ENT (Head and Neck)

Head and Neck Pathology 

The Head and Neck Pathology Division (HNPD), directed by Dr. Peter Sadow, is a vibrant clinical service at Massachusetts General Hospital and one of the highest volume divisions of the Mass General Pathology Service. This subspecialty division is responsible for providing surgical pathology services for Mass General as well as for the Department of Otolaryngology – Head and Neck Surgery (OHNS) at Massachusetts Eye and Ear (MEE). Our greatest service volume comes from our OHNS colleagues at MEE, who subspecialize in ENT oncology, otology (and neurootology), rhinology (sinus center), laryngology, thyroid/parathyroid surgery, pediatric otolaryngology and facial plastic surgery. At Mass General, most cases come from the Division of Endocrine Surgery (thyroid/parathyroid), as well as the Mass General Voice Center (laryngology), Neurosurgery (skull-based tumors typically done alongside MEE-based otolaryngologists) and our distinguished Oral Maxillofacial Surgery colleagues.

The Mass General HNPD provides consultative diagnostic services to partner institutions, including the Mass General Aligned Martha’s Vineyard Hospital, Nantucket Cottage Hospital, Newton-Wellesley Hospital, Salem Hospital, Wentworth-Douglass Hospital (NH), Cambridge Health Alliance, and Cooley Dickinson Health. More broadly, our pathologists provide consultative services for colleagues and patients who are local, national and international.

Faculty

• Peter M. Sadow, MD, PhD - Director, Head and Neck Pathology
• Bayan A. Alzumaili, MD
• William C. Faquin, MD, PhD 
• Adam S. Fisch, MD, PhD
• Vânia Nosé, MD, PhD

The faculty of the HNPD is diverse. All five division faculty are primary head and neck pathologists with complementary expertise. Dr. Faquin is world-class Cytopathologist and Editor-in-Chief of Cancer Cytopathology, the premier cytology journal, as well as primary author of the Milan System for Reporting of Salivary Gland Cytopathology. Dr. Nosé is a world-class Endocrine Pathologist and chief editor of major endocrine and familial cancer textbooks. Dr. Sadow, Editor-in-Chief of Head and Neck Pathology journal, is also a regarded genitourinary pathologist and primary go-to pathologist for adrenal neoplasia, part of the MGH Genitourinary Pathology Service. These leaders are also major editorial participants in the World Health Organization’s tumor classification series, particularly Head and Neck, Endocrine, and, for Dr. Faquin, the new complementary cytology series. Dr. Fisch, who is co-boarded in Molecular Genetic Pathology, is a rising leader in head and neck/endocrine molecular pathology, including assay development, with leadership roles within the Association for Molecular Pathology. Dr. Alzumaili, who translates his knowledge of salivary neoplasia into a dual position on the Breast Pathology Service, has been quite successful in early studies of molecular pathogenesis of thyroid neoplasia and salivary neoplasia.

Clinical Program

The HNPD is among the most generalized of the surgical pathology services, as it encompasses the diversity of organs and tissue-types within a compact geographical space (head & neck), including the middle and external ear, sinonasal tract/nasopharynx, oral cavity, oropharynx, larynx and hypopharynx, salivary glands, thyroid and parathyroid glands, soft tissue and bones of the head and neck, lymph nodes, and skin. In addition to sign-out of surgical specimens, the HNPD also provides intraoperative subspecialty consultation (frozen section) services for Mass General and MEE. Intraoperative consultation for MEE is provided in the Max Goodman Frozen Section Laboratory, providing services for both Otolaryngology and Ophthalmology, the two surgical arms of MEE.

Academic and Research Accomplishments

Our HNPD has a broad educational and research mission, including a clinical fellowship program, whose graduates are providing the next generation of academic leadership across the country and around the globe. The Division has the responsibility for training up to 80 resident physicians per year in pathology, as well as the MEE otolaryngology – head and neck surgery residents, and one to three clinical and research fellows. Our Division Faculty participate in formal lectures at both Mass General and MEE, with clinical fellows having opportunities to participate in the teaching of resident trainees and clinical colleagues in formal and informal settings. Our HNPD faculty have authored more than 500 manuscripts in the past five years, both primarily and in collaboration.

Teaching and Educational Activities

Fellowship

The HNPD supports a one-year clinical fellowship program funded by Pathology Associates, the pathology arm of the Mass General Physicians Organization. This is a sign out fellowship offered to Board-eligible, fully-licensed (in MA) physicians, depending on departmental need, so this sign out option is only variably available. Clinical fellows, also appointed as clinical fellows at Harvard Medical School, serve as mentored adjunct faculty and perform with guided independence at a 70% service effort. Clinical fellows often work on clinical research projects with HNPD faculty and collaborators on route to careers within the field in academia or as subject matter experts within other settings. Recent graduates have joined the faculty at the University of Chicago, Dartmouth Hitchcock Medical Center, Albany Medical College, University of Wisconsin, Mayo Clinic, Emory University, UCLA, Harvard Medical School, the University of British Columbia, McGill University, Nagoya University (Japan) and the University of the Western Cape (South Africa).

In addition to the sign out fellowship position, applicants might alternatively be interested in participation in the Mass General Pathology Service Surgical Pathology Fellowship as part of the ACGME. Participation in the non-sign out ACGME fellowship incorporates subspecialty training in head & neck pathology supplemented by other surgical pathology subspecialty areas. Applicants to the Mass General Pathology Surgical Pathology ACGME-sponsored fellowship may indicate a special interest in head & neck pathology among the thirteen surgical pathology subspecialties.

Residency

Mass General Pathology residents rotate through over thirteen surgical pathology subspecialty divisions as part of their training in anatomic pathology. While rotating in the HNPD, residents have daily activities that involve performing gross pathology assessment and dictation of complex head & neck specimens as well as daily microscopic sign out with faculty and graduate assistants (clinical fellows).

The HNPD is unique among Mass General Pathology Service Divisions in that it participates simultaneously in the residency training programs of three different departments at three institutions, primarily the Anatomic Pathology Residency Training Program at Mass General and, on a more limited basis, the Otolaryngology Residency Training Program at MEE and the Oral Maxillofacial Pathology Training Program at Harvard School of Dental Medicine. This gives Mass General Pathology residents the opportunity to train side by side on occasion with ENT surgery residents and dental residents who offer an indispensable clinical perspective. Additionally, while on service, ENT surgery residents and dental residents sign out in the Goodman Frozen Section Laboratory at MEE and learn the importance of providing proper clinical information and the critical value of communication while patients are under anesthesia during intraoperative consultation.

Medical School

Members of the HNPD are faculty at Harvard Medical School. They are variably involved in the training of Harvard Medical School students through formal course work at the undergraduate medical education level along with clinically for students rotating through Anatomic Pathology, either as an advanced clinical elective or as part of their surgery clerkship.

Postgraduate Courses, Invited Major Lectures

Mass General HNPD faculty participate in several local, national and international continuing medical education courses. In addition to playing a prominent role in the annual Mass General Surgical Pathology course, “Current Concepts in Surgical Pathology”, Drs. Faquin and Sadow initiated a “Current Concepts in Head & Neck Pathology” course in 2012, and following two successful years, expanded with the addition of Dr. Nosé, to “Current Concepts in Head & Neck and Endocrine Pathology”, a four day CME course, the largest of its kind, now given every other year in Boston.

Each year, our HNPD faculty are prominently featured in courses and lectures, at international meetings/congresses, state and national pathology societies and as institutionally invited speakers.

Research

Faculty of the HNPD are extensively involved in a robust clinical research as part of our academic mission. Research projects involve division-initiated projects or those in collaboration with clinical colleagues (intramurally and extramurally) or basic scientists. Funding sources involve grants to individual faculty through the department or extramural foundation awards. Internal funding sources also include funds from HNPD educational courses through Harvard Medical School or the Mass General Cancer Center with funds slated for Mass General Pathology.

Many HNPD projects investigate the molecular basis of head and neck-related neoplasia, developing ancillary markers for testing and/or treatment. Most projects within the division are faculty-initiated and involve mentorship of Mass General Pathology residents and fellows as primary authors. Areas of current investigation involve follicular neoplasms of the thyroid, salivary gland tumors, and oropharyngeal squamous cell carcinomas among several others.

The Mass General Pathology HNPD is highly collaborative with our pathology colleagues at academic institutions locally (Brigham and Women’s) and across the globe, especially in cases of rare tumors. Additionally, the HNPD faculty serve as faculty mentors and pathology collaborators for our clinical colleagues and their trainees in clinically-initiated, pathology-related projects, especially in otolaryngology, endocrine surgery and oral maxillofacial surgery.

For more detailed information regarding specific research interests, please view physician profiles associated with individual faculty (listed below).

Institutional Conferences

There are several institutional conferences with participation from faculty and fellows of the HNPD. Within the department, we have a weekly Head & Neck Pathology Staff Conference during which we discuss and show interesting and/or challenging cases or discuss any pressing administrative issues. There is a weekly Head & Neck Tumor Board, attended by faculty and fellows of the HNPD as well as surgeons and radiologists from MEE, along with oncologists and radiation oncologists from Mass General. We attend a monthly Oral Maxillofacial Surgery Pathology Teaching Conference for faculty and residents of the OMFS division. We also participate in the monthly Endocrine Oncology Conference, including Mass General Pathology, Endocrine Surgery, Endocrinology, and Radiology along with MEE Endocrine Surgery and remote participation via video link with colleagues in Maine. In addition, we participate as needed in several conferences at Mass General and MEE, including clinical pathological conferences and morbidity and mortality conferences.