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HISTORY OF AMERICAN SURGICAL PATHOLOGY

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At the core of surgical pathology is a surgeon's obligation to their patient. In studying the tumor, a surgeon can better care for their patient. Historically, upon removing the tumor, a surgeon would walk with the specimen from the operating room to an adjacent laboratory. There he or she would dissect relevant sections for examination. This exercise paired with the growing academic influence of established schools of anatomy provided the framework for modern surgical pathology.

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Johannes Muller's (1801–1858) careful experimental methods at autopsy laid the groundwork for the young Rudolph Virchow (1821–1902) to form his cell theory “omniscellula ecellua” or “all cells come from cells.” The concept rebuilt the understanding of human disease based on the dynamics of cell interactions. Inflammation and tumor growth were considered in the intercommunication of cellular populations. Virchow's remarkable teaching methods influenced capable followers like Francis Delafield (1841–1915) and Theophil Mitchell Prudden (1849–1924) to publish their Handbook of Pathological Anatomy and Histology in 1885. They too went on to influence other devotees of the cellular vision. James Ewing (1866–1943) who studied under Delafield and Prudden and William Welch (1850–1934) built on prior intellectual works and observations. They forged a lifework that became American surgical pathology.1

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Technical advances in the field continued to sustain and grow this burgeoning discipline. While invented by Zacharias Janssen (1585–1632) and optimized by the lens work of Antoine Leeuwenhoek (1632–1723), it wasn't until 1673 that the compound microscope made its way into the laboratory. The mid- to late 1800s saw substantial advances in optics to demonstrate its deciding value within the laboratory. Even engineering of the 3" × 1" glass slide and coverslip were not trivial achievements. Like any innovation, the microscope had to demonstrate that it was better than benchmark standards at that time. As with many innovations, dissenting opinions existed regarding the microscope's usefulness. Alfred-Armand-Louis-Marie Velpeau (1795–1867), an anatomist at the University of Paris, commented, “the invention of the microscope is not at all necessary to decide whether such a tumor is of cancerous nature.”2

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Another important development in the field was the use of differential staining. Up until 1850, tissue was examined unstained; as early as 1858 pathologists were experimenting with tissue staining. Probably the most noteworthy was a stain from the logwood tree (Haematoxylum campechianum) found in northern Central America, southern Mexico, and Haiti. This pigment was coupled with a mordant that fixed the color to the test tissue and perfected the staining process. Ten years later, pairing this methodology with developing synthetic dyes such as eosin provided a synergistic combination that became and remains one of the most heavily utilized staining method in the surgical pathology laboratory—Hematoxylin and Eosin or the H&E.1

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In all likelihood, the most historical and iconic technical advance in the surgical pathology field was the development of the frozen section. This test was conducted within the surgery suite for ...

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