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Dr. Yener Erozan...

Dr. Erozan

Profiles in Cytopathology

by Aylin Simsir, MD, New York University , New York , New York

One of the most challenging tasks I had to undertake since I became the editor of the Focus Newsletter over a year ago has undoubtedly been writing this synopsis of the remarkable career of a world renowned cytopathologist, Dr. Erozan. Dr. Erozan is well known to us as an extraordinarily talented clinician, a prolific scientist, a gifted educator, and a wonderful human being. It truly is impossible to summarize Dr. Erozan's accomplishments in such a limited space and be fair to his exceptionally prolific career. Therefore, I decided to leave most of the talking to him after a brief introduction.

Dr. Erozan completed his fellowship in Cytopathology under the mentorship of John K Frost, MD in 1964 and then spent the great majority of his career at The Johns Hopkins Hospital. He briefly left The Johns Hopkins Hospital in 1965, and relocated to his home country Turkey for a few years where he was on faculty at one of the most prestigious medical schools in Turkey , The Hacettepe University in Ankara . Shortly thereafter, he returned to Johns Hopkins to resume his outstanding career in academic cytopathology.

Over the years, he became the director of the cytopathology laboratory, and was promoted to professorship in 1995. Dr. Erozan published more than 100 peer-reviewed articles, numerous book chapters, two books ( Erozan YS, and Bonfiglio TA (Eds): Fine Needle Aspiration of Subcutaneous Organs and Masses. Lippincott-Raven 1996, Philadelphia , PA and Bonfiglio TA and Erozan YS (Eds): Gynecologic Cytopathology. Lippincott-Raven, 1996, Philadelphia, PA), and a variety of multimedia teaching materials. He has been an Associate editor of Acta Cytologica since 1992. Dr. Erozan served as the President of the American Society of Cytopathology (ASC), and received many high honors including the Papanicolaou Award of the ASC, and the educator of the year award of the Papanicolau Society of Cytopathology.

Dr. Erozan continues to inspire newer generations of cytopathologists by his relentless active involvement in professional societies including the Papanicolaou Society of Cytopathology. His lifelong dedication to cytopathology, both with his research and his teaching, continues to touch the lives of many patients and students of medicine at every level from residents, fellows to practicing pathologists. On a more personal note, Dr. Erozan is a remarkably kind, gentle and a wonderfully pleasant human being. The following excerpts are from my communication with Dr. Erozan:

What made you decide on pursuing a career in medicine, and specifically in the field of cytopathology?
As long as I can remember, I wanted to be a doctor. Perhaps it was because my father died from lung cancer when I was 5 years old. My interest in pathology started during Dr. Philip Schwartz's lectures in our pathology course in medical school at Istanbul University . Although my main interest was internal medicine, I realized that pathology is the basis of medicine and decided to get training in pathology before my clinical training. I was fortunate to have great mentors during my pathology training: Professor Muammer Yenerman in Turkey and Colonel James E. Ash in the United States . I became more interested as I learned more about pathology and decided not to pursue my original plan to train in internal medicine. When I completed my pathology residency in the USA , I thought it would be a good idea to do a fellowship in cytopathology before returning to Turkey , since there were only a few trained cytopathogists in the country at that time. After two years of fellowship and one year on the faculty at Johns Hopkins with Dr. John K. Frost, another great mentor, I was "hooked."

Having trained in medicine and practiced in Turkey for a short while, what are the major differences you see in the practice of cytopathology in the US and a developing country such as Turkey?
Cytopathology practice differs among the developing countries. I am most familiar with practice in Turkey and somewhat familiar with practice in Romania (going back to the early nineties). There were differences between these two countries, and I am sure that that is true among "developing countries" worldwide. Cytopathology has flourished in Turkey during the past two decades. Many competent cytopathologists practice similarly to the practice in the USA . Some differences, such as a somewhat limited use of ancillary techniques, are due to financial constraints which probably apply to all developing countries. Other differences include lack of well-structured and regulated training of cytotechnologists and pathology residents, and lack of cytotechnologists and pathologists with Cytopathology experience in many medical centers, all of which are being addressed. One more difference, in Turkey 's favor, is the virtual nonexistence of malpractice suits involving Cytopathology.

Your career in cytopathology expands over almost 40 years. How has the practice of cytopathology changed during this time?
Reporting of cytopathology results has been improved. Gynecologic cytopathology reporting has become more descriptive and uniform. Non-gynecologic cytopathology has become a more definitive diagnostic method, especially in the diagnosis of cancer, based on which patients can

be treated. Abrasive and minimally invasive specimen collection techniques, such as brushings and fine needle aspirations (FNAs), have replaced or been added to "exfoliative cytology." Advancements in imaging and endoscopic techniques and their use in combination with the above techniques, especially with FNAs, have expanded the field of diagnostic cytopathology. New ancillary techniques, such as flow cytometry and immunohistochemistry, have become a part of the routine cytopathology practice, and emerging molecular techniques have been increasingly used in cytologic specimens. New techniques (or new versions of old techniques) such as liquid preparations and automation in cytologic specimen preparation, have been introduced. Training of pathology residents in cytopathology is better organized and regulated. Programs offering fellowships in cytopathology, as well as applications to these programs, have significantly increased. And, examination for qualification in cytopathology has been added to the Anatomic Pathology Board.

In your opinion, what has been the single most important advancement in the practice of cytopathology?
Introduction of fine need aspiration into the routine practice of cytopathology.

What do you feel are your most important professional accomplishments?
To be a good diagnostician and an effective teacher have been my goals. I hope I have accomplished these.

What do you feel are the major challenges the young cytopathologist faces today, and will continue to face in the future?
To keep up with the emerging technologies and their applications to cytopathology. In addition to immunohisto/cytochemistry, which is routinely used in diagnosis today, molecular, genetic and quantitative analytical techniques have been increasingly employed for the detection and diagnosis of diseases, especially of cancer.

With the new developments in gynecologic cytopathology such as the liquid based cytology and HPV testing, how do you see the future of gynecologic cytopathology? Will Pap smear screening be obsolete in the future?
Gynecologic cytopathology will survive, but probably not as we are practicing it now. HPV testing can tell us the patient's risk of having a cervical neoplastic or preneoplastic lesion, but not that a lesion is present. In contrast, cytopathology detects morphological evidence of the lesion. I do not think screening of gynecologic cytology samples will become obsolete in the near future. We will probably do it in a more "sophisticated" way, in combination with some form of automated cytology.

What are your hobbies and nonmedical interests?
I like photography, traveling, theater, music, and reading mystery books.

If you had a chance to travel back in time, is there anything you would consider doing differently?
Yes, I would pursue training in internal medicine and somehow combine my practice with pathology.

 Any advice for the new generation of cytopathologists and residents who would like to specialize in cytopathology?
For those who choose an academic career in cytopathology my advise is, in order to become an effective investigator, get additional training in one of the fields (e.g., molecular pathology, genetics) which are complimentary to morphology. I would also advise them, above all, not to forget their obligation to the patient.

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