An appreciation of Robert E. Scully, MD, and an introduction to a symposium in his honor on recent advances in gynecologic pathology

Ovarian tumors: a survey of selected advances of note during the life of this journal

The author reviews highlights of advances in knowledge concerning ovarian tumor pathology since the time of an essay in the first issue of this Journal written by Dr Robert E. Scully, who, both before and for several decades after the Journal was instituted, made many original contributions to the field and was the major architect of the 1973 World Health Organization classification of ovarian tumors which was much more clear and logical than prior ones. The current review considers the neoplasms in essentially the same order as was done in the first issue of this journal and presents a personal look at the highlights of new information concerning various well-known categories, surface epithelial, germ cell, sex cord-stromal, metastatic neoplasms and briefly, benign so-called tumor-like lesions. Some of the most notable developments are as follows: (1) an orderly approach to the classification of implants of serous borderline tumors into noninvasive and invasive categories; (2) recognition of distinctive micropapillary patterns seen in some borderline tumors and low-grade carcinomas; (3) a remarkable propensity for some endometrioid carcinomas to mimic sex cord- stromal tumors; (4) appreciation of the differences between primary mucinous tumors of intestinal and müllerian types; (5) the importance of distinguishing within primary mucinous carcinomas between expansile and destructive stromal invasion; (6) emphasis on the diagnosis of immature teratoma being based on the presence of primitive-embryonic-appearing tissues; (7) appreciation of variant morphology of cases of struma ovarii which may lead to significant diagnostic problems; (8) subdivision of granulosa cell tumors into adult and juvenile types because of the differing features of the two groups including in the second category the propensity for more malignant neoplasms to be mimicked; (9) recognition of a distinctive form of Sertoli-Leydig cell tumor, the retiform variant, with a propensity to occur in the young; (10) appreciation of a unique highly malignant neoplasm that typically afflicts the young and may be associated with hypercalcemia, so-called small cell carcinoma of hypercalcemic type; (11) greater awareness than was hitherto the case of the propensity for metastatic intestinal adenocarcinoma to mimic primary endometrioid carcinoma and similarly for metastatic mucinous carcinomas to simulate primary mucinous cystic tumors; (12) recognition of the distinctive features of low-grade appendiceal mucinous neoplasms that spread to the ovary and are typically associated with pseudomyxoma peritonei; and (13) appreciation that the histologic spectrum seen in cases of Krukenberg tumor is broader than often previously thought.

The rich history of gynaecological pathology: brief notes on some of its personalities and their contributions

The careers and contributions of some of those who have played a major role in the development of knowledge concerning gynaecological pathology are summarised. The emphasis is on workers of prior times beginning with those of the German-speaking school: Carl Ruge, Felix Marchand, Hermann Pfannenstiel, Oskar Frankl, Walter Schiller, and Robert Meyer. The two great Scandinavian investigators Lars Santesson and Gunnar Teilum are then considered, followed by those of the British school: John H. Teacher, Elizabeth Hurdon, Magnus Haines, Claud Taylor, Fred Langley, and Harold Fox. North American workers reviewed are: Thomas S. Cullen, Emil Novak, John Albertson Sampson, Arthur Hertig, and Robert E. Scully. The essay concludes with Australasian contributors, those considered in detail being: Hans Frederick Bettinger, Rupert A. Willis, Hazel (Mansell) Gore, Robert Barter, Harold Attwood, Andrew Ostör (the last two also noted historians), Denys Fortune, Alan Ng, and Peter Russell.

A brief history of the pathology of the gonads

Our understanding of gonadal pathology has reached its current state as a result of the contributions of numerous outstanding investigators. Knowledge of testicular tumor pathology dates back to the great British workers Percival Pott and Sir Astley Cooper but the single greatest early stride was made with the description in 1906 by the French urologist Maurice Chevassu of the seminoma. The seminal 1946 paper of Nathan B Friedman and Robert A Moore, which segregated out as a distinct entity embryonal carcinoma, is, however, the foundation for the current classification of testicular tumors. In that year Pierre Masson described the distinctive neoplasm, the spermatocytic seminoma. The 1950s saw the publication of an important paper by Frank J Dixon and Dr Moore and they also wrote the first series fascicle on testicular tumors. In this same timeframe, and thereafter, Robert E Scully made significant contributions to testicular pathology, writing the first English language paper on spermatocytic seminoma, describing several subtypes of sex cord tumor, and also the distinctive lesion of intersex, the gonadoblastoma, as well as playing a major role in 1980 in formulating the current classification of premalignant lesions of the testis. The current classification of testicular tumors was arrived at in the early 1970s when the World Health Organization, under the leadership of Dr FK Mostofi, who himself made notable contributions to testicular pathology, devised what is fundamentally the current classification of neoplasms of the male gonad. Although comments on ovarian pathology were made by such legendary figures of earlier times as Giovanni Battista Morgagni and Matthew Baillie, it is only in the mid to later years of the 19th century that contributions, mostly in Europe, began to move knowledge of ovarian pathology to its current state. Thomas Hodgkin, Richard Bright, and Sir James Paget all wrote extensively on ovarian neoplasms. In 1870, Heinrich Waldeyer, and later in that century, another German, Hermann Johannes Pfannenstiel wrote important papers on the surface epithelial tumors. The latter was likely the first to refer to neoplasms now known as of 'borderline malignancy' and also wrote on pseudomyxoma peritonei and other topics. Their work was followed by that of Robert Meyer who made monumental contributions to gynecological pathology, including recognizing the Brenner tumor as a distinctive neoplasm and proposing the first classification of Sertoli-Leydig cell tumors (arrhenoblastomas). He also coined the term 'disgerminoma' (soon changed to dysgerminoma) for the ovarian tumor that had been described in detail by the French investigator Marcel Chenot 5 years after Chevassu had mentioned the tumor in his paper describing the seminoma. During the Meyer era other significant contributions were made by, among others, Howard C Taylor writing on the borderline tumors and John A Sampson writing on endometriosis and tumors, associated with it. In the second-half of the 20th century major contributions were made by Gunnar Teilum of Denmark and Lars Santesson of Sweden. Dr Teilum delineated the morphologic features of the yolk sac tumor and noted the resemblance of papillary formations within it to the endodermal sinuses of the rat placenta. He also wrote extensively on sex cord tumors in both gonads. At a FIGO meeting in 1961 Dr Santesson played a major role in formulating the first organized classification of the surface epithelial-stromal tumors of the ovary and also promoted the endometrioid carcinoma as a special variant of ovarian cancer. In a career spanning over 50 years, Dr Scully was the architect of the modern classification of ovarian tumors being the driving force behind the influential 1973 World Health Organization classification of them. His many original observations have touched upon virtually all categories of ovarian tumor pathology. His second series fascicle 'Tumors of the Ovaries and Maldeveloped Gonads' utilized the WHO classification and presented a lucid elaboration of his by then vast experience with ovarian tumors. All the above have left a rich legacy which those who follow in their path will be challenged to equal.