr. Ackerman was largely responsible, in my estimation, for putting the "academic" into surgical pathology.
I remember talking to Drs. Ackerman and Kissane about those tentative, early steps into something that I wished to call pediatric surgical pathology. Several trends in the care of children began to emerge in the 1960s and were well on their way in the 1970s including pediatric surgery and anesthesia and subspecialties in pediatrics. One of the latter was pediatric hematology-oncology since chemotherapy and/or radiation therapy were proving their efficacy in the management of solid malignant neoplasms in children. As the pioneer pediatric surgeon at St. Louis Children's Hospital, Dr. Jessie Ternberg said that if a childhood cancer could not be "cut out" then the "kid was a goner." But obviously all of that has changed. The pathologist could no longer get away with the diagnosis of an "undifferentiated or primitive malignant neoplasm" in child without a succession of calls from clinicians expressing their opinion about our so-called diagnostic skills. At the time electron microscopy was beginning to lead the way as a powerful adjunct in the diagnosis of those "small cell tumors" to be succeeded in my life time by immunohistochemistry and now molecular diagnostics. Some of that early work on the application of electron microscopy and immunohistochemistry in diagnostic surgical pathology was done by my good friend and colleague, Juan Rosai, M.D.
As one of the first steps into the world of pediatric surgical pathology, I submitted a proposal to the Academy in 1973 for a short course entitled, "Surgical Pathology of Infancy and Children," which was accepted and I gave it for the first time in 1974. I selected eight cases including a Wilms tumor, neuroblastoma and several other basic representatives of surgical pathology problems in children. During this period, I took the opportunity to review the types of pediatric cases which were on file in the Division of Surgical Pathology at Barnes Hospital (now Barnes-Jewish Hospital). Because the old St. Louis Children's Hospital did not have its own operating rooms, several Barnes Hospital operating rooms were utilized for pediatric cases which created the unusual situation of pediatric surgical pathology being practiced outside of the physical setting of a children's hospital. Out of these experiences, the first edition of Pediatric Surgical Pathology was born in 1976.
The next 15 years (1974-1989) were spent at the University of Minnesota with Juan for 12 of those years. It is a time that he and I have referred to on more than one occasion as a "golden" period for both of us. We had the opportunity to build a program in surgical pathology from the ground up. Juan and I were fortunate to have a chairman, Ellis S. Benson, M.D., who encouraged and supported all of our efforts.
It was at the University of Minnesota that I saw my first case of pleuropulmonary blastoma (PPB) on a very cold first of January, 1977 and with it the 20-year odyssey with this unique pediatric neoplasm which filled the hiatus of a primary embryonic neoplasm of the lung which we now know begins as a multicystic pulmonary lesion that progresses to a complex multipatterned primitive sarcoma over the first 3 to 4 years of life. Today the International Pleuropulmonary Blastoma Registry has enrolled over 240 pathologically documented cases. John (Jack) Priest, M.D., pediatric hematologist-oncologist in St. Paul, MN, whom we have worked with for almost 30 years, initiated the Registry and has largely devoted his life to the afflicted children with PPB and their oncologists and parents. The other individual who has dedicated herself to the PPB is my former resident, pediatric pathology fellow and colleague, D. Ashley Hill, M.D. With the recognition that there is a PPB - familial predisposition syndrome, Ashley and others have been in pursuit of the constitutional mutation responsible for PPB as well as the other tumors which occur in affected kindreds. It has been a great privilege and highly rewarding experience to be a part of the PPB saga which could never have progressed to this point without the enormous efforts of many individuals named and unnamed. We have had two PPB family weekends, the first in St. Louis in 2006 and this past summer in Bloomington, MN. Families from all over the United States and several other countries have come together with their PPB - child and siblings. As pathologists, we do not often see the faces of our diagnostic efforts, but for a weekend, names and faces become embodied. We have had the opportunity to meet and talk with the parents whose child with PPB has become a "parent's worst nightmare."
For the opportunity to return to St. Louis in 1989 as Director of Anatomic Pathology and to hold the same position as Surgical Pathologist-in-Chief at Barnes-Jewish Hospital as Dr. Ackerman, I wish to thank and acknowledge Emil R. Unanue, M.D. who was my chairman from 1989 to 2006. He allowed me the opportunity to shape the Division of Surgical Pathology and supported by the idea of designating ourselves as the Lauren V. Ackerman Laboratory of Surgical Pathology. Dr. Ackerman regarded this as his singular greatest honor. The torch has now been passed to my successor, Peter A. Humphrey, M.D., Ph.D., who was one of early faculty recruits. Life goes on.
Dr. Lauren Ackerman once said that "one's papers and books become yellowed and forgotten," but those residents and fellows whom you have educated and trained and in turn the ones that they will educate and train become one's enduring legacy. I have now had the opportunity to live out what Dr. Ackerman had to say many years ago about one's legacy. Over these 40 years at the Barnes Hospital, University of Minnesota Hospital and now at Barnes-Jewish and St. Louis Children's Hospital, I would estimate that nearly 1,000 pathology residents and fellows have had to endure me in one way or another. They are the ones who will speak for me in the years ahead.
Louis P Dehner