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Pⁿ Blog
The Pⁿ Blog is a forum for opinions, questions, controversies, and instructive discussions across the field of pathology and its relevant subspecialties.
Wednesday, March 13, 2013
The Loss of Two More "Giants"
The last few weeks have seen the loss of two more greats in surgical pathology, John Azzopardi and John Batsakis.  Although younger readers may not immediately recognize these names, those who trained in the 1970's and 1980's will immediately recognize both as immensely important to our understanding of surgical pathology.

I unfortunately never had the opportunity to meet Dr. Azzopardi.  He was born in Malta and spent virtually all of his professional career at the Hammersmith Hospital in London.  Although he has primarily been identified for his pioneering monograph on breast pathology, John Azzopardi was the consummate general surgical pathologist and authored exquisitely written papers on many areas of surgical pathology including lung, salivary gland, soft tissue, GI tract, genitourinary tract, and gynecologic tract, as well as numerous other areas.  He first identified the deposition of nucleic acids around blood vessels in necrotic small cell carcinomas, a finding for which the term "Azzopardi effect" is now widely used.  Juan Rosai noted in 2010 that, "the majority of the papers he has written have become the standard reference for the respective entities."  His monograph of breast pathology (Problems in Breast Pathology, 1979) with an emphasis on problematic intraductal and in-situ lesions, was the first cogent treatise on what for many was an almost incomprehensible area of surgical pathology.  It served as the foundation for much that followed in this field.  As a resident, I read it cover to cover at least twice and came away feeling that, thanks to Dr. Azzopardi, for the first time I now (at least partially) understood breast pathology.  Not only did the text explain things in a logical manner, including numerous black and white photomicrographs, but it contained many first time observations that have stood the test of time in breast pathology.  Even today, almost 35 years later, many of his histologic descriptions remain umatched, even if a very few of the terms have been changed (ie. "clinging carcinoma" = flat epithelial atypia).

I did have a chance to speak briefly on several occasions with John Batsakis and I found him to be quite approachable, friendly and more than willing to chat with anyone sharing his interest in ENT pathology.  Dr. Batsakis began his career at the University of Michigan and ended it as the Chair of Pathology at the M.D. Anderson Cancer Center in Texas.  Like Dr. Azzopardi, he was also the author of a seminal text in surgical pathology, this time on head & neck pathology (Tumors of the Head and Neck.  Clinical and Pathological Considerations, 2nd ed. 1979).  Again, I read his monograph (both the first and second editions) cover to cover and it formed the basis for my understanding and love of this area of pathology.  His text was also full of astute observations that have stood the test of time and emphasized the clinical as well as the histopatholgic features of the entities that he described.  Because of this, many ENT surgeons, as well as pathologists, found his text to be indispensible.  In particular, much of the foundation of our understanding of salivary gland pathology is attributable to Dr. Batsakis and his junior colleagues.  When I began work on the 3rd series AFIP fascicle on head and neck pathology, I frequently referred to Dr. Batsakis' text to make certain that I hadn't forgotten to cover an important point.  Ever one to utilize new technology without short changing the old, I'm sure that he would be fascinated by what we now know about molecular anomalies in salivary gland neoplasia and the role of HPV and EBV in squamous carcinogenesis in the head and neck.
 
A much more detailed "In Memorium" for Dr. Azzopardi is already in press in AJSP, and I hope to have one for Dr. Batsakis shortly. 
3/20/2013
Dr. MING LEE said:
I think flat epithelial atypia and clinging carcinoma are two different things nowadays. The former is a columnar cell lesion with certain criteria , and the jury is still out on whether this should be treated as malignant. The latter is stone-cold DCIS and treated as such, with frankly malignant cytology but not the prototypical DCIS architecture, only coating the insides of ducts as a thin layer. Maybe I'm wrong..... (Dr. Mills sez: If you look at Dr. Azzoparid's pictures of "clinging carcinoma, I agree that some of it does look like a thin rim of high-grade DCIS without necrosis. Howver, other figures show less atypia and look like FEA. In my opinion, the term "clinging carcinoma" shouldn't be used anymore.)
About the Author

Stacey E. Mills, MD
Stacey E. Mills, MD, a graduate of University of Virginia (UVA) and the UVA Medical Center, has authored nearly 230 articles, 20+ books, atlases and monographs—including the renowned Sternberg's Diagnostic Surgical Pathology. He has been a practicing Professor and Staff Pathologist at UVA for 30+ years and is Director of Surgical Pathology and Cytopathology. His clinical specialty is general surgical pathology with emphasis on neoplasms and neoplasm-like lesions. Dr. Mills is also Editor-in-Chief of The American Journal of Surgical Pathology.