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aapaaapaA . A . P . A

n e w s l e t t e r

american association of pathologists’ assistants inc.President: Jon Wagner, Path. Asst.

Editor: Tisa Lawless, Path. Asst.

Vol. XXXI No. 4

WINTER 2003

Page 1President’s Message

Page 2President-Elect’s Report

Pages 2-8Committee Reports

Page 8Denver Meeting Announced

Pages 9-10Book Review

Pages 11-12Denis Akim, PA Pioneer

Page 13Chicago Preview

Page 14Conference Photos

Page 15TCC of the Renal

Pelvis and Ureters

Pages 16-18Winning Essay

Page 19Training Programs

Pages 20-22Job Hotline

Page 23Golf Wrap-Up

Denver Registration Form

Page 24Sustaining Members

Page 25New Members

Central Office Update

Page 26Winter Quiz

Coding Q & A

Page 27Bulletin Board

Page 28President’s Award

The 2003 AmericanAssociation of Pathologists’Assistants ContinuingEducation and BusinessConference in Arizona was,without doubt, the most

productive meeting I have ever attended. Forme, it was my once a year opportunity topersonally interact with many of the leaders ofour organization. And this year, more than anyother year, I could sense just how close we areto certification.

There are many noteworthy events which Iwould like to touch on briefly. First, for those ofyou who do not know, Jana Joslin-Akers, whostarted as Conference Committee Chair just afew months ago, had the opportunity to view aconference from the driver’s seat for the firsttime. And, I must say, she did a wonderful job(as did the rest of the committee). Moreover, shedid so in spite of a host of challenges specific tothis conference (more on that at a later time).Second, Jim Moore and the CertificationCommission presented what likely representsthe single largest piece of work our organizationhas ever undertaken. The certificationcommission presentation was impressivelythorough. Finally, as the concepts of certificationtook another step towards reality, there was agreater revealing of the types of things theAAPA must do to best serve its members.

Oh yeah, then there was Sedona, golf (Iactually birdied one hole), southwesternrestaurants, baseball, friends I wish I could seemore than once a year, someone else to make mybed, and those thin after dinner mints on mypillow each night. Sorry, just a quick digression.Let me get back on track.

During the business meeting, many excellentquestions were asked. One important questiontouched on the financial impact of certificationon the individual Pathologists’ Assistant. Iwould like to begin addressing that now. With99.9% certainty, I can tell you that all currentfellows of the AAPA will be grandfathered tocertified status. However, the grandfatheringprocess will involve a fee, likely equal to the

amount charged as an exam fee. As aconsequence, all fellows desiring to achievecertified status will have to pay a one-timegrandfathering fee of approximately $500.00(again, this is an approximate figurerepresenting the same fee that exam registrantswill pay). Second, the certifying body willrequire an annual maintenance fee that eachcertified member will have to pay once peryear. This fee has been speculated to run about$100.00 per year. This is in addition to AAPAmembership dues which currently run $100.00per year. So during the first year, certificationplus membership dues could run in the rangeof $700.00. Thereafter, approximately $200.00per year would be the expected membershipfee expense.

In addition to membership dues, certificationmaintenance will likely require CME units. Thisis tricky to address from a financial standpoint.Moreover, it is not known at this time how manyunits must be obtained or what requirementswill distinguish acceptable CME units from non-acceptable CME units. Nevertheless, I can assureyou of two things. The AAPA will providesufficient and acceptable CME units, incombination with CME tracking services, which,if you take advantage of the offerings, willassure certification maintenance. In fact, it is ourhope/intent to offer all of the necessary units atthe AAPA national meeting. We will, of course,create other mechanisms of providing CME.However, for those seeking simplicity,attendance of the AAPA national meeting is asure-fire way of acquiring the necessary units(among many other great reasons to attend). Asmentioned above, from a financial standpoint,this facet of certification is difficult to speculateon. Nevertheless, without question, this is anarea of additional expense which eachindividual member must address.

So what kind of financial picture am Ipresenting? Simply put, I encourage allmembers to look at their current employmentcontracts/agreements and see if your CME andprofessional membership requirements will bemet (reimbursed). Obviously, since all of the

President’s Message . . . . Jon Wagner

INSIDE

Deadline for Spring Issue February 1, 2004

President’s Message continued on pg. 2

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certification details are not known, there is acertain degree of speculation. However, thisis the time to begin the work of enlighteningyour employers/directors as to the costs andbenefits of certification; ask for their support.

Yes, some employers/directors maytrivialize certification. However, they stand togain by your acquisition and maintenance ofcertification. Malpractice insurancecompanies have made it known that defensecases gain a degree of fortification when onecan prove that a continuing effort has beenmade towards ongoing, professional medicaleducation/professional advancement.Moreover, should licensure become an issuein your state, certification helps to insure

continued employability when legislativebodies look to create ground rules for whocan and cannot practice in their state. Inaddition, certification can help to simplifyinstitutional credentialing requirements,laboratory policies regarding non-pathologistgrossing personnel, etc. In short, though wehave, to this point, focused largely oncertification benefits as they pertain to ourmembers, there is also a very tangible benefitfor those employing a certified Pathologists’Assistant. Consequently, certification not onlyrepresents a progressive step for thePathologists’ Assistant, it is a wiseinvestment for the employer as well.

President-Elect’s ReportLarry Marquis

AAPA NEWSLETTER STAFFEditor . . . . . . . . . . .Tisa Lawless

Associate Editor . . .Bob BladekArticle & Book Review . . . . . . . . . . . . . . . . . . . . .Chet SloskiCME Quiz . . . .Barbara DufourJob Classifieds Editor . . . . . . . . . . . . . . . . . . . . . .Mike LambAlternate Meetings List . . . . . . . . . . . . . . . . . . . .Marty Stone

AAPA NEWSLETTERSUBMISSIONS

The AAPA Quarterly Newsletterencourages any AAPA member orinterested party to contributearticles, updates, photos, orupcoming event announcements.In particular, articles of pathologicinterest are welcomed.

Articles and photos may besubmitted via postal mail or as e-mail attachment files to ensurethat a hard copy is available forediting purposes. Photo filesmust be a minimum of 300 dpiresolution. Use the link on theAAPA web site to send yoursubmissions via e-mail (or you cansend your e-mail attachmentdirectly tonewsletter@pathologistsassistants.com). With prior editorialapproval, faxed submissions willbe accepted. All submittedmaterial is edited for content andclarity.

2004 Deadlines are set asfollows:

Spring Issue—February 1Summer Issue—May 1Fall Issue—August 1

Winter Issue—November 1

Our goal is for each issue to bemailed to the membership withinfour to six weeks of thenewsletter deadline.

Mail submissions to:Tisa Lawless

Decatur Memorial HospitalDepartment of Pathology2300 N. Edward Street

Decatur, IL 62526

AAPA CENTRAL OFFICEOffice Enterprises, Inc.Rosewood Office Plaza,

Suite 300N1711 W. County Road B

Roseville, MN 55113800/532-AAPA or 651/697-9264

Fax: 651/635-0307msok@assocmgmt.orgContact: Michelle Sok

Once again, we managed to squeak out asuccessful annual conference. It was great tosee everyone in Phoenix. Thanks to all thosewho decided to take an active interest in ourgroup and join a committee. Every little bithelps. There have been no new updates onthe legislative committee front, but I willcertainly keep my eye out. As usual, ifanyone has any questions or concerns, feelfree to contact me.

Legislative CommitteeJennifer Titus

From the HeartI have seen death far too often in my life,

yet one of my responsibilities as Pathologists’Assistant is to detach from the emotionalityof it as I prepare to perform an autopsy. Anddetachment has carried over into mypersonal life, more than I care to admit.Now, death has become very personal—mymom passed away late October, about ninedays before I typed this article.

She died after a several year battle withemphysema. She was a 1-2 pack per daysmoker for more than twenty years, havingquit about six years ago. This illness robbedher of so many things I no longer take forgranted—oxygen, independence, and qualityof life, to name just a few. Instead, she dealt

with increasing weakness, solitude, thestruggle to breathe, and her ever greaterdependence on oxygen delivered via nasalcannula from a portable tank she had athome.

Today, my feelings of sadness and loss arein a constant struggle with detachment. Andthis struggle annoys me—a lot! I had awonderful relationship with Mom. I have amultitude of special memories. And I knowshe is in a better place—she had one heck ofa welcoming committee at “the pearly gates.”Yet the ache in the pit of my stomach persists.To all of you, I have a suggestion. Why nottell your mom how much you love her. I didone last time and so wish I could do it today.

VOTE NOW FOR 2004In an effort to help each Fellow member

better meet their association responsibility tovote, the official 2004 ballot will accompanythe dues announcements mailed this month(December 2003). Just vote and put the ballotin with your dues payment.

IT’S THAT EASY!Voting results will be posted in the spring

2004 newsletter. New officers and boardmembers will take over their new duties onJanuary 1, 2005.

The committee has updated theassociation’s training program brochure.Should you know a potential student, havethem call the Central Office (1-800/532-AAPA[2272]) to get a free brochure—an easy andexcellent way to compare training programs.

Administrative CommitteeLeo J. Kelly

President’s Message continued from pg. 1

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AAPA OFFICERSPresident . . . . . . . . .Jon WagnerPresident-Elect . . . .Larry MarquisVice President Maryalice AchbachTreasurer . . . . . .Lisa FleischmannSecretary . . . . .Jeff Wiedenmann

AAPA BOARD OF TRUSTEESChair . . . . . . . . . . . . . .Tom ReillyVice Chair . . . .Anne Walsh-FeeksPast President . . . . . . Bob Kutys

Rae Rader Jayne TessitoreTina Rader Jerry Phipps

AAPA CHAIRPERSONSAdministrative . . . . . .Leo Kelly

Election . . . . . . .Bonnie AltmanConference . . .Jana Joslin–Akers

Audiovisual . . . . .Steve SuvalskyExhibitor Recruitment . . . . . . . .

. . . . . . . . . . . . . .Eva OsbornFinance . . . . .Ken WhittenburgFood & Beverage . . . . . . . . . .

. . . . . . . . . . .Heather WrightFun . . . . . . . . . . . . . . . . .OPENPoster Display . . . . . .Don PerrinRegional Conference . . . . . . . .

. . . . . . . . . . . . . .Fern SzulgitSpeaker Recruitment . . . . . . . .

. . . .Jon Bakst & John VitaleEducation Michelle Rosenow

CME . . . . . . .Kathy WashingtonCME Quiz . . . . .Barbara DufourEssay/Scientific Paper . . . . . . . .

. . . . . . . . . . .James EdwardsExam . . . . . . . . .Susan MorganRemedial Education

. . . . . . . . . . . . . .Sarah PietzVideotape Library

. . . . . . . . . . .Richard DykoskiFinance . .Daniel & Susan FaasseLegislative . . . . . Jennifer TitusMembership . . . .Colleen Galvis

Membership Survey . . . . . . . . . . . . . . . . . . . . .Debra Martin

New Members/OJT . . . . . . . . . . . .Dan Galvis & Patrick Foley

New Members/Students . . . . . . . . . . . .Shannon McWilliams

OJT Mentor . . . . .Jason FowlerRemedial Education Application

. . . . . . . . . . . . . .Sarah PietzPublic Relations . . .Leo Limuaco

Exhibit/Booth Management . . . . . . . . . . . . . . . .Larry Briggs

Newsletter . . . . . . .Tisa LawlessWeb Site . . . . . . .John Eckman

Conference CommitteeJana Joslin-Akers

Well, now that things are finally windingdown from our just completed conference inPhoenix…I thought it would be a good timeto take a small break and catch my breath!Ha! It’s already full steam ahead withpreparations for next year’s conference inChicago and, once again, I have lots toreport!

The most noteworthy news is the creationof three new subcommittees which now fallunder the umbrella of the ConferenceCommittee. The Audiovisual Subcommitteewas created just prior to the PhoenixConference and is headed by none other thanSteve Suvalsky, our photography guru! Themain objectives of Steve, along with fellowsubcommittee members Dick Dykoski, BobKutys, Bill Larsen, and Sarah Pietz, are tomaintain and operate all AV equipment nowowned by the AAPA. They will also researchand develop methods to reduce our futureAV costs through the purchase and rental ofadditional AV equipment.

The new Exhibitor Recruiter Subcommitteewas created with the goal of increasingparticipation at our annual exhibitor sessionand hopefully broadening our sustainingmembership program. This subcommittee isheaded by Eva Osborn, whose enthusiasm,high energy, and great people skills made herthe perfect choice for this highly interactiverole. If you know of or use a product orservice that you would like to seerepresented at next year’s conference, pleasecontact either Eva or me.

The new Regional ConferenceSubcommittee has actually been transferredto the Conference Committee from theEducation Committee and is now headed byFern Szulgit. This transition was madebecause it was felt that the needs and goals ofthe Regional Conference Subcommitteeclosely mirror those of the ConferenceCommittee, only on a somewhat smallerscale. Due to her previous experience asConference Committee Chair, Fern was theobvious choice to chair this subcommittee.(I’m also happy to announce that Fern andher husband, Eric, are now the proud parentsof a healthy baby boy! Fern gave birth toOlin Phillip on October 13th, her actual duedate, after what will surely go down inhistory as one of the most flawlesspregnancies and labors ever!! True to form,Fern, you are perfection!) Now, back tobusiness…there are two regional conferencestentatively scheduled for early next year, one

in Montreal, Canada and the other in Denver,Colorado. Both of these conferences willrequire a minimum number of registrants toactually take place and be cost effective. Thegoal of regional conferences is not to competewith the Annual Continuing Education andBusiness Conference, but to add the option ofa less expensive alternative for those who areunable to attend the annual conference due toeither their place in rotation, funding, oranother reason. If you are interested infinding out more about one of the upcomingregional conferences, please contact RockyAckroyd for the PANE (Pathologists’Assistants of New England) sponsoredmeeting in Montreal or John Eckman for theDenver meeting.

In addition to our new subcommittees, wealso have two new speaker recruiters for ourupcoming Annual Continuing Education andBusiness Conference in Chicago, to be held atthe Renaissance Hotel October 2-8, 2004. JonBakst and John Vitale will collaborate to puttogether what is sure to be one of the bestlecture and workshop series yet. If there areany Pathologists’ Assistants out there whoare interested in presenting either a lecture orworkshop this coming year, please contactJon or John to let them know.

By the time this newsletter goes to print,most of you should have already received,completed, and returned a conference surveythat was mailed out to you at the end ofOctober. At least, I hope you did! Thepurpose of this survey is to help me, asConference Committee Chair, put togetherthe best possible conferences that are notonly financially viable for the AAPA as anorganization, but are also educationally,professionally, and recreationally rewardingto each and every one of you.

Finally, I want to put all rumors to rest andlet you all know that we will be going toBoston in 2005 after all!! Following a roundof successful negotiations by our MeetingPartners’ rep, Kate Wolfe, the Royal SonestaHotel in Cambridge lowered their room ratefor us to an unbelievable $155.00 per night.Situated right on the banks of the beautifulCharles River, the Royal Sonesta is in an ideallocation, with easy access to inexpensivepublic transportation that will get you to allmajor Boston attractions quickly. So, markyour calendars now—the Boston conferencewill be held September 16-23, 2005!!

I wish you and your families a spectacularholiday season and a Happy New Year!!

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C O M M I T T E E R E P O R T S

POST PHOENIX UPDATEAs you all know, the National

Commission on Certification ofPathologists’ Assistants was initiallyformed as a group some five years ago bythe BOT in keeping with its long-termstrategic plan. The intent was for theCommission to be created as a stand-aloneentity whose primary charge was toconduct a feasibility study in regards tocreating a national certification programfor Pathologists’ Assistants and reportback to the BOT with their findings. Thiseffort was funded by the AAPA, and theCommission has worked very closelywith the BOT over the past four years intheir pursuit of this goal. The Commissionheld their latest annual meeting at theWigwam Resort in Phoenix, Arizona, on

Saturday, 9/13/2003. The Commissionevaluated two final proposals forcertification, one for an IndependentProgram and the other for certificationthrough the ASCP Board of Registry.

On the following day, the Commissionpresented both proposals, along with theirrecommendations, to the AAPA Board ofTrustees during the annual Board ofTrustees meeting. Based upon theproposals being quite similar, with thefundamental aspects being virtually thesame, the Commission recommended thatthe BOT review each of the final proposalsin even greater depth before making afinal determination. With newinformation being presented for each ofthe proposals, the BOT accepted theCommission’s recommendations, and will

take an additional four to six months tofurther explore the proposals. A specialBOT conference call will be scheduled forno later than March of 2004, during whichmeeting the results of the in-depthreviews will be presented for the Board’sfinal determination.

The Board’s options are essentiallythreefold:• Opt for an Independent Certification

Program.• Opt for the ASCP BOR Certification

Program.• Opt to choose neither program, but

rather to look into other options.

The following information is offered forthe benefit of the general membership:

National Certification Commision and BOT ReportTom Reilly, Jim Moore, & Anne Walsh-Feeks

COMPARE & CONTRAST THE PROGRAMS

INDEPENDENT PROGRAM ASCP BOR PROGRAM

GOVERNANCE

Board of Governors – Proposed Board of Governors- 6 AAPA representatives - 6 ASCP pathologists- 1-2 APATP representatives - 6 ASCP certified professionals- 5-6 representatives from pathology - 7 professionals representing each of

stakeholder groups (1 from each) the examination committees- 1 public member (will include 1 AAPA member)

- 2 public members

Executive Director- Coordinates all activities of certification program- Reports to Board of Directors

Committees Examination Committee- Eligibility Committee – 3 members - 8-10 members- Grievance/Appeals/Disciplinary Committee – 3-5 members - 2-4 AAPA members- Examination Committee – 10-15 members - Remaining members to be- Marketing Committee — 2-4 members selected from APATP and

pathology stakeholders

Additional Consulting Services Job Analysis Task Force- Examination Development - 10-12 subject matter experts chosen- Legal Representation from AAPA, APATP & pathology- Association Management stakeholder groups

- This function could be performed by the exam committee members

FEES

Certification - $450.00 Certification - $450.00Certification Maintenance - $100.00 per year Certification Maintenance - $100.00 per year

National Certification Commision and BOT Report cont. on pg. 5

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TESTING

Paper and pencil format Computer adaptive testing – Pearson VUETest given annually in conjunction with AAPA Conference Year round testing – 200 sites nationally

AAPA may opt to have testing done yearly at conference

ADDITIONAL BENEFITS

AAPA would maintain, at least initially, a greater ASCP Registrant & Associate membershipdegree of independence. Globalization of credential

AAPA would maintain a degree of control and Program Director Servicesinfluence over the process. Financially feasible

POLICY MAKING

Memo of understanding between Certification Memo of understanding between ASCP BORCommission and AAPA. and AAPA.

Exam Committee makes recommendations Exam Committee makes recommendationsto Board of Directors. to Board of Governors.

AAPA advised of all policy changes and AAPA advised of all policy changes andprovided opportunity for review/comment. provided opportunity for review/comment.

Board of Directors has final decision on all Board of Governors has final decision on allpolicy changes. policy changes.

GRANDFATHERING

Commission to grandfather all eligible AAPA ASCP BOR will grandfather all eligibleFellow members for a time limited period. AAPA Fellow members for a time limited period.

ELIGIBILITY CRITERIA

Graduation from a NAACLS accredited Graduation from a NAACLS accreditedpathologists’ assistant training program or pathologists’ assistant training program orBachelor’s degree in a biological or allied Bachelor’s degree in a biological or alliedhealth science with a minimum of three health science with a minimum of threeyears of on-the-job training as a years of on-the-job training as a pathologists’ assistant.pathologists’ assistant.

NOTE: The on-the-job route for certificant NOTE: The on-the-job route for certificanteligibility would be phased out over eligibility would be phased out overa three to five year period from the a three to five year period from thebeginning of the program. beginning of the program.

CERTIFICATION MAINTENANCE

Mandatory 25 CME/year to maintain certification Mandatory 25 CME/year to maintain certification

FINANCIAL SUPPORT

Program funded by program and non-program Program funded by ASCP BOR, ASCPrevenue. (indirect), and program revenue.

AAPA to provide financial support for start up costs. AAPA pays travel for 1-2 AAPA examOngoing support of program to be provided by AAPA committee members.

and possibly the pathology stakeholder groups. AAPA could be asked to provide futureAdditional financial support anticipated from vendors, financial support for program.

foundations, and grants.AAPA pays travel expenses for all AAPA volunteers.

C O M M I T T E E R E P O R T SNational Certification Commision and BOT Report cont. from pg. 4

National Certification Commision and BOT Report cont. on pg. 6

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Newsletter SubcommitteeTisa Lawless

I was very pleased with the twentyfine photographs entered in this year’s2003 Photography Contest. DavidPinkhasov was judged winner of thecompetition for his entry,“Chondrosarcoma of Rib.” His winningphoto is featured in the color pages at thecenter of the newsletter. Two photoswere also selected by the judges forhonorable mention: “Cauliflower-likeBorderline Serous Ovarian Tumor” byJim Yip and “Carcinoma of the Ureter”by Vincent Moylan. Colleen Galvis wasselected as the 2003 Newsletter Awardwinner for her article about melanomaentitled “Even Where the Sun Doesn’tShine.” The winning photograph andarticle have been forwarded to JohnEckman for posting on the AAPA website. Congratulations to both David and

Colleen for their award-winningperformances, and thank you to allparticipants as well.

Thank you to Tina Rader for anotherinformative submission. Her article ontransitional cell carcinoma of the ureterand renal pelvis appears in this issue andis the basis for the winter newsletterquiz. Two photos accompany the article.Tina provided one of the photos andVincent Moylan graciously grantedpermission for use of his photo contestentry as an accompaniment to Tina’sarticle.

Norm Gerard, our first newslettereditor and a founding member of theAAPA, was waxing nostalgic at thePhoenix conference in September. Normbelieves, as do I, that it would beinstructive to our members to learn of the

seminal events that brought the AAPA towhere it is today. I have promised Normthat I will start combing early newsletterissues with a view to reprintinginteresting articles and accounts of AAPAevents, including a look at the firstrudimentary salary survey.

Luckily for us, Norm and LarryMarquis were able to persuade DenisAkim to write up reminiscences of hisearly days as a pathologists’ assistant. Inreading Denis’ chronicle, I gained awhole new view of what those early daysas a pathologists’ assistant were like—and a much greater respect for thecontributions Denis has made to ourprofession and our organization. Denis’article appears elsewhere in this issue.Read it and stand in awe!

PERCEIVED POSITIVES AND NEGATIVES FOR EACH OPTION

OPTION 1: INDEPENDENT CERTIFICATION PROGRAM

Positive: The AAPA might, at least initially, maintain a greater degree of independence.The AAPA would maintain a greater degree of control/influence over the process.

Negative: The financial burden may be too great for the AAPA to bear.All stakeholders may not value an independent credential.At least 25 - 30 AAPA volunteers, in addition to the number it already takes to run the AAPA, would be required, year in

and year out, in order to administer the program.

OPTION 2: ASCP BOARD OF REGISTRY

Positive: Turnkey operation.Preeminent certification agency for laboratory personnel.Willing to work with the AAPA to identify an appropriate certification category. Financially feasible.Relieves AAPA of the bulk of responsibility for the exam process.Relatively few (6-10) AAPA members required year in and year out.

Negative: Loss of some degree of independence (how much is acceptable?).Danger of eventual “dummying down” of exam and credential.Potential for BOR to request monies from the AAPA in future.

OPTION 3: NONE OF THE ABOVE

Positive: Allows AAPA to continue to pursue options.

Negative: Delays our quest for national recognition and certification.Will this opportunity ever present itself again?

Well, that about wraps it up. I hope that this brief summary of the options for certification affords you all a better understanding ofthe issues with which the Board is currently dealing as regards taking the next step toward certification. We will be constructing acertification survey to be distributed to the entire membership in the near future. Please take the time to fill it out and return it in a timelyfashion. Your input is very valuable to us as we continue our deliberations regarding this very important issue.

Thank you.

C O M M I T T E E R E P O R T SNational Certification Commision and BOT Report cont. from pg. 5

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C O M M I T T E E R E P O R T S

Exhibit/Booth Management SubcommitteeLarry Briggs

Those that were able to attend theannual meeting in Arizona may have hada chance to see the exhibit booth. Thankyou to Rich Pucci, former PR chair, forhelping Leo Limuaco at the meeting.During 2003, several changes were madein the presentation of the booth as well asthe literature that is handed out. Thebooth will not be traveling for the rest ofthis year. Currently, renovations areunder way to improve its look. Theliterature is also being updated to include

the most recent developments in nationalcertification.

March 2004 will be a busy month. TheUS/CAP meeting is scheduled for early March in Vancouver, BC, and the CLMAmeeting is scheduled for late March in Atlanta. If you are in the area and areinterested in helping out, e-mail me atlarry.n.briggs@questdiagnostics.com.Even if you cannot help out, stop by, check out the booth, and show yoursupport.

Congratulations to all of the AAPAmembers who have passed the 2003AAPA Fellowship Examination. Thepassing score for the 2003 Exam was 75%answered correctly. This year, 69%passed and 31% failed. The averagescore was 77%.

Thank you very much to everyonewho volunteered at the year’s exam:Shannon McWilliams, Dick Dykoski, LizSquire, Lisa Ware, Rod Slyter, and TedMitchell. Each of you helped the 2003exam run smoothly.

The Exam Subcommittee is nowaccepting digital photos for use in theexam database. Autopsy stories and newquestions are always welcome. Pleasesend photos, exam questions, andvolunteer inquiries tosusanthelioness@hotmail.com.

Examination SubcommitteeSusan Morgan

I can’t believe summer is over and fallis here, especially since as I write this, itis 80 degrees outside!! This year’s examwent well. Thank you to all who helped.There were 83 applicants for the 2003AAPA Fellowship Exam: 57 (69%)passed, 26 (31%) failed, and the averagescore was 77% answered correctly.Congratulations to all of the newFellows!

The winner of the 2003 Essay/Scientific Paper Competition Award isWendy D. Rieger, for her paper entitled“Awareness of and Defense againstMycobacterium Tuberculosis in thePractice of Gross Pathology.” Wendy isthe first OJT affiliate to enter thecompetition. Wendy’s awards include aplaque, textbook, and $250. Her paperwill be posted on the AAPA website andprinted in this edition of the AAPAnewsletter. Congratulations, Wendy!Remember that the Essay/ScientificPaper Competition is open to all studentmembers and new OJT affiliate members.Anyone interested can contact JamieEdwards at 434/947-3925.

The Regional Meeting AssistanceSubcommittee has been moved from theEducation Committee to the Conference

Committee. The move will allow theConference Committee to better helpthose with larger regional meetings inareas that the Education Committee isunfamiliar (i.e. hotels, food, AV, etc.). Theamount allotted for regional meetingshas increased from $500 per year to$1000. Anyone interested in holding aregional meeting, please contact FernSzulgit at 919/680-3139. With all of thatsaid, I would like to thank HeatherStewart for her work with the RegionalMeeting Assistance Subcommittee andwish her well with her move to theConference Committee.

Dick Dykoski has once againvideotaped the 2003 AAPA Conference;anyone interested in viewing the tapescan contact Dick at 612/725-2099. Inorder to receive CME credits, anaccompanying quiz must be returned toKathy Washington.

I would like to take a moment andthank everyone who sits on theEducation Committee, especially all ofthe subcommittee chairs. You all do awonderful job and the EducationCommittee could not run without you.Thank you all for all of your hard work!!

Education CommitteeMichelle A. Rosenow

Since we are fresh out of theconference, I can make this short andsweet—not much new news to reportsince then. The one thing that everyoneis curious about is the survey results.The survey was distributed at theconference. In addition, it was alsodistributed by mail to those who couldn’tattend the conference. Deb Martin iscurrently waiting for those surveys to bereceived to compile the results. Thebiggest difference in the surveys is thefact that people were asked to list theiractual state of residence as opposed togeographic region. It is hoped that thiswill prove to be a more useful tool whennegotiating with employers. It wasbrought to our attention that this mayreveal a bit too much about individuals.Some states that employ fewpathologists’ assistants will essentiallylist what those individuals make for alleyes to see. We are working out a plan toreduce the level of exposure for thosepeople. Results will be posted on theweb site. Any additional analysis can beobtained by contacting Deb Martin.

Every quarter, I get a message fromTisa telling me that I haven’t submittedanything for the newsletter yet. I haveyet to come up with anything trulyeloquent to say. So, I have a new gameplan. I will continue to encourage eachsubcommittee chair to make their ownsubmission. They know best what to tellyou anyway. Why not leave it to thepros? I will instead use this space to lookat our membership. Where we work,how long we have worked, do programgraduates stay in the area where theytrained, etc. It might be interesting to seehow our membership is distributed andif that has changed over time. I benefitfrom being able to spend quality timewith Michelle Sok and the database.Hopefully, you will learn about us as awhole. Have a good winter and happyholidays!

Membership CommitteeColleen O. Galvis

8 1-800-532-A APA

No one was more surprised aboutattending this year’s conference inPhoenix, Arizona than I was. It was niceto see old acquaintances and meet newones. That was probably one of thebetter conferences that I have attended.Great job, Jana “Vegas Baby!” Joslin-Akers!

I won’t belabor the issues that werebrought forth in this year’s businessmeeting, but it was quite important to bethere. I was glad that a majority of themembers did attend and listen, askquestions, and participate.

I was also glad to meet some fairlynew members in the association who

wanted to volunteer their time, not justfor my committee, but also for othercommittees that need help. For those ofyou who expressed an interest in the PRcommittee—if I have not contacted youat the time of this writing, you will becontacted.

Two new brochure designs werepresented to the Board of Trustees andone was selected for presentation to themedical public “at large.” This newAAPA brochure will hopefully debut bynext fall, if not sooner.

May all of you have a safe, warmwinter.

Public Relations CommitteeLeo Limuaco

Statistics for the Phoenix meeting havebeen compiled. 344 people registered toattend the meeting. A total of 310persons attended the lectures. Thirty twopersons (or 10%) attended all sixteenlectures. 115 registrants (37%) attendedat least thirteen (or 80%) of the sixteenlectures. The Tuesday 9:15am lecture hadthe best showing with 262 persons or85% attendance. Friday’s lecture from10:30-11:30am had the lowest attendance,with 81 people or 26%. The workshopshad a total of 138 participants.

I am in the process of compiling thePACE certificates for the meeting. They will be mailed through the AAPACentral Office. I hope to have themcompleted by mid to late November2003.

The CME year deadline is 31December 2003. Worksheets should bepostmarked no later than 31 December2003. As a reminder, the following arePACE approved credits:

• AAPA Meeting: 1 CME per lectureattended; 3 CME per workshop

• AAPA Newsletter quizzes: 1 CMEper quiz

• Hospital-based lectures (i.e. Tumor Boards, Grand Rounds, M & M Conferences, etc.): 1 CME per hour with proof of attendance

• Videotaped lectures from theAAPA meetings: 1 CME per lecture, with completion of a quiz for each lecture (send completed quizzes to me)

PACE requires much moredocumentation. For the hospital-basedactivities, I require a copy of the sign-insheet for each lecture. Some institutionshave a central “CME Office” that keepstrack of employees’ CME activities. I canaccept their documentation. The CMEworksheets are still valid and need to bepostmarked no later than 31 Dec 2003. Ican no longer approve:

• Reading journal articles or entirejournals

• Taking post-graduate courses• Teaching activities• Writing newsletter articles or quizzes• Submitting kodachromes or

questions for the examThe minimum CMEs to earn an AAPA

Award Certificate is 25. If there are anyquestions regarding CMEs, feel free to e-mail me at kawash@erols.com orwashingtonka@hotmail.com. Have ahappy Holiday season!

CME SubcommitteeKathy Washington

C O M M I T T E E R E P O R T S

VOTE AND RENEWin one easy step!!

AAPA Dues Announcements will bemailed in mid-December.

A 2004 ballot for officer and boardpositions will be included.

(Those elected will assume duties onJanuary 1, 2005.)

Sponsored by the AAPA, Denver areaPAs, and Unipath, Inc.

Join us in Denver,Colorado, on Saturday,February 28, 2004 for a fullday of pathology lectures.Pathologists’ AssistantJason Fowler willpresent his larynxworkshop, which wasvery well received at the annual AAPAconference. Several area pathologists willlecture on topics ranging from perinatalpathology to an interesting zoologicalcase. PACE CME credit has been appliedfor and will be given to all attendees. Alight breakfast and a wonderful lunch willbe provided. The registration fee is $75.

The meeting will takeplace at PSL MedicalCenter, locatedminutes fromdowntown Denver whereone can find a variety of hotelaccommodations and experience the bestDenver has to offer in dining, shopping,and entertainment. Extend your weekendand enjoy some of the best skiing in NorthAmerica at world class resorts such asVail, Steamboat Springs, and manyothers—all located within a one to threehour drive from Denver.

Complete information will be providedto all registrants, including travel options,suggested hotel accommodations forevery budget, post meeting entertainmentoptions, and, of course, ski area and liftticket discount information. For moreinformation, contact John Eckman by e-mail at jme5@pvh.org. Please useregistration form on page 23; registrationdeadline is February 15, 2004.

2004 AAPA DenverRegional Meeting

www.pathologistsass istants.org. 9Book Review continued on pg. 10

S T I F F

Written by Mary RoachCopyright 2003W. W. Norton & Company New York,

London303 pages, $23.95Review by Chet Sloski

In her latest book, Stiff: The CuriousLives of Human Cadavers, Mary Roachexplores what might happen to yourbody after you donate it to science.

Roach is of the opinion that, onceyou’re dead, hey, you might as well “do”something useful like willing your bodyto science. She says that hers is “a bookabout notable achievements made whiledead.” She then goes on to write aboutsome of these notable achievements—achievements that they may not want toadvertise on those “Willed Body” formsthey get you to sign off on.

Chapter one, A Head is a Terrible Thingto Waste, finds Roach in a face liftrefresher course sponsored by auniversity medical center. For $500, thesurgeons get to brush up on theirtechniques, two to a head ($500 doesn’tbuy what it used to). As Roach enters theclassroom, she counts forty severedheads, each in its own pan to “catch thedrippings.” Roach compares the humanheads to the size and weight of roaster

chickens. (Throughout the book,Roach has a propensity forcomparing body parts to foods.)

It isn’t long before theinquisitive Roach wants toknow, “Who cuts off theheads?” Answer? Yvonne.When she meets this Yvonne,Roach can’t help but think,“You cut off heads. You cut offheads. You cut off heads.”

Observing the surgeonspracticing on the heads, Roachis thinking what most of usare thinking—heads inroasting pans being proddedby plastic surgeons is notwhat comes to one’s mindwhen pondering whether ornot to donate your body toscience. Roach laterdiscussed this with thedirector of a medicalanatomy program at auniversity. He told her thatmany donors don’t reallycare what happens to their

bodies after they donate them to scienceand that they consider it a practical andaltruistic means of disposing of theirbody. To this I say, “Speak for yourself,Mr. Medical Anatomy Program Director!”Roach agrees with the director and,although she admits that it is easier tojustify the use of a cadaver for practicefor, say, coronary bypass surgery, it isalso justifiable for face lifts or nose jobsbecause, face it, cosmetic surgery is hereto stay and it’s better for surgeons topractice on a cadaver than on a livehuman—especially when that humanmay be you.

Chapter two, Crimes of Anatomy, dealswith corpse procurement. Roach says,“Few sciences are as rooted in shame,infamy, and bad PR as human anatomy.”Seems back in the old days, no onedonated his or her body to science. God-fearing people believed in a literal risingof the body from the grave, anddissection would nix your chances of abodily resurrection and—if I have myeschatology right—the body’ssubsequent reunification with the soul atthe end of the world. Indeed, in 1836 inBritain, it was only legal to dissect anexecuted murderer. Far from an altruisticmotive, this was allowed as an “extrapunishment” for the murderers. It alsoserved as an added deterrent.

Crime apparently not at today’s levels,back then the available cadaver list wasshort and medical schools scrambled tofind a steady supply. This led to someodd partnerships and desperatemeasures. Anatomists would bring intheir own deceased relatives fordissection. Roach tells us that WilliamHarvey, discoverer of the circulatorysystem, as you may remember, is said tohave dissected his own father and sister.As Freud might have said, “He had someissues.”

Of course, you know what this isleading to. Yes, body-snatching! Someanatomy instructors encouraged studentsto raid graveyards to provide bodies forclass. In 1700’s Scotland, tuition could bepaid in corpses rather than cash. Roachreminds us that as bizarre as all thissounds, these were well meaning peoplededicated to the training of futurephysicians. Not so for the infamousWilliam Burke and William Hare. It musthave been too much for Burke and Hareto dig up graves, what with breaking asweat and all. They felt that there mustbe an easier way. As Roach says, “themen decided to speed things along.” Thetechnique? Hare pressed a pillow to thevictim’s face while Burke lay on top ofthe victim (affectionately known as“Burking”). This nefarious duoapparently repeated this crime at leastfifteen times, delivering the corpses to aRobert Knox, an Edinburgh anatomist,who, we all assume, had to know howthese bodies were obtained, if for noother reason than freshness alone.

But Burke got his due. Oh, yes. He washanged before a crowd of 25,000.(Puzzlingly, Hare beat the rap. Liberaljudges, no doubt.) And being that Burkewas a murderer, and in accordance withthe law, his body was duly madeavailable for dissection. Today Burke’sskeleton is on display at the RoyalCollege of Surgeons of Edinburgh. So ifyou’re ever in Edinburgh…

Chapter 3 is Life after Death, or, as Iwould have called it, Fun withDecomposition. Here, researchers burycorpses in shallow graves and let naturetake its course. The researchers thenanalyze tissues samples for time-dependent decay chemicals. Theyalso keep track of flies laying their eggs,maggot evolution, etc. One interesting thing that I learned in this chapter wasthat handlers of “human remains dogs”

The Curious Lives of Human Cadavers

10 1-800-532-A APA

could buy synthetic versions of thedecomposing chemicals. There’s skatole,indole, putrescine, and cadaverine.

In chapter six, The Cadaver Who Joinedthe Army, we receive a primer on militaryballistics research. This is a particularlyodious chapter in the history ofemploying cadavers in research.Understand, this research wasundertaken not to alleviate human painand suffering, but to get a handle on themost efficient way to promulgate humanpain and suffering. Then again, I guessthat you could look at it as alleviatingpain and suffering for the side doing theresearch in a “Hooray for our side!” kindof way.

Captain Louis La Garde of the U.S.Army Medical Corps received his ordersin 1892. His orders, rifle in hand, were tofire upon the corpses of men who haddied of natural causes. The corpses wereto be suspended from a firing rangeceiling and then shot in a dozen differentbody sites with a dozen different charges(to mimic different distances). La Gardewould then examine the effects of hishandiwork on the bones and soft tissuesof the corpses.

Roach believed that La Garde andKocher (another ballistics researcher)“expressed a desire that their ballisticswork with cadavers would lead to amore humanitarian (italics mine) form ofgun battle. Kocher urged that the goal ofwarfare be to render the enemy not dead,but simply unable to fight.”

In the above quote, Roach surely errsin using the adjective humanitarian. Yes,the goal of warfare is to incapacitate yourenemy, not necessarily to kill him. Butdoes this really have anything to do withhumanitarian reasons? A dead soldier isdead and, obviously, can’t fight. But aninjured soldier, in addition to not beingable to fight, also requires immediatemedical attention, thereby tying upadditional personnel who must also laydown their arms. It’s a perverse logic.

Ultimately, La Garde found that thestopping power of munitions could notbe gleaned from human corpses. LaGarde needed something alive.Criminals? No. (And shame on you forthinking that.) What then? Try this:

unindicted livestock from the Chicagostockyards. Later, pigs would be usedbecause, as Roach reminds us, theirorgans are a lot like ours. Speak foryourself, Mary Roach.

Today Roach tells us that ballisticsstudies involving corpses areproblematic. “How do you decide it’sokay to cut off someone’s grandfather’shead and shoot it in the face?” It’s evendifficult to get permission when theresearch is indeed humanitarian, such asfor the study of the effects of (usually)nonlethal munitions, such as plastic andrubber bullets, beanbags, etc.

Roach goes on to discuss cadaversused in explosion research—what shecalls, “perhaps the most firmlyentrenched taboo of the cadaver researchworld.” Anyway, researchers in thisspecialty found that human cadavers arenot the best test material. Seems that abomb does the most damage to the lungsand, being that a corpse’s lungs aredeflated, the data is of limited value.

Chapter 8, How to Know if You’re Dead,addresses the problem that doctors havehad through the centuries: ascertainingwhether a person’s heart has stoppedbeating or whether the beating or pulse isjust too faint to hear with the naked ear.Such can be the case involvingdrownings, strokes, and poisonings.Stethoscopes? Not invented until themid-1800’s.

You see, people back then had amorbid fear of being buried alive. Sophysicians came up with methods for“verifying” death. Some were quitehumorous and some, if you were indeedalive, could be quite painful. Painful? Thesoles of the feet were sliced with razors,needles jammed beneath toenails.Humorous? Bugle noises and “hideousshrieks and excessive noises” went intothe ears. Painful? Red-hot pokers stuck intight spaces. Humorous? Tobaccoenemas. Want painful and humorous?Nipple pincers.

All the above methods fell out of favoras a means for death verification,although I’m told that the last three arestill available in some of our larger citiesfor recreational purposes. What fell intofavor as a means of verifying death wasputrefaction. Of course this meant thatthe bodies had to lie around the housefor a few days, probably on the livingroom couch, for the ripening process totake hold. This, obviously, was notoptimal. So special buildings wereerected, called waiting mortuaries. Theywere common in 1800’s Germany.Attendants, undoubtedly on minimumwage, kept watch for any signs of lifethrough a system of strings tied to the

corpses. The strings in turn were linkedto a bell. You get the idea. But by 1940,no one had come back to life, so to speak.The waiting mortuary was defunct,people no longer feared being buriedalive, and ultimately found plenty ofother things to fear.

In the last chapter, Remains of theAuthor, Roach ponders whether or not todonate her body to science. She doesn’trelish the thought of young people“gazing in horror and repulsion at mysagging flesh and atrophied limbs.” Shetells us that she’s forty three and theyoung people, they already stare.

The thought of being a skeleton in aclassroom holds some appeal for her,though. It’s relatively unembarrassing,and a shot at immortality. But shelearned that they don’t make skeletonsfor medical schools in this country. Mostof the world’s skeletons came fromCalcutta, birth control there beingfrowned upon by future saints. As amatter of fact, skeletons don’t even comefrom Calcutta anymore. Seems Indiabanned the exportation of this uniquecommodity after reports (urban legends?)of children being kidnapped andmurdered for their bones. Since this ban,the supply of human bones has dwindledto almost zero. Plastic skeletons havetaken their place. So the dream of havingyour skeleton displayed alongsideBurke’s in Edinburgh, or posed onMichael Jackson’s dresser, is probably notgoing to happen.

But there’s another way. Plastics.(Perhaps someone whispered a tip toRoach at a cocktail party.) We all knowthat plastination is used for organs.We’ve seen them. But whole bodies? Whoknew? Plastination takes organic tissueand replaces the water in it with a liquidsilicone polymer. German anatomistGunther von Hagens developed it. Heeven has a plastinated whole-body artexhibit, “Korperwelten” (or“Bodyworlds).” It has toured aroundEurope and is quite a hit. Eight millionare said to have visited it. The bodies,without skin to better see their muscles,are posed as action figures: swimming,riding a horse (plastinated also), andplaying chess.

While Gunther’s plastination takesover a year to accomplish, enterAmericans Roy Glover and DanCorcoran who, working with DowCorning, got the process down to onetenth of the time. They even got up theirown museum project called: “ExhibitHuman: The Wonders Within.” It wasscheduled to open in mid-2003 in SanFrancisco, but is almost sure to find apermanent home in Vegas. The Mirage

Book Review continued from pg. 9

Book Review continued on pg. 26

When first approached to write anarticle about the early days in theAmerican Association of Pathologists’Assistants (AAPA), I was a bitapprehensive. Then I figured, what theheck. So now I’m going to try and showyou what I and many others wentthrough to help create the foundation forthe association we have today.

Since many of you may not know me,here is a quick introduction and mybiography: I grew up in Wisconsin andmarried a woman from Minnesota. Wehave three grown children and, currently,three granddaughters. I graduated fromQuinnipiac College (the third graduatingclass) in the summer of 1975. I have beena Fellow since 1975 and have served theAAPA on the Membership Committee(1975-1976); was elected Secretary for twoterms 1978-1982); and have been on andoff the Board of Trustees for aboutthirteen years (1983-1984, 1986-88,and 1991-98).

I started my pathologists’ assistantcareer in Sioux Falls, South Dakota,with the Laboratory of ClinicalMedicine (LCM); I was employedthere from 1975-78. I then moved onto Iowa Methodist Medical Center inDes Moines, Iowa (1978-89), andEast Carolina University inGreenville, North Carolina (1989-91).Since 1991, I have been employed atPeninsula Pathology Associates, aprivate group in Salisbury,Maryland.

The Laboratory of ClinicalMedicine was a private groupconsisting of ten pathologists andapproximately 125 laboratorypersonnel. The LCM was affiliatedwith Sioux Valley Hospital, a 350-bedteaching hospital in South Dakota. TheLCM was very involved with continuingeducation and hosted numerous weeklyeducational seminars; the pathologistswere also active with the University ofSouth Dakota Medical School inVermillion. I think my first salary was$13,500, which I remember was not evenas much as one of my classmates. But itwas a start, and aren’t we all glad justhow far starting salaries have cometoday!

As the first pathologists’ assistant inthe state of South Dakota, I had to belicensed by the South Dakota Board ofMedical Examiners. When I was firsttested for the position, I barely passedthe core exam for physicians’ assistants.

After further discussion and clarificationon what a pathologists’ assistant’s dutiesspecializing in pathology are, as well asresearch on another state’s program(Oregon), I had to retake the written,oral, and practical exam given by apathologist on the South Dakota Board ofMedical Examiners. This pathologist wasa member of a rival pathology group. Iwas ill at ease, but still managed to passall phases of the examination. They gotfree work out of me for one day doinggross examination and description. I waslicensed as a Physicians’ Assistant -Specialist in Pathology (Number 038).

At the LCM and at Sioux ValleyHospital, I did the usual cutting in ofsurgicals as well as some teaching tofirst- and second-year pathologyresidents. We did a fair number ofautopsies at Sioux Valley, but we also

drove or flew to various placesthroughout South Dakota, southernMinnesota, northwestern Iowa, andnortheastern Nebraska. We wereprovided excellent company cars, which“really moved.” I usually drove the GreyGhost—a Delta 88 Royale—and pickedup a few speeding tickets. After anotherpathologist and I racked up a number ofspeeding tickets, our insurance rateswent out the roof. The LCM needed adeterrent and refused to pay any moretickets. Oops, another lost benefit!

One winter day, I drove to a southernMinnesota town to do an autopsy. Theweather was cold, about minus 30degrees with a 10 mile-an-hour wind, fora wind chill factor of around 42 degreesbelow zero—for those of you who aren’t

familiar, that is REAL COLD. My carbroke down due to the extreme cold, so Iwas forced to get out and walk the threeto four miles to the next town forassistance. When I returned from theouting, my employer created “SurvivalKits” for all the company vehicles. Thekits included candy and othernonperishable foods, Sterno for heat,matches, a snowmobile suit, space agewarming blankets, and big insulatedboots. They also installed CB radio units;my CB handle was the “Flying Scalpel.”

I flew in single-engine airplanes tomany small towns to perform theautopsies. I usually worked in thepreparation rooms of the local funeralhome and, only on occasion, in an actualhospital morgue.

My first flight was to Pierre, the capitolof South Dakota. The temperature was 90

degrees and we ran into manythermals (radical changes in airtemperature). I bounced aroundlike a pinball, was green when welanded, and already feared thereturn flight. The pilot laughedwhen I sincerely asked where theparachutes were. Little did Iknow, there were none on theaircraft. Most of our pilots wereoff-duty South Dakota AirNational Guardsman, and allwere excellent.

I enjoyed flying and preferredthe V-tail and T-tail BeechcraftBonanza planes over the mightyMooney aircraft; rumor had it theMooneys built up ice more readilythan the Bonanzas, and I can nowverify that it is true. I almost wentdown twice!

Some weekends I flew approximately1,200 air miles and performed three orfour autopsies. When I flew to do anautopsy, I carried a BIG black bag whichcontained all of our tools necessary toperform an autopsy, and I even broughtmy own formalin specimen containers.Anything I found unusual or questionedat the time of the autopsy, I simplybagged up and brought back. I alsomaintained telephone communications tomy supervising pathologist in Sioux Fallsat all times. Get an atlas and look atSouth Dakota and those areas describedabove—it is a huge coverage area. Thefederal government at one time fined theLCM as a monopoly with regards to itsintra- and interstate work network.

www.pathologistsass istants.org. 11

Denis Akim, PA Pioneer

PA Pioneer continued on pg. 12

4th Annual AAPA ConventionArlington, VA

1978 Attendees, from left: Carl (Bill) Walden, Denis Akim, Brian McCarthy, Carol Lazzara, and Terry O’Donnell

(photo courtesy of Leo Kelly)

12 1-800-532-A APA

We also did forensic cases at SiouxValley Hospital and, on occasion, flew outto do a medical examiner case. Whenavailable, a pathologist would come withme and we would do the case together. Iwas also a Minnehaha County DeputyCoroner and got the opportunity toinvestigate and examine many deathscenes. This experience has helped mewith later jobs. And as you can probablytell by now, this was too much work forone pathologists’ assistant, so the groupdecided we should get another.

At the same time, the firstorganizational meeting of pathologists’assistants was to be held in Atlanta,Georgia, in November 1975. I requested toattend the meeting in hopes of recruitinganother pathologists’ assistant for theLCM in Sioux Falls. The meeting wasscheduled to last less than a week. I reallynegotiated for funds to go to this firstmeeting—I had a young family, schoolloans to repay, and routine bills.

Somehow I managed to come up withthe money and made arrangements to flyto Atlanta. An early snow blizzardthwarted my plans, however, and closedthe airport. Not only could I not fly out,but I couldn’t even get out of my owndriveway. The histology supervisor pickedme up in a snowmobile and took mecross-country to the airport when itopened. I darn near fell off three times;my suitcase was not as lucky as I was—itdid fall off a couple of times.

On the flight to Atlanta, I thought tomyself how exciting and historic thismeeting would be. It marked the first timeI would be in a group of my peers in anew profession as a pathologists’ assistant.I considered myself a sort of modernpioneer with a new profession and now anew organization to represent itsmembers. Then I questioned, will thisprofession prosper? Will this AAPA as anorganization continue to grow? Asindividuals we can only do so much, butunited we can pool all of our collectivetalents for the benefit of the group. Iwondered if I would have any direct inputin the running of this organization.Although I considered it an honor toattend the first meeting, it was scary toknow that decisions we would make atthis first meeting could affect the future ofthe association for years to come. Thiswas a challenge that I and all the others atthe first meeting were willing to proceedwith and undertake.

When I finally arrived in Atlanta, themeeting was partially over. Sinceeveryone worked, the organizers tried tomake the meeting time and place asaccessible and convenient to all travelers.

As a reality check, the registration fee forthis first meeting was $10.00.

I met pathologists’ assistants from allover the United States, who mainlyattended training programs at QuinnipiacCollege, Duke University, and UAB(University of Alabama at Birmingham). Iwas duly impressed at the ease we all hadtogether. I am not really sure how manyof us there were, but I guess around 30-35.Although I missed meeting HarveyGipson (the first AAPA president), Iformed many new friendships. My newcolleagues now included Norm Gerard,Rob Heineman, John Mitchell, BarryMullins, Coy Wagner, Floyd Courtwright,Paul Newby, and Ken Broda. I was alsoreacquainted with old friends like LeoKelly and former classmates from mydays in Connecticut. (I truly apologize if Ihave forgotten any other friends there atthe first meeting.)

Since I arrived late and missed some ofthe previous day’s work and discussions, Ihad to catch up with all of the new,exciting information. At this first meeting,we broke into small groups to work on thefirst five standing committees—Convention, Administrative, Membership,Public Relations, and Finance. Themembers of each committee elected thefirst committee chairs, which is differentfrom today’s procedures. I joined theMembership Committee. We set fees formembership, created member categories,and examined a Code of Regulations forthe membership, a continual work inprogress. We even defined thepathologists’ assistant, which is practicallyidentical to the definition used today. Thedays were long, and it seemed likeeverything went slow, but before I knewit, the meeting was over. The first groupgathered in Atlanta was a diverse groupwith a common goal and mission. I amamazed today what was started at thattime and how it has grown today from abunch of dedicated volunteers.

While in Atlanta, I also tried to recruitanother pathologists’ assistant, and laterthat year, Paul Newby joined me in SiouxFalls. We were a dynamic duo and sharedthe pathology duties. Our dutiescontinued to expand when thepathologists saw what we could do. Theytruly utilized the pathologists’ assistantsas a human resource.

After the meeting, I continued to workon membership issues. We continued toevaluate the nonprogram, or on the jobtrained (OJT), individuals functioning as apathologists’ assistant. I was appointedChair of the Subcommittee on ProgramApproval, which dealt with unifying astandard of training for all pathologists’

assistant training programs (in existenceand those created in the future) and alsoset the requirements for those on the jobpathologists’ assistants.

At the second meeting held in VirginiaBeach in 1976, I realized that the AAPA isa great new organization of talentedpeople working together for thebetterment of the association through hardwork, compromise, and unselfishvolunteerism.

In 1977, we met in New Orleans andstayed at a beautiful hotel near the FrenchQuarter. I ran for Secretary and becamean officer in the AAPA. For me, this was adream come true. I had a tape recorderthat worked only part of the time, so I hadto go to all of the meetings (committee,officer, general, or impromptu) and be ascribe and take notes. I thought this wasgoing to be an easy job—boy, was I everwrong! But I learned a lot, and Leo Kellywas a great mentor.

Here is an example of the typicalmeeting report. First, the meeting had tobe transcribed, then I typed out anoriginal (no computers then). Sometimesthe President or Board of Trustees editedthe report. Then, back to the new editedreport, about ten copies were made. Thenthe final meeting report was snail mailedto each committee chair, each officer, andeach board of trustees member. Iabsorbed all those costs and paid for all ofthe mailing expenses out of my ownpocket. We tried to keep expenses down,and this was a way of contributing a littlefor the AAPA.

All the AAPA correspondence was very,very slow to disseminate to theappropriate association officer. Onerecorded meeting usually took about twomonths to distribute to the hierarchy ofthe association. Thanks to improvedtechnology over the years – the Internet, e-mail with attachments, and a centraloffice - our dissemination of informationhas vastly improved.

After three years and almost crashingthree times in the air, I decided to leavethe LCM in Sioux Falls and our littlehouse on the prairie. Brian Fraser joinedthe group to help ease the workload, and Imoved to Des Moines, Iowa and joinedthe Iowa Methodist Medical Center in1978.

I worked for a private group under Dr.John W. Green, Jr., who was very activewith the ASCP Board of Registry.Unbeknownst to me, he hired me to seefor himself what a program trainedpathologists’ assistant could do in a large750-bed medical center. I did not know itat the time, but I was a “guinea pig”under his microscope. The ASCP had

PA Pioneer continued from pg. 11

PA Pioneer continued on pg. 24

www.pathologistsass istants.org 13

The 30th Annual AAPA ContinuingEducation & Business Conference will beheld in Chicago, Illinois, October 2-8, 2004.Contrary to popular belief, Chicago wasnot named the “Windy City” because ofits weather. Chicago was named the“Windy City” by New York Sun editorCharles Dana in 1893. Dana was tired ofhearing long-winded politicians boastingabout the World’s Columbian Expositionheld in Chicago.

Chicago is a city filled with beautifularchitecture, world renowned museums,and rich culture and history. Here is aglimpse at some popular Chicagoattractions; corresponding web sites areprovided so you can find moreinformation on those spots that interestyou.

Grant Park, a short distance from theRenaissance Hotel, is where you will finda variety of activities, including the ArtInstitute and the Field Museum. One ofthe world’s great art museums, the ArtInstitute of Chicago has collections datingback to 3000 BC and extending to thepresent day. The museum featuresfamous French Impressionist paintingsand drawings as well as fine anddecorative arts from America, Europe,Africa, Asia, and Latin America. Themuseum has ten curatorial departmentshousing over 300,000 pieces of art.Featured exhibits change at the ArtInstitute, so be sure to visitwww.artic.edu/aic for more information.

The Field Museum is a natural historymuseum also located in Grant Park. TheField Museum was incorporated in 1893 tohouse the biological and anthropologicalcollections assembled for the World’sColumbian Exposition. Over the years,the museum’s collection has grown toover 20 million specimens, including Sue,the world’s most complete, largest, andbest preserved Tyrannosaurus rex. For moreinformation, visit www.fieldmuseum.org.

The Shedd Aquarium is the world’slargest, with more than 19,000 aquaticanimals from all over the world. WildReef-Sharks at Shedd, the aquarium’snewest exhibit, features coral polyps,sharks, rays, beautiful colored reef fish,and more. The Shedd Aquarium is a goodplace for the entire family! For moreinformation, visit www.sheddnet.org.

Adler Planetarium opened in 1930 andwas the first planetarium in the westernhemisphere. The planetarium showcases arenowned collection of historicalastronomy artifacts and features state-of-the-art computer technology in theworld’s first star-rider theater. Eachmonth, something new can be seen in thesky and at the Adler on “Far out Fridays.”For more information, visitwww.adlerplanetarium.org.

A great way to see Chicago and enjoyits beautiful architecture is by taking aninety minute architectural cruise. Thecruise places you at the base of hundredsof skyscrapers designed by modernists ofnearly a century ago. As you cruise along,a trained guide describes the work ofthose who revolutionized the building artsas well as how they are linked structurallyand architecturally. For more information,visit www.chicagonline.com/archtour.

For history buffs, there is a ninetyminute historical cruise. You’ll hear thestory of Chicago, how it grew from itsdays as a frontier outpost, to the GreatChicago Fire, to present day. This cruisetakes you out on Lake Michigan for abeautiful view of the Chicago skyline, aprofile recognized around the world. Formore information, visitwww.chicagonline.com/historytour.

Finally, the John Hancock Observatory,located on the 94th floor of the JohnHancock Center, features an open-airskywalk which takes you on a personalaudio tour of Chicago’s incredible sightsand remarkable history. Experience thespectacular views spanning eighty milesand four states from the newly renovatedHancock Observatory. For moreinformation, visitwww.hancockobservatory.com.

Chicago 2004By Kate Wolfe, Meeting Planners Representative

AAPA

Mission Statement

The American Association of

Pathologists’ Assistants is an

organization of highly skilled allied

health professionals supporting the

concept of providing trained

professionals to become an integral part

of the anatomic pathology team,

assisting the pathologist to provide

appropriate, high quality, cost effective,

comprehensive pathology and laboratory

medicine services to the consumer. The

AAPA also serves as the main vehicle for

supporting, promoting and sustaining

the pathologists’ assistant as an

established allied health professional.

14 1-800-532-A APA

PH

OE

NI

X

20

03

2003 AAPA Photography ContestWinning Photograph

“Chondrosarcoma of Rib,” by David Pinkhasov, PhD

2003 AAPA Photography ContestWinner

David Pinkhasov, PhD

2003 Newsletter AwardWinner

Colleen Galvis for herarticle,

“Even Where the SunDoesn’t Shine”

Phoenix Conference—PA VIPs!!Pictured from left:

Dick Dykoski (lecture topic “The Vegetable Man”),Pamela Younes (HIPAA Lecture),

and Steve Groebner (Phoenix Speaker Recruiter).

Conference PlottersMeeting Planners On-site

Representative Kate Wolfe andConference Committee

Chairperson Jana Joslin-Akers

AAPA President’s Award2003 Recipient—James Moore

( seen here with President Jon Wagner )

**Conference photos courtesy of Steven Suvalsky. Anyone who has photographs that they would like to contribute to the AAPA Photo Album collection may contact Steve at Suvalsky@aol.com.

AAPA BoothRich Pucci mans the booth in Phoenix

www.pathologistsass istants.org 15

The ureters and renal pelvis arebasically a pathway for the passage ofurine. Although they differ slightly inanatomic structure, their embryogenesisand reactive abilities are so similar thatdiseases of both organs can be consideredtogether. They form by elongation andbranching of diverticular outgrowthsfrom the mesonephric ducts. Initialbranches are absorbed by dilatation ofthe advancing ureters to form the renalpelvis, but later branches are retained asrenal calices and terminal portions ofcollecting ducts. Both the renal pelvisand ureters are lined by a foldedepithelium supported by a laminapropria and surrounded by a muscularwall with a fibrous adventitia. Theepithelial lining and supporting laminapropria of these organs are structurallysimilar to those of the urinary bladder.In contrast to the bladder, however, theurothelial lining of the upper collectingsystem is normally arranged in folds,creating crypts from which roundedaggregates of cells may be dislodged intourinary specimens during catheterizationor ureteroscopy.

In well-prepared specimens, ureteraland renal pelvic urothelial cells areuniform in size with regular chromatinand without prominent nucleoli. Theureteral and renal pelvic urothelial cellsappear larger with slightly more irregularnuclear borders than their bladdercounterparts. These features also occurin dysplasia. Both normal and slightlyreactive ureteral mucosa can be easilyconfused with dysplastic bladderepithelium, especially at frozen section orin washings collected for the evaluationof hematuria.

Neoplasia of the Upper Collecting System

Over the past six decades, thefollowing clinical findings, pathology,and behavior of ureteral and renal pelvicneoplasms have been fairly constant.Most patients are 50 to 70 years old andapproximately two thirds of patients aremale. Lesions occur throughout theupper urinary tract, but are mostcommon in the distal third of the uretersand extrarenal portions of the pelvis.Although single lesions are mostcommon, multiple and bilateral tumorsdo occur. Significant laterality has notbeen reported. A palpable mass isidentified in approximately 10% of

patients.3 90% of patients complain ofhematuria, and flank pain is reported in20% of patients;3 asymptomatic lesionsare uncommon

The majority of upper tract neoplasmsare detected by radiography rather thanendoscopy. Intravenous and retrogradepyelography provides the most accuratemeans of diagnosis. Factors complicatingcytological evaluation of upper urinarytract neoplasms include:

• The lack of exfoliated cells appearing in random voided samples

• Excessive degeneration of tumor cells

• The inability of the method to localize lesions in washings often contaminated by bladder cells

• The resemblance of normal upper urinary tract cells to slightly atypical bladder urothelium

Lesions representing almost allhistological types of urothelial neoplasmshave been reported, including invertedpapilloma, spindle cell carcinoma, mixedcarcinoma, undifferentiated carcinoma,and even cystadenoma. Rarely, thesetumors acquire a sarcomatoidappearance, with prominent spindling ofthe tumor cells. A neoplasm withfeatures analogous to those of giant celltumor of bone can be seen in the pelvis inassociation with papillary or in situ

transitional cell carcinoma. Atransitional cell carcinoma patternassociated with small cell carcinoma hasbeen described. In rare cases, the entiretumor has a choriocarcinoma-likeappearance. Rhabdoid features andtrophoblastic differentiation have alsobeen reported.

Neoplasia of the upper collectingsystem differs from neoplasia of theurinary bladder in the following ways:

• Lower frequency of all types of neoplasms

• Stronger association with certain types of chemical agents. Cyclophosphamide and the radiopaque medium Thorotrast have been implicated as risk factors. There has been a particular association between renal pelvic tumors and phenacetin (analgesic) abuse.

• Stronger association with obstruction to urinary outflow, with stones being identified in 15 to 20% of cases3

• Decreased value of cytology for detection and monitoring

• Decreased value of endoscopy for detection and monitoring

• Increased frequency of subsequent urothelial neoplasms at other sites (primarily bladder)

• Greater association with renal diseases

Transitional Cell Carcinoma of theUpper Collecting System

Transitional cell carcinoma of the renalpelvis and ureters occurs mostly in adultswhere it accounts for 7% of all primarytumors. It is associated with a history ofanalgesic abuse and/or coexistence ofrenal papillary necrosis in approximatelyone quarter of the cases. Neoplasmsarising in the ureters are uncommon,making up approximately 0.03% ofhospital admissions for urologicaldisease, 1 in 11,000 autopsies, 1% oftumors of the upper urinary tract, and2% of all urinary neoplasms. As many as10% of patients with upper collectingsystem tumors have had previousurothelial neoplasms, simultaneouslesions have occurred in 6 to 38%, andsubsequent tumors are found in 4 to 30%. 1,3

Transitional cell carcinomas of theureter may be located anywhere alongthe length of the ureter and usually result

Transitional Cell Carcinoma of the Renal Pelvis and UretersBy Tina Rader

Photo 1: Papillary TCC of the Ureter, Grade II

Photo 2: Papillary TCC of Renal Pelvis, Grade II

TCC continued on pg. 19

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Imagine you are performing your dailyduties as a dedicated pathlogists’ assistantwhen a routine specimen of a testicularmass arrives from the operating room forfrozen section evaluation. You process itlike any other specimen that a surgeon hassent requesting this type of diagnosis; youprobably slice through the specimen,photograph the mass, describe it, andfreeze it. You use pressurized quick-freezespray in the cryostat, and you also use anaerosol cleaner type spray to clean thearea after you are finished photographingand grossing the specimen. Almostsimultaneously the pathologist informsyou and the surgeon that the mass, whichgrossly appeared to be some type oftumor, shows “granulomatousinflammation.” Although this diagnosiscan indicate various disease processes,your first thought is, “Tuberculosis!” andimmediately after, “I’ve just sprayed it allover the place!!” When the diagnosis isrelayed to the surgeon, he repliessomething to the effect of, “I had a feelingthat’s what it was,” which causes you togrimace in frustration and anger. Doesthis type of scenario occur in the surgicalpathology laboratory? Yes—all toofrequently. Should this type of scenariohappen? Absolutely not. The goal of thispaper is to review the danger ofMycobacterium tuberculosis to the surgicalpathology staff, and to promoteminimization of this danger by educationand improved laboratory practices.

While performing traditional androutine duties in the gross cutting roomand during autopsy, the pathologists’assistant faces a spectrum of dangers,including, but not limited to: blood-bornepathogens, exposure to toxic chemicals,mechanical injuries from specimens ortools of the trade, and even radiationexposure. Although formalin exposureand the risk of HIV infection are the mostemphasized occupational hazards in ourprofession, perhaps the most insidiousand under recognized threat thepathology staff faces is the aerosolizationof Mycobacterium tuberculosis. OSHAmandates yearly formaldehyde and blood-borne pathogen training for employeesexposed to these agents, but there iscurrently no required standard for theeducation and training of laboratory staffwho are at risk for exposure to M.tuberculosis. Some health-care institutionsrequire annual TB training for allemployees, but some only require it for

staff members who come into contact withlive patients. Despite this lack ofconsistency and lack of currentgovernment rules to follow, we, asresponsible and conscientious members ofour profession, need to be aware of thethreat of tuberculosis, and be responsiblefor protecting others and ourselves fromit.

Robert Koch stated in 1882 that, “If thenumber of victims which a disease claimsis the measure of its significance, then alldiseases…must rank far behindtuberculosis.”(1) One hundred twentyyears later, even after the discovery ofanti-tuberculosis drugs, the World HealthOrganization estimates that globally thereare nearly two million deaths fromtuberculosis annually.(2) The UnitedStates is not spared from this epidemic, aspresently an estimated thirteen millionU.S. adults are infected with TB.(3) M.tuberculosis is an airborne infection, carriedby droplet nuclei measuring 1-5 micronsin size.(4) Not only can these dropletnuclei be released from an infectedperson’s respiratory system duringcoughing, singing, sneezing, orspeaking,(4) but they can also becomeaerosolized during certain medicalprocedures performed on an infectedpatient’s blood, sputum, and tissues.Because tuberculosis infection issometimes latent, miliary (disseminatedby the bloodstream to sites other than thelung), or both, it is not always suspectedin an infected patient. This creates agreater risk to pathology and autopsy staffsince they usually do not take TBprecautionary measures when workingwith infected tissue unless the disease isknown or suspected. It is estimated thatas many as half of the cases of pulmonarytuberculosis seen at autopsy have beendiagnosed there (the autopsy room) forthe first time.(5) Considering thisinformation, it is clear that anyoneworking in the field of pathology shouldbe aware of the risks of TB transmissionfrom human tissues.

What are the specific risks?Frozen sectioning of tissue specimens

containing tuberculosis poses a hazard tothe cryostat operator and anyone standingclose-by, especially when a quick-freezespray is used during the procedure. If thespecimen in question is suspected by thepathologist or the surgeon to contain thebacterium, then the frozen section shouldbe deferred or done only if absolutely

necessary. In an article for HumanPathology, Dr. Jerome Smith recounts hisfirst encounter with tuberculosis in afrozen section and stresses how he wasreprimanded for cutting infected tissue ona cryostat.(6) The scenario regarding thegranulomatous testicular mass in the firstparagraph actually occurred less than ayear ago in the hospital where I’mcurrently employed. If a frozen sectionmust be done on a suspicious specimen,persons present within the vicinity of thecryostat should wear an appropriaterespirator or mask (discussed later), andcare should be taken by the cryostatoperator to generate as little aerosol aspossible during the procedure. Amodicum of caution should be used whileperforming all frozen sections, since manytimes TB is not even suspected until thefrozen section diagnosis is made, as in thetesticular mass case.

Three cases of TB infection associatedwith frozen section preparation werereported in 1981. (7-8) Two pathologistspresent during frozen section preparationof infected lung tissue converted to PPDpositive status three months after theprocedure. During the procedure, a heavyaerosol was said to have been created dueto use of a compressed gas coolant.(7) Thethird case involved a histotechnologist’sconversion to PPD positive status afteralso using a compressed gas coolant tofreeze a pulmonary nodule.(8) In thiscase, the patient from whom thepulmonary nodule was taken wassuspected of having bronchogeniccarcinoma, so the frozen section wasprobably considered innocuously routine,until the surprise diagnosis of tuberculosiswas made. Both of these articles warn ofthe creation of aerosol during frozensectioning, and the need for caution whenusing compressed coolant. One of theauthors went further to state, “Thistechnique (gas coolant spray to promotequick freezing) should be used withextreme caution, if it is used at all.”(7)

Recent interest has been generatedregarding occupational hazards of TBfrom two articles which describe M.tuberculosis transmission from cadaver tofuneral home worker during theembalming process.(9-10) The proceduresused during embalming are similar andrelated to those used during autopsy, andthese additional cases support theevidence that TB can be aerosolized in away that does not require a living host for

Awareness of and Defense Against Mycobacterium Tuberculosis In the Practice of Gross Pathology

By Wendy D. Rieger

Mycobacterium Tuberculosis continued on pg. 17

www.pathologistsass istants.org 17

transmission via a functioning respiratorysystem. The first case describes thetransmission of M. tuberculosis from a 35-year-old male patient with AIDS to a 45-year-old male embalmer with no historyof HIV or TB. The methods used tosupport this claim included the use ofRFLP (restriction fragment lengthpolymorphism) analysis of genomic DNAtaken from TB isolates from bothindividuals. The results showed anidentical DNA fingerprint, that whencompared to other M. tuberculosis DNApatterns from the geographic area, wasshown to be unique only to the twopatients identified by this study. Thismolecular data strongly supports “…thehypothesis that M. tuberculosis wastransmitted from the cadaver to theembalmer during the embalmingprocess.”(9) The report also states that,“…bacteremia with M. tuberculosis is morecommon in patients who have AIDS…andthe presence of bacteremia may haveincreased the likelihood that aerosolsgenerated during embalming wereinfectious.” This is a valid concern tokeep in mind while autopsying AIDSpatients with or without TB.

The second case(10) used microbiologicand molecular techniques to compare theDNA fingerprints from the TB isolatestaken from the cadaver and the embalmer.Both isolates were shown to be a rifampinmono-resistant (RMR) strain oftuberculosis, and more importantly theyboth had the same DNA fingerprint. Thisstudy described the embalming processused during this particular case in somedetail, and after considering severalpossibilities, concluded that the mostlikely mode of TB transmission betweencadaver and embalmer was aerosolizationof the tubercle bacilli from the suctionmaterial generated during embalming.This information can be applied to thepractice of autopsy, as stated by Nolte in apaper on autopsy biosafety: “Given theuniform use of oscillating saws and sprayand aspirator hoses by prosectors, a fairassumption is that all autopsies generatepotentially infectious aerosols.”(11)Jerome Smith, MD, a pathologist at theUniversity of Texas stated that, “Somemighty pathologists of yore succumbed tothe disease (tuberculosis) that they hadpresumably contracted at the autopsytable.”(6) Although a routine, diagnostic,and educational tool used in the practiceof pathology, the autopsy procedure maybe the greatest source of TB exposure andsubsequent infections that members of thepathology profession encounter.Nonparticipating observers are at risk aswell if they share the same air space as the

cadaver. As Nolte states, “An autopsy isan exceptionally efficient method oftransmitting tuberculosis from decedent tothose present in the dissection room.”(11)This statement may sound facetious, but itis most unfortunately factual.

Several papers have demonstrated thateven a brief exposure to TB during anautopsy on an infectious individual carriesa high risk of infection.(11-13) A report ofMDR-TB (multi-drug resistanttuberculosis) transmission on personsexposed in a New York medicalexaminer’s office showed an increasedrate (28%) of skin test conversion to PPDpositive status among workers involved inautopsies on MDR-TB positivepatients.(14) In a study on nosocomial(hospital acquired) transmission of TB, itwas reported that three of five employeespresent during an autopsy on anindividual with unsuspected disease hadskin test conversions after theprocedure.(5) Another autopsy workerwho had a prior BCG vaccination (whichcauses skin test results to always readpositive) developed active TB five monthsafter the infectious autopsy which isclinically consistent with becominginfected at the time of the autopsy. Aneven more frightening article in the Annalsof Internal Medicine reported that none ofthe workers caring for a particular patientwith unsuspected disease before his deathshowed a skin test conversion later on,while after a three hour autopsy on thispatient, all five previously negativeemployees present during the autopsysubsequently converted to positive PPDstatus.(13) All five of these employeesused double tie standard surgical masksduring the autopsy. Two of the autopsyworkers had positive sputum cultureseight weeks after the autopsy. Thecultures from these two workers and thesource patient yielded identical DNAfingerprints. Fortunately, all five of theskin test converters were treated withisoniazid or isoniazid and rifampin anddid not develop active TB. The articleconcludes: “A patient who did nottransmit tuberculosis before deathreleased a prodigious number of tuberclebacilli during autopsy.” The datadiscussed here should certainly alert thereader to the immense need for awarenessto and personal protection against TBduring all autopsies.

Is formalin fixation adequate protection from infection?

When dealing with infectious tissuesand specimens containing blood and bodyfluids, a popular practice is to “throw it informalin,” based on the assumption thatformalin is toxic and will kill or disable

whatever pathogens are present withinthe tissue and associated blood and bodyfluids. Formaldehyde is a toxic chemicalwhich is known to be bactericidal andvirucidal against certain pathogens, butshould not be taken for granted as aneffective weapon against all infectiousagents, including TB. Collins writes, “It isgenerally assumed that M. tuberculosis isnot viable in formalin fixed material,including lung tissue from tuberculosispatients, and that such material maytherefore be handled without risk ofinfection. The data supporting thisassumption are, however, very weak.”(12)A 1951 study reported cultures fromembalmed bodies yielding isolates of M.tuberculosis as long as sixty hours afterfixation.(15) In the most recent study ofthe effect of formalin on M. tuberculosis,the authors were not able to culture TB informalin-fixed tissue, however, theyconcluded, “…the true disinfectionefficacy of formalin for tissues infectedwith M. tuberculosis is unclear. Larger,prospective studies…are needed toestablish guidelines to ensure the safetyfor those handling infected, fixedtissue.”(16) Jerome Smith gives us aneven more descriptive scenario toconsider: “Dense fibrocaseous lesionsseen in old chronic active intrapulmonaryor pleural tuberculosis may providesanctuaries in which tubercle bacilli cansurvive fixation anddecontamination…”(6) Considering theavailable data, it seems prudent to becautious even with formalin-fixedtuberculous specimens, and to consider“fixed” TB specimens as potentiallyinfectious as fresh specimens containingthe disease.

What is the government doing to protect us?

At the time of this writing, “Guidelinesfor Preventing the Transmission ofMycobacterium tuberculosis in Health-CareFacilities, 1994” has been published by theCDC.(4) This publication consists ofrecommendations and reports—not lawsor requirements. In 1996, OSHApublished a directive entitled,“Enforcement Procedures and Schedulingfor Occupational Exposure toTuberculosis.”(17) This directive requiresemployers to schedule routine PPD testingand medical follow-up for employeesexposed to TB; but there are not any lawsyet requiring employers to help preventand protect health-care workers frominitial exposure to TB. The OSHA rule onoccupational exposure has been in theproposed stage since 1997.(3) There is aneed for increased infection controlguidelines and enforcement procedures

Mycobacterium Tuberculosis continued from pg. 16

Mycobacterium Tuberculosis continued on pg. 18

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within autopsy rooms and health-carefacilities in general. The United Kingdomrequires that cultures and specimenscontaining TB, as well as autopsies onknown TB patients, be handled inContainment Level 3 laboratories.(12) TheU.S. has no such requirements, and mosthospital laboratories in this country areonly Level 2 Biosafety facilities. Ourcurrent CDC guidelines are in place butare not necessarily being followed. OSHAstates: “…in every recent TB outbreakinvestigated by the CDC, noncompliancewith CDC’s TB control guidelines wasevident.”(18) Guidelines alone are notenough to combat the TB epidemic; rulesand enforcement procedures aredesperately needed as well.

OSHA’s Proposed RuleThe proposed standard on occupational

exposure to TB covers workers in a varietyof occupational settings, including health-care facilities. The standard recognizesthe danger of TB, the role of HIV infectionin increasing the efficacy and frequency ofTB transmission, and the additionaldanger of multi-drug resistant TB.(18)The standard calls for employers to adhereto several important and urgently neededmeasures, including: identifying allemployees at risk of TB exposure andlisting job tasks which involve higher risksof transmission (autopsy is recognized inthis document as a high-hazard procedure);developing an exposure control planwhich includes TB education and trainingfor employees; prompt identification ofindividuals with infectious TB; andproviding employees with routine skintesting. The standard also requiresemployers to utilize proper work practicesand engineering controls in places wherepatients with TB or their specimens can befound. These types of controls includemaintaining negative pressure isolationrooms and providing employees who maybe exposed to TB with acceptablerespirators, specifically either NIOSHapproved HEPA (high efficiencyparticulate air) masks or N95 respirators.The standard also recommends but doesnot require additional anti-TB controls,including HEPA filtration to clean airsystems in which TB is carried and UVGI(ultra violet germicidal irradiation)systems to kill or inactivate airbornemicroorganisms.(3)

What can we do to protect ourselves?It is more than evident that we as

pathologists’ assistants cannot take apassive role in the fight against TBexposure or wait for directives and newpolicies to be handed down to us from ouremployers or the state and federalgovernments. We must be proactive in

protecting ourselves against thismicroscopic, insidious, and practicallyubiquitous infectious organism. There areseveral types of actions we can take inorder to lessen TB exposure fromspecimens and autopsy cases that we mayface at any time due to the nature of ourspecific occupational duties. The easiestand most obvious form of protection is theuse of personal respirators. Wearing amask is appropriate whenever exposure toTB is even remotely anticipated. Standardsurgical masks are not adequate protectionagainst TB, as we have seen from theTempleton study.(13) N95 respirators arepractical and less costly than HEPAmasks, and are efficient in filtering theinfectious droplet nuclei from the air webreathe.(4) These masks require fit testingbefore wearing, and your facility shouldprovide this service as well as providingthe masks for employee use. Other workpractices we can utilize to guard againstTB include cutting specimens under ahood or very close to a vent, and by notusing gas coolant during frozen sections,as discussed earlier. It is also important tocomply with scheduled TB skin testing,which every health-care facility is requiredto provide (17), and to report anyconfirmed or suspected TB exposure ofemployees or others to the immediatehead of your department and to infectioncontrol services. We should also try to beactive in educating other staff of thedangers of TB transmission, and to try tobecome involved in developing TBprevention plans and policies for thelaboratory and autopsy room.Misconceptions or ignorance of the modesof TB transmission discussed in this paperare prevalent and must be overcome.

Perhaps the most important defensesagainst TB are heightened awareness andyour own common sense. For example, ifyou receive a surgical specimen for frozensection that you determine to besuspicious, relay your fears to thepathologist on duty. The surgeon can beasked for additional information, and thefrozen section may be deferred or anotherprocedure, such as smear or touchpreparation of the lesion, can beperformed. Any lesion which is soft,granulomatous-appearing, and especiallycaseous-appearing (resembling crumbly orliquefied cheese) should be treated assuspicious, even if it is not from the lung.

As health-care workers, M. tuberculosisis a danger we face from a variety ofsources; it does not matter whether wework in busy city hospitals or facilitieslocated in sparsely populated areas. Aspathologists’ assistants, we face uniqueand serious risks of TB transmission

during virtually every step of humantissue examination and processing. If thegovernment and health-care facilities ingeneral have shown less recognition andgiven less emphasis to these risks, thenconversely we should be more motivatedto promote awareness of these risks andincrease our own responsibilitiesregarding protection of our coworkers andourselves. Facts regarding specific TBtransmission in the pathology lab andautopsy room should become part of ourongoing collective professionalknowledge. Educating others, improvingour work practices, and contributing tonew policies in order to lessen the risk ofexposure to TB will make our work areasmuch safer places. This in turn willenable us to provide better patient care,thereby making us all the more valuableas professionals who represent the field ofpathology.

References

Ciegelski PJ, Chin DP, Espinal MA, et al. The globaltuberculosis situation-Progress and problems in the20th century, prospects for the 21st century.Mycobacterial Infections 2002; 16:1-58.

2. Dye C, Scheele S, Dolin P, et al. Global burden oftuberculosis: estimated incidence, prevalence, andmortality by country: WHO Global Surveillance andMonitoring Project. JAMA 1999; 282:677-686.

3. Occupational exposure to tuberculosis-ProposedRule. OSHA Federal Register 62:54159-54309; 29 CFRPart 1910. October 17, 1997.

4. Centers for Disease Control. Guidelines forpreventing the transmission of Mycobacteriumtuberculosis in health-care facilities, 1994. Morbidityand Mortality Weekly Report 1994; 43:1-132.

5. Kantor HS, Poblete R, Pusateri SL. Nosocomialtransmission of tuberculosis from unsuspected disease.The American Journal of Medicine 1988; 84:833-838.

6. Smith JH. The hazard to pathologists fromtuberculous specimens. Human Pathology 1996;27:1251-1252.

7. Barrett RN, Renteln HA. Tuberculous infectionassociated with tissue processing. Morbidity andMortality Weekly Report 1981; 30:73-74.

8. Duray PH, Flannery B, Brown S. Tuberculosisinfection from preparation of frozen sections. NewEngland Journal of Medicine 1981; 305:167.

9. Sterling TR, Pope DS, Bishai WR, et al.Transmission of Mycobacterium tuberculosis from acadaver to an embalmer. New England Journal ofMedicine 2002; 342:246-248.

10.Lauzardo M, Lee P, Duncan H, and Hale Y.Transmission of Mycobacterium tuberculosis to afuneral director during routine embalming. Chest2001; 119: 640-642.

11.Nolte KB, Taylor DG, Richmond JY. Biosafetyconsiderations for autopsy. The American Journal ofForensic Medicine and Pathology 2002; 23:107-122.

12.Collins CH, Grange JM. Tuberculosis acquired inlaboratories and necropsy rooms. CommunicableDisease and Public Health 1999; 2:161-167.

Mycobacterium Tuberculosis continued from pg. 17

Mycobacterium Tuberculosis continued on pg. 26

www.pathologistsass istants.org 19

NAACLS-Accredited Pathologists’ Assistant Training Programs

DUKE UNIVERSITYJames Lewis, PhD, Program DirectorDepartment of PathologyBox 3712Durham, NC 27710phone: 919/684-2159lewis026@mc.duke.edu http://pathology.mc.duke.edu

FINCH UNIVERSITYJohn Vitale, MHS, Program Director and

Clinical CoordinatorFUHS/Chicago Medical SchoolDepartment of Clinical Lab Sciences3333 Green Bay RoadNorth Chicago, IL 60064-3095phone: 847/578-8638fax: 847/578-8651vitalej@finchcms.eduhttp://www.finchcms.edu/

OHIO STATE UNIVERSITYCharles Hitchcock, MD, PhD, Program

DirectorGretchen Staschiak, Pathology Education

CoordinatorDepartment of Pathology129 Hamilton Hall, 1645 Neil AvenueColumbus, OH 43210phone: 614/247-6461staschiak.2@osu.eduhttp://www.pathology.med.ohio-state.edu

QUINNIPIAC UNIVERSITYScott Farber, Director, Graduate Admissions275 Mount Carmel AvenueHamden, CT 06518-1904phone: 203/582-8795graduate@quinnipiac.eduLeo Kelly, Clinical Coordinator(contact for employment information)phone: 203/932-5711 x4758

UNIVERSITY OF MARYLAND,BALTIMORERaymond Jones, PhD, Program DirectorDepartment of Pathology22 S. Greene StreetBaltimore, MD 21201phone: 410/328-1221fax: 410/328-5508rjones@som.umaryland.eduhttp://medschool.umaryland.edu/pathology

WAYNE STATE UNIVERSITYPeter Frade, PhD, Program DirectorSchool of Mortuary Science 5439 Woodward AvenueDetroit, MI 48202phone: 313/577-2050fax: 313/577-4456ab8123@wayne.eduhttp://www.mortuarysciencewayne.org

in dilatation of the portion proximal to thetumor (see photo 1). These tumors have atendency to implant along the ureter,especially in its terminal portion. It istherefore important to include bladdercuff in the resection to avoid tumorrecurrence.

Grossly, the tumors form soft, gray-redmasses with smooth, glistening surfacesthat resemble the transitional cell tumorsof the bladder. They often diffuselyinvolve the entire renal pelvis and formspreading, branching masses that mayextend down the ureter (see photo 2).Grade III and grade IV lesions can spreadinto the renal parenchyma and even reachthe renal capsule. They can bedistinguished from renal cell carcinomabecause of their white or gray color,granular appearance, and extensive pelvicinvolvement.

The microscopic appearance oftransitional cell carcinomas, whether inthe renal pelvis or ureter, is identical tothat of the more common lesions in thebladder. Almost all recorded cases ofureteral and renal pelvic cancer havearisen in the urothelium. Well over 90% ofthese have been transitional cellneoplasms,3 with the majority being gradeII or III neoplasms. The pelvic neoplasmssometimes extend proximally along thecollecting tubules, a pattern that shouldnot be confused with adenocarcinoma.

Histologic examination of urotheliumadjacent to and distant from primarytransitional cell neoplasms of the upperurinary tract has revealed multiple areasof carcinoma in situ and dysplasia(atypia). The presence of fibrousthickening of small stromal vessels hasbeen found to correlate with a history oflong term analgesic ingestion. DNAploidy levels, as measured by flowcytometry, and vascular invasion (presentin about 35% of the cases1) have beenfound to provide valuable prognosticinformation.

Like bladder tumors, upper collectingsystem neoplasms initially grow byextension into adjacent structures.Involvement of the distal renal collectingducts, especially by high gradecarcinomas, is common. Renal pelviccarcinomas commonly invade the adjacentcollecting ducts and invasion of the renalvein is common. Several cases of tumorextension into the inferior vena cava havebeen reported.

Metastases usually involve regionalstructures, including lymph nodes,peritoneum, and liver. Metastases to theupper collecting system generally involvethe ureters and arise from cancers of thekidney, breast, and lymph nodes.

Hematuria is the most common clinicalpresentation. Synchronous ormetachronous tumors elsewhere in the

urinary tract are found in almost 40% ofthe patients. Rarely, an independent renalcell carcinoma may be found in the samekidney.

The standard treatment for transitionalcell carcinomas of the renal pelvis andureter is nephroureterectomy. Segmentalresection is sometimes used formidureteral lesions. Endoscopic removalhas been done for low grade noninvasivelesions, but the high incidence ofmulticentric coexistence of dysplasiaindicates radical surgery as the treatmentof choice in the majority of the cases.

The overall five year survival rate insurgically resected cases is approximately50%.1 The prognosis is largely determinedby the stage of the lesion for both pelvicand ureteral lesions. It varies with thelevel of invasion and the existence ofcarcinoma in situ.

1. Ackerman’s Surgical Pathology, Rosai, J.,Mosby, 1996

2. Atlas of Tumor Pathology, Tumors of theKidney, Bladder, and Related UrinaryStructures, Murphy, W.M., Beckwith J.B.,Farrow, G.M., AFIP, 1994

3. Urological Pathology, Murphy, W., WBSaunders, 1989

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J O B H O T L I N E S E R V I C EWINTER 2003 JOB CLASSIFIEDS

MIDWEST

AmeriPath IndianaDepartment of Pathology2560 N. Shadeland Avenue, Suite AIndianapolis, IN 46219Responsibilities include case volume ofapproximately 400 specimens per day,autopsy pathology, help train and instructother lab personnel in tissue anatomy andcellular structure. Requirements: AAPAcertified or eligible, 1-3 years surgicalpathology/autopsy experience. Excellentbenefits, compensation package.Contact: Sara Pechin by phone 317/275-8044, by fax at 317/275-8046, or by e-mail at spechin@ameripath.comwww.ameripath.com

AmeriPath Milwaukee, SC5000 W. Chambers StreetMilwaukee, WI 5321014 pathologists, 5 Pathologists’ Assistantscurrently providing service to a system offive hospitals and a local referencelaboratory in Milwaukee, Wisconsin.41,000 surgicals. Quality assuranceprojects, preparation of quality assurancestatistics, coding, and autopsy pathology.Candidates must have or be eligible forAAPA Fellow status. Prior experiencepreferred. New graduates welcome toapply. A competitive salary and benefitpackage is provided. Relocation expensesare covered.Contact: Karin Hague, MD, by phone at 414/447-2271 x2025, by fax at 414/447-2965, or by e-mail at klhague@covhealth.orgwww.AmeriPath.com

NORTHEAST

Massachusetts General HospitalDepartment of Pathology55 Fruit StreetBoston, MA 021141000 beds, 50 pathologists, 72,000surgicals, 350 autopsies, 4 PAs. Saturdaycoverage on rotation. A Bachelor’s degreeand successful completion of anaccredited Pathologists’ Assistant programrequired. Candidates must have or beeligible for AAPA Fellow status. Priorexperience preferred. New graduateswelcome to apply. Competitivecompensation package.Contact: Stephanie Kuehn by phone at 617/724-1449, by fax at 617/726-6829, or by e-mail at skuehn@partners.org

William V. Harrer, MD PADepartment of Pathology1600 Haddon AvenueCamden, NJ 08043Supervisory position. 4 pathologists, 375beds, approx. 10,000 surgicals, 4,200 GYNand 1,225 non-GYN cytology cases, 85FNAs, 25 bone marrows, 330intraoperative consultations, and 30autopsies. The group would put aparticular premium on high levels ofverbal and written communicationsabilities and knowledge of anatomicpathology computer systems, as well asthe ability to manage the histologydepartment. Responsibilities will includeactivity in anatomic pathology,participation in frozen sections, andresponsibilities and coordination ofautopsies. Promotion and salary futureare commensurate with experience andcapacity of the individual to contribute tothe practice as it operates currently and inthe future. Competitive benefits andconsideration will be given toreimbursement of relocation expenses.Candidates must have or be eligible forAAPA Fellow status. Contact: Albert L. Giles, PracticeManager, by phone at 856/354-0965, by fax at 856/795-1186, or by e-mail at anodynegrn@aol.com

Sinai Hospital of BaltimoreHuman Resources2401 W. Belvedere AvenueBaltimore, MD 212157 pathologists, 3 assistants, rotationinvolving coverage of two hospitals, 467beds, 18,000 surgicals, 70 autopsies. Everythird Saturday required. Prior experiencepreferred, new graduates welcome toapply. Must be AAPA fellow or eligible.Competitive compensation package,including free parking.Contact: Karyn Gold by phone at 410/601-8236, by fax at 410/601-9055, or by e-mail at kgold@lifebridgehealth.orgwww.lifejobs.org

University of RochesterDepartment of Pathology601 Elmwood Avenue, Box 626Rochester, NY 14642Full time position and immediatetemporary position available through June30, 2004. 28 Anatomic Pathologists, 12Residents, 4 Pathologists’ Assistants,55,000 surgicals. The individual will havethe opportunity to rotate through andcover the autopsy service and to attendone national meeting a year. Generousbenefits package.Contact: Christine Taillie, ChiefSupervisor, Surgical Pathology, by phone at 585/275-1875, by fax at 585/273-3637, or by e-mail atchris_taillie@urmc.rochester.eduwww.urmc.rochester.edu/path

Main Line Clinical Labsc/o The Lankenau Hospital100 Lancaster AvenueWynnewood, PA 19096Bachelor’s degree from a Pathologists’Assistant program required, Master’sdegree preferred. Candidate should beAAPA certified or equivalent withexperience in all areas of pathology.Competitive compensation and excellentbenefits, including a generous paid time-off program and $2,000 Sign On Bonus.Contact: Jennifer Smith by fax at 610/645-8492 or by e-mail at smithj@mlhs.orgJob Hotline (610) 526-8313www.mainlinehealth.org

JOB HOTLINE SERVICEAAPA Central Office

1711 W. County Road BSuite 300N

Roseville, MN 55113-4036Phone: 800-532-2272 or 651-697-9264

Fax: 651-635-0307E-mail: msok@assocmgmt.org

Contact: Michelle Sok

For a more detailed description ofthese ads, please visit the Job Hotline

section of the “Members Only” area onthe AAPA web site

www.pathologistsassistants.org.If you are interested in advertising

through the Hotline, select “Post a JobAd” from the selections on the left of

the AAPA home page.

www.pathologistsass istants.org 21

SOUTHEAST

Ruffolo, Hooper & AssociatesDepartment of Pathology4511 Woodland Corp Blvd., #300Tampa, FL 336147 community hospitals, 15 pathologists, 6 pathologists’ assistants, 15,000 surgicals,100 autopsies. Weekend call rotationrequired. Candidates must have or beeligible for AAPA Fellow status. Priorexperience preferred, new graduatesencouraged to apply. Contact: Susan Colangelo, HumanResources Manager, by phone at 888/747-9576, by fax at 813/885-6352, or by e-mail at scolangelo@pims-iuc.com

University of Florida Jacksonville, Inc.Human Resources580 W. 8th StreetJacksonville, FL 32209Graduate of NAACLS accreditedPathologists’ Assistant training programor successful completion of AAPA examrequired. Must be able to achieve nationalcertification. Generous benefits, including29 Paid Days Off, tuition reimbursement,retirement plans, flexible schedules.Contact: Fax your resume to 904/244-9523 or e-mail resumes@jax.ufl.eduwww.ufhscj.edu/ufjp

Pathology Medical AssociatesDepartment of Pathology200 New York Avenue, Suite 320Oak Ridge, TN 37830300 beds, 5 pathologists, 11,000 surgicals,2000 skins, 6 – 10 autopsies. Degree at anaccredited pathologists’ assistant programor college degree in biological sciencewith experience as a pathologists’assistant. Excellent salary and benefitscommensurate with training andexperience.Contact: Deborah Deane Sliski by phone at 865/482-9633, by fax at 865/482-9655, or by e-mail at dsliski@pmapath.comwww.pmapath.com

Medical University of South CarolinaDepartment of Pathology & LaboratoryMedicine165 Ashley Avenue, Suite 309PO Box 250908Charleston, SC 29425700 autopsies, 30,000 surgicals, 28,000cytologies. Duties include medicalautopsy, forensic autopsy, and teachingnew residents/fellows. Generous benefits.Interested persons should mail a letter ofinterest with Curriculum Vitae and namesof three (3) references to Janice M. Lage,MD.Contact: Janice M. Lage, MD, Professorand Chair.

University of Kentucky Medical CenterSanders-Brown Center on AgingRoom 101 Sanders-Brown800 S. Limestone StreetLexington, KY 40536-0230The Alzheimer’s Disease Research Center(ADRC) at the University of Kentuckywishes to employ a pathologists’ assistantwith interest, and preferably experience,in neuropathology. The ADRC follows alarge number of normal subjects andAlzheimer’s disease (AD) patients all ofwhom have agreed to donate their brainsfollowing their death. Under thesupervision of the director of theNeuropathology Core, the specificresponsibilities of the assistant will be: 1)act as the contact person for families ofdeceased normal and AD subjects; 2)organize the prompt removal anddissection of the brain withneuropathology core faculty support; 3)provide the gross and microscopicdescription of the brain; 4) participate indetermining the qualitative andquantitative differences between normaland demented brains; 5) supervise theADRC brain and tissue banks, includingthe distribution of tissue to investigators;and 6) other duties as assigned. Salary iscommensurate with experience andtraining. Excellent fringe benefits. TheUniversity of Kentucky is an equalopportunity employer.Contact: David Wekstein, PhD, by phone at 859/257-1412 x225, by fax at 859/323-2866, or by e-mail atdwekstein@aging.coa.uky.eduwww.mc.uky.edu/coa/

Quest Diagnostics, Inc.Department of Pathology4225 E. Fowler AvenueTampa, FL 33617Third shift (10:30 pm - 6:00 am).Requirements include a B.S. in Biology orPathology or equivalent combination ofeducation and experience. QuestDiagnostics offers an excellent salary plus17% shift differential, full range of medicaland dental benefits, tuition assistance,company matched 401K, generous paidtime off, and more. Contact: R. Schlossberg by phone at 813/972-7100 x7158, by fax at 813/972-3986, or by e-mail attampa.recruiter@questdiagnostics.comwww.questdiagnostics.com

University of North Carolina at Chapel HillPathology and Laboratory MedicineCB #7525201 Brinkhous Bullitt BuildingChapel Hill, NC 27599-752512 pathologists, residency program, 20,000surgicals, 200 autopsies. Faculty openingfor Clinical Instructor. No on-call dutiesor weekend responsibilities. BS or MSdegree and AAPA certification ispreferred. As state employee, competitivesalary and excellent benefits. Equalopportunity/ADA employer. Send a letterof interest, resume, and names andaddresses of four (4) references to contactvia postal mail or e-mail. Contact: Dr. Thomas Bouldin, Chair ofSearch Committee,tbouldin@med.unc.edu

The Brody School of Medicine,East Carolina UniversityDepartment of Pathology and LabMedicinePitt County Memorial HospitalGreenville, NC 27858-4354700+ beds, 21 pathologists, residencyprogram, 20-25,000 surgicals, 550-700autopsies. Successful completion of apathologists’ assistant training program orsimilar experience is required. Must haveor be eligible for AAPA Fellow status.Salary commensurate with training andexperience. EqualOpportunity/Affirmative Actionemployer. Send CV and names andaddresses of three (3) references to contactat above address.Contact: Peter J. Kragel, MD, Professorand Chairman

JOB HOTLINE SERVICEWINTER 2003 JOB CLASSIFIEDS

22 1-800-532-A APA

SOUTHEAST (continued)

VCU Health System of MCV Hospitalsand PhysiciansHuman Resources980066701 E. Franklin St., 9th FloorRichmond, VA 23298750 beds, 6 pathologists, 37,000 surgicals,200 autopsies. BS degree in Sciences orMaster’s degree required; AAPA memberrequired, HTL (ASCP) preferred.Experience in surgical pathology andautopsy dissection, skills in histologytechniques and procedures requested.Benefits effective the following month ofhire date; relocation assistance available.Please apply on-line at web site listedbelow.Contact: Jaime Suttler Cook, Recruiter, by phone at 804/827-1699, by fax at 804/628-0012, or by e-mail at jcook@mcvh-vcu.eduwww.vcuhealth.org

SOUTHWEST

Austin Pathology AssociatesDepartment of PathologyPO Box 164106Austin, TX 78716-4103Community based pathology groupaffiliated with four major area hospitals.Candidates must be a graduate of aNAACLS accredited pathologists’assistant training program or be aqualified OJT individual who has or iseligible for Fellow status within theAAPA. Prefer candidates to be an AAPAmember in good standing. Newgraduates welcome to apply. Competitivebenefits; possible reimbursement ofrelocation expenses.Contact: Brenda Cox by phone at 512/496-9989, by fax at 512/842-1227, or by e-mail at texpath@onr.com

Quest Diagnostics IncorporatedDepartment of Pathology4770 Regent Blvd.Irving, TX 75063Senior PA position, requiring 3-6 yearsexperience. Excellent compensation andbenefits package, including 401(k) withcompany match, medical and dentalbenefits, and educational reimbursement. Contact: Fax resume to 972-916-3268 or e-mail to hr.dallas@questdiagnostics.comBe sure to reference job requisitionnumber MD777.

Baylor College of MedicineDepartment of PathologyOne Baylor PlazaHouston, TX 7703025,000 surgicals at teaching hospital,outpatient load is 23,000 cases.Opportunities for teaching, research, andadministrative responsibilities areavailable. Program trained AAPA Fellowor eligible required. Baylor College ofMedicine is an Equal Opportunity/Affirmative Action/Equal AccessEmployer.Contact: Mary R. Schwartz, MD, by phone at 713/394-6482 orby e-mail at mschwartz@bcm.tmc.edu

WEST

City of Hope / Soliant HealthPathology1230 Rosecrans Avenue, Suite 210Manhattan Beach, CA 90266Position Summary: Examines surgicalspecimens for diagnosis, autopsyprosection, and photography. Participatesin a variety of departmental activities andservices, including patient services,research, teaching, and technicalprocedures. Candidate must have or beeligible for AAPA Fellow status. Priorexperience preferred. New graduateswelcome to apply. Additionalresponsibilities depending on experienceand training. Excellent benefits.Contact: Mitch Cardoza by phone at 310/727-3263, by fax at 310/727-1920, or by e-mail at mitch.cardoza@soliant.comwww.soliant.com

Tarzana Medical Center /Interscope PathologyDepartment of Pathology18321 Clark StreetTarzana, CA 91356Supervisory position. 215 beds, 4pathologists, 15,000 surgicals, 10autopsies. Additional stipend forautopsies. Supervise the AP section at thehospital with responsibility for thegrossing room, the autopsy room, and thefrozen section rooms as well as superviseone to two lab aides who help in theabove duties. Cut gross tissue at thehospital and at our private lab. Additionalresponsibilities possible depending onexperience and training. Prior experiencepreferred. New graduates welcome toapply. Competitive compensationpackage.Contact: Alan Bricklin, MD, or WilliamColburn, MD, by phone at 818/708-5528, by fax at 818/222-7384, or by e-mail at bricklins@aol.com

Central Coast PathologyConsultants, Inc.Department of Pathology3701 S. Higuera Street, Suite 200San Luis Obispo, CA 934015 hospitals, 10 pathologists, 45,000surgicals, 0-5 autopsies. Candidate musthave completed a Pathologists’ Assistantprogram at an accredited institution. Priorexperience preferred. New graduateswelcome to apply. Additionalresponsibilities possible depending onexperience and training. We offer anexcellent salary and competitive benefitspackage.Contact: Jolie Burns by phone at 805/787-0480, by fax at 805/541-6116, or by e-mail at jburns@ccpathology.com

Northwest Permanente, PC500 NE Multnomah, Suite 100Portland, OR 97232-209913 pathologists, 3 pathologists’ assistants,45,000 surgicals, 60 autopsies. Certifiedpathologists’ assistant requested.Nationally derived salary andcomprehensive benefit package. Equalopportunity employer. Forward CV withcover letter to contact.Contact: Laura Russell, Staff Recruiter, by phone at 800/813-3762 or by e-mail at nw.perm.careers@kp.org

Providence/St. Joseph Medical CenterDepartment of Pathology501 S. Buena Vista StreetBurbank, CA 91505350 beds, 5 pathologists, 18,000 surgicals,0 autopsies. No night or weekend call.Prior experience preferred, new graduateswelcome to apply. Well compensated.Please contact by phone for additionaldetails.Contact: Jose Esteban by phone at 818/847-4452, by fax at 818/847-4429, or by e-mail at jesteban@phsca.orgwww.providence.org

Laboratory Medicine ConsultantsDepartment of Pathology3059 S. Maryland Pkwy., #100Las Vegas, NV 89109Seeking additional pathologists’ assistant.2 hospitals and 1 off-site facility, 800 beds,48,000 surgicals. One weekend day permonth, no on-call. AAPA Fellow/eligiblerequired. Competitive packagenegotiable, relocation expenses covered. Contact: Lindsay Sinn by phone at 702/732-3441 x 225, by fax at 702/948-8544, or by e-mail atsinn@lasvegaspathologist.comwww.lasvegaspatholgist.com

JOB HOTLINE SERVICEWINTER 2003 JOB CLASSIFIEDS

www.pathologistsass istants.org 23

Sun-filled Arizona skies and a dry 102 degreesgreeted a record fifty-four (54) golfers in the 9th

annual AAPA golf tournament on the RedCourse at the Wigwam Resort. Tournamentwinners were announced at the banquetfollowing the tournament and are as follows:

1st place: Dick Dykoski Doug HebbenaPatrick Foley Barry Mullins

2nd place: Steve Suvalsky Kyle GrahamLloyd Kennedy Chris Rodrigues

3rd place: Jon Wagner Jeff TitusCam Ketchersid Samantha Ketchersid

Closest to the pin (Ladies), Hole #12: Joyce Matsuoka-HayashiClosest to the pin (Men), Hole #5: Jeff HarveyLongest drive (Ladies), Hole #6: Tisa LawlessLongest drive (Men), Hole #6: Tom Wenink

A very special THANK YOU to our friend, Rick Bell, atMOPEC. MOPEC has been a tournament sponsor for the pasteight years, providing each golfer with a sleeve of golf balls. Thisyear, Rick extended his generosity by sponsoring the 1st, 2nd and3rd place plaques. And one more thing: Rick, Kirk, and Johnplayed in this year’s event.

From the bottom of my heart, I’d like to thank all of yougolfers who have supported this event the past nine years. Thistournament is truly a “labor of love” for me. I only hope that allof you have had half the fun I have had. See you in Chicago!!

2003 AAPA Golf Tournament Wrap-Upby Larry Marquis

2003 AAPA Golf Tournament WinnersStanding, from left: Cam Ketchersid, Jeff Titus, Jon Wagner, Chris Rodrigues,Lloyd Kennedy, Barry Mullins, Patrick Foley, Doug Hebbena, Dick Dykoski.

Kneeling, from left: Samantha Ketchersid and Steve Suvalsky.

Individual Golf Award WinnersFrom left: Tom Wenink and Tisa Lawless (longest drives),

Jeff Harvey and Joyce Matsouka-Hayashi (closest to the pin).

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24 1-800-532-A APA

issues about cytology and thepathologists’ assistant. But I proved to bea dedicated ambassador for pathologists’assistants and strove for professionalrecognition.

I continued my work as secretary forthe AAPA and then went onto the Boardof Trustees (BOT) at the end of my term.The BOT is a dynamic group of seventhat, in the old days, did a lot of the day-to-day operations of the association.Throughout the 1980s (then the 1990s), theBOT reorganized and streamlined theoverall operations of the AAPA. TheCentral Office was a valuable addition aswell as an expensive necessity. After yearsof examining and reorganizing, the AAPAbegan to modernize as an efficientvolunteer organization. You all have toremember that our efforts were also givenat times when we all had growingfamilies, job changes, good and bad

economic times. My kids would complainabout using the telephone when we had aBOT teleconference. The teleconferencecall usually started at 7:30 P.M. and mostof the time lasted past midnight.

The BOT continued to strengthen theassociation and created a strategic plan forthe immediate “firestorm” needs, theshort-term (2 to 5 years) and the long-term(5-10 year) goals and objectives. An actionplan was developed and applied to eacharea in the association. Each member onthe BOT had one of seven major areas todeal with and present to the board and theassociation. This required an immenseamount of personal time and commitmentto meet the deadlines and other work, allfor the benefit of the membership weserved. I am amazed to see that thoseactions developed by the BOT in regard tonational certification, standardization oftraining programs, and recognition

initially created ten, fifteen and twentyyears ago are coming true today.

I have been on and off the BOTwhenever needed to fill a midyearvacancy. During my time at the boardlevel, I have been blessed to work withtruly some of the most gifted individualsin this association, far too many tomention by name. Everyone in the AAPAhas an opportunity to get involved—youknow your special talents and interests. Iinvite you to explore this great volunteerorganization.

In closing, I hope that you have gainedsome insight from my perspective aboutthe historical beginning of the AAPA.Throughout this article, I have tried toshow what one person could do. I amexcited with all of the new opportunitiesand challenges now set before us; I feellike I am a new pioneer again.

PA Pioneer continued from pg. 12

BENEFITS FOR SUSTAININGMEMBERS OF THE AAPA

1. Receive $75 off exhibit space fee of manned table at the Association’s annual conference.

2. Receive one-half page ad space free in one issue of the AAPAquarterly newsletter.

3. Receive one free set of member mailing labels.

4. Acknowledgment as a Sustaining Member in the Association’s conference program and at the exhibitor’s session.

5. Receive AAPA quarterly newsletter.

6. Acknowledgment as a Sustaining Member in the AAPA quarterly newsletter.

7. Use “MEMBER OF AAPA” in advertisements.

8. Establish a link from AAPAwebsite to that of the Sustaining Member.

2003 AAPA SUSTAINING MEMBERSBrandon KelleyNational Accounts ManagerCancer Diagnostics, Inc.P.O. Box 1205Birmingham, MI 48012Phone: 877/846-5393Fax: 877/817-1716E-mail: cancerdiagnostics@msn.comWeb Site:http://www.cancerdiagnostics.com

Patrick Muraca, PhDPresidentClinomics Biosciences, Inc.165 Tor CourtPittsfield, MA 01201Phone: 413/447-1919Fax: 413/447-1917E-mail: pmuraca@clinomicsbio.comWeb Site: www.clinomicsbio.com

Rick BellVice PresidentMOPEC, Inc.21750 Coolidge HighwayOak Park, MI 48237Phone: 800/362-8491 or 248/291-2040Fax: 248/291-2050E-mail: rbell@mopec.comWeb Site: www.mopec.com

Heiner OphardtPathmor, Inc.4743 Christie DriveBeamsville, OntarioL0R 1B4 CANADAPhone: 905/563-4689Fax: 905/563-6266E-mail: hophardt@hygienetechnik.comWeb Site: www.propath.be

Kitty MaxeyDirectorProPath LaboratoryHuman Resources8267 Elmbrook, Suite 100Dallas, TX 75247Phone: 214/237-1608Fax: 214/237-1808E-mail: kmaxey@propathlab.comWeb Site: www.propathlab.com

Jim RogersProgram DirectorScienceCareTissue Services2020 W. Melinda LanePhoenix, AZ 85027Phone: 602/331-3641Fax: 602/288-0036E-mail: jimr@sciencecare.comWeb Site: www.sciencecare.com

Tom O’BrienVice President-Equipment SalesSurgipath Medical Industries, Inc.5205 Route 12Richmond, IL 60071Phone: 815/678-2000, ext. 123Fax: 815/678-6805E-mail: surglo@mc.netWeb Site: www.surgipath.com

New Member!!

www.pathologistsass istants.org 25

NOTES FROM THE CENTRAL OFFICEby Michelle Sok

A lot has happened since the lastnewsletter! The Phoenix conference isover, and we’re already looking ahead tothe 2004 and 2005 conferences. I’m sorryI missed this year’s conference. I hear itwent well. I was here in MN taking careof my new baby boy. Ethan is 3 monthsold now, and time really is flying by, aseveryone said it would. I look forwardto each day as his smiles get bigger andhe tries so hard to talk.

The fellowship exam results weremailed in October. Congratulations to

the new Fellow members! Next year’sexam application will automatically bemailed to Affiliate members andgraduating students in March.

The 2003 Membership Survey wasmailed in mid-October to those who didnot register for the conference.Responses are to be sent to DebbieMartin.

A new conference survey was mailedto all members at the end of October.Responses are to be sent to the CentralOffice.

Dues notices and ballots will be mailedin mid-December to all Fellow, Affiliate,Sustaining, and Institutional members.Be sure to send in your dues payment soyou can continue to enjoy memberbenefits, such as this newsletter andaccessing the Members Only section ofthe web site.

Happy Holidays!

W E L C O M E , N E W M E M B E R S(listed by month of admittance)

. . . . Name . . . . . . . . . . . . . . . .Location . . . . . . . . . . . . . . . . . .Type of Member . . . . . . . . . . . .Education/Training JULY 2003Maria E. Azuola . . . . . . . . . . .Ocean Springs, MS . . . . . . . . .Affiliate . . . . . . . . . . . . . . . . . . . .On-the-job trainingWillie D. Bass . . . . . . . . . . . . .Waukegan, IL . . . . . . . . . . . . .Student . . . . . . . . . . . . . . . . . . . . .Finch UniversityNicholas W. Daniels . . . . . . . .St. Paul, MN . . . . . . . . . . . . . .Affiliate . . . . . . . . . . . . . . . . . . . .On-the-job TrainingRobin M. Gastorf . . . . . . . . . .Waukegan, IL . . . . . . . . . . . . .Student . . . . . . . . . . . . . . . . . . . . .Finch UniversityJesse J. Greenwood . . . . . . . . .Wauwatosa, WI . . . . . . . . . . .Student . . . . . . . . . . . . . . . . . . . . .Finch UniversityTemple K. Howard . . . . . . . . .Fort Worth, TX . . . . . . . . . . . .Affiliate . . . . . . . . . . . . . . . . . . . .On-the-job trainingMonica B. Lemos . . . . . . . . . .Pearland, TX . . . . . . . . . . . . . .Affiliate . . . . . . . . . . . . . . . . . . . .On-the-job trainingOlga Leontovich . . . . . . . . . . .Rochester, MN . . . . . . . . . . . .Affiliate . . . . . . . . . . . . . . . . . . . .On-the-job trainingParker R. Marquardt . . . . . . .Fargo, ND . . . . . . . . . . . . . . . .Affiliate . . . . . . . . . . . . . . . . . . . .On-the-job trainingAmy T. Matthews . . . . . . . . . .Gurnee, IL . . . . . . . . . . . . . . . .Student . . . . . . . . . . . . . . . . . . . . .Finch UniversityHeiner Ophardt . . . . . . . . . . .Beamsville, Ontario . . . . . . . .Sustaining

CANADADennis M. Strenk . . . . . . . . . .Oak Creek, WI . . . . . . . . . . . .Affiliate . . . . . . . . . . . . . . . . . . . .On-the-job trainingAUGUST 2003Moses A. Barget . . . . . . . . . . .Onoville, CA . . . . . . . . . . . . . .Student . . . . . . . . . . . . . . . . . . . . .Finch UniversityMounir Beshai . . . . . . . . . . . .Kingston, Ontario . . . . . . . . . .Affiliate . . . . . . . . . . . . . . . . . . . .On-the-job training

CANADALisa L. Brohas . . . . . . . . . . . . .Lake Bluff, IL . . . . . . . . . . . . .Student . . . . . . . . . . . . . . . . . . . . .Finch University Amanda C. Domer . . . . . . . . .Evanston, IL . . . . . . . . . . . . . .Student . . . . . . . . . . . . . . . . . . . . .Finch UniversityChristopher K. Dunne . . . . . .Troy, MI . . . . . . . . . . . . . . . . . .Student . . . . . . . . . . . . . . . . . . . . .Wayne State UniversityMaria T. Juaniza . . . . . . . . . . .Chicago, IL . . . . . . . . . . . . . . .Student . . . . . . . . . . . . . . . . . . . . .Finch UniversityBrooke R. McCale . . . . . . . . . .Waukegan, IL . . . . . . . . . . . . .Student . . . . . . . . . . . . . . . . . . . . .Finch University Beth E. Nash . . . . . . . . . . . . . .Round Lake Beach, IL . . . . . .Student . . . . . . . . . . . . . . . . . . . . .Finch UniversityTrina A. Sherlitz . . . . . . . . . . .Westland, MI . . . . . . . . . . . . . .Student . . . . . . . . . . . . . . . . . . . . .Wayne State UniversityPatti J. Stewart . . . . . . . . . . . .Seattle, WA . . . . . . . . . . . . . . .Affiliate . . . . . . . . . . . . . . . . . . . .On-the-job trainingLaura A. Welsh . . . . . . . . . . . .Lemont, IL . . . . . . . . . . . . . . . .Student . . . . . . . . . . . . . . . . . . . .Finch UniversityFrances E. Zitano . . . . . . . . . .Sacramento, CA . . . . . . . . . . .Affiliate . . . . . . . . . . . . . . . . . . . .On-the-job trainingSEPTEMBER 2003Adrian L. Winters, III . . . . . .Temple, TX . . . . . . . . . . . . . . .Affiliate . . . . . . . . . . . . . . . . . . . .On-the-job trainingOCTOBER 2003Pamela L. Cipolla . . . . . . . . . .Rolling Meadows, IL . . . . . . .Student . . . . . . . . . . . . . . . . . . . . .Finch UniversityKeli L. Fadooul . . . . . . . . . . . .Warren, MI . . . . . . . . . . . . . . .Student . . . . . . . . . . . . . . . . . . . . .Wayne State UniversityTami J. Fowler . . . . . . . . . . . . .Shelby Twp, MI . . . . . . . . . . .Student . . . . . . . . . . . . . . . . . . . . .Wayne State UniversityMarlene M. Parker . . . . . . . . .Columbus, OH . . . . . . . . . . . .Student . . . . . . . . . . . . . . . . . . . . .Ohio State UniversityNorman Poch . . . . . . . . . . . . .Gvelph, ON . . . . . . . . . . . . . . .Affiliate . . . . . . . . . . . . . . . . . . . .On-the-job training

CANADAHeather M. Ptaszek . . . . . . . .Sterling Heights, MI . . . . . . .Student . . . . . . . . . . . . . . . . . . . . .Wayne State UniversityJeffery R. Purcell . . . . . . . . . . .Columbus, OH . . . . . . . . . . . .Student . . . . . . . . . . . . . . . . . . . . .Ohio State UniversityKrystal M. Wilhelmi . . . . . . .Westland, MI . . . . . . . . . . . . . .Student . . . . . . . . . . . . . . . . . . . . .Wayne State UniversityAndrea Zerilli . . . . . . . . . . . . .Macomb, MI . . . . . . . . . . . . . .Student . . . . . . . . . . . . . . . . . . . . .Wayne State University

Based upon TRANSITIONAL CELLCARCINOMA OF THE RENAL PELVISAND URETERS by Tina RaderQuiz by Barbara Dufour

1. When describing a transitional cellcarcinoma of the ureter, one mightdescribe the tumor as:

a) A firm gray-red mass that has a grittycut surface

b)A firm pink-tan mass with a fleshycut surface

c) A soft pink-tan mass with a smooth glistening cut surface

d)A soft gray-red mass with a smooth glistening cut surface

2. Synchronous or metachronous tumorselsewhere in the urinary tract are found inalmost 80% of the patients with TCCs ofthe ureter or pelvis.

a) Trueb)False

3. Examining a cytology specimen forupper urinary tract neoplasms can belimited by all of the following EXCEPT:

a) Excessive degeneration of tumor cellsb)The resemblance of normal upper

urinary tract cells to slightly atypical bladder urothelium

c) Copious amounts of exfoliated cells and hematuria

d)The lack of exfoliated cells appearing in random voided samples

4. Approximately 1/4 of transitional cellcarcinomas of the renal pelvis and uretersare associated with:

a) A history of alcohol abuseb)A history of analgesic abusec) Ischemic bowel diseased)Renal insuffiency

5. The majority of patients with TCCs ofthe ureter and renal pelvis have clinicalfindings including:

a) Hematuria, fever, and flank painb)A palpable mass, fever, and

hematuriac) Hematuria, a palpable mass, and

flank paind)None of the above

6. TCCs of the renal pelvis and ureterfrequently metastasize to all of thefollowing organs EXCEPT:

a) Lymph nodesb)Liverc) Peritoneumd)Bone

7. The majority of TCCs of the ureters andrenal pelvis are categorized as:

a) Grade I or IIb)Grade II or IIIc) Grade III or IVd)Grade II only

8. TCCs of the renal pelvis and ureter canbe distinguished from renal cellcarcinomas because of their granularappearance, difference in color, andextensive pelvic involvement.

a) Trueb)False

9. Neoplasia of the upper collectingsystem differs from neoplasia of theurinary bladder by all of the followingEXCEPT:

a) Stronger association with obstruction to urinary outflow

b)Increased frequency of subsequent urothelial neoplasms at other sites (primarily bladder)

c) Increased value of cytology for detection and monitoring

d)Lower frequency of all types of neoplasms

10. Renal pelvic carcinomas commonlyinvade the adjacent collecting ducts, butinvasion of the renal vein is not common.

a) Trueb)False

26 1-800-532-A APA

WINTER 2003 QUIZ

You may respond to this quiz in twoways: via web site or postal mail. Onthe AAPA web site, go to the MembersOnly area, click on CME Page, and thenselect the Newsletter CME Quiz Form.For postal replies, send your responsesto:

Kathy WashingtonAbington Memorial HospitalDepartment of Pathology1200 Old York RoadAbington, PA 19001 Answers to Fall 2003 Quiz

1)b ; 2)d ; 3)e ; 4)b ; 5)a ; 6)c ; 7)b ; 8)d ; 9)a ; 10)b

Q: How do you bill a specimen that failsprocessing?

A: You cannot bill anything that is signedout as “unsatisfactory” or “insufficient.”This would include those specimenswhich do not survive processing.Medicare considers billing for suchspecimens fraud, even though we havedone the work to get to that answer (andthat, in cytology, “unsatisfactory” actuallymeans something). However, if you cansay anything else besides “unsatisfactory”or “insufficient,” the specimen can bebilled. For example, instead of signing outan ECC as “insufficient,” report “bloodand mucus present, no endocervicalepithelium identified.”

CODING Q & APam Younes

has an opening. Their exhibit will havetwelve bodies, each displaying a differentsystem—digestive, nervous, etc. I canhardly wait.

You say you want to be plastinated? Acompany, Eternal Preservation, offers itfor the general public at the bargain priceof $50,000. I know that it soundsexpensive, but you can’t take it with you.

So would I donate my body to science?Maybe. I wouldn’t care if they blew it up.I wouldn’t care if they used it as a crashtest dummy. Heck, I wouldn’t even care ifthey plastinated it and mounted it on ahorse (also plastinated). But I’ll tell youwhat I wouldn’t let them do: sever myhead, place it in a rotisserie pan, and letfuture Beverly Hills plastic surgeons haveat it. No way. After six years of college,my head is worth more than $500.

13.Templeton GL, Illing LA, Young L, et al. The risk oftransmission of Mycobacterium. Annals of InternalMedicine 1995; 122:922-955.

14.Ussery XT, Bierman JA, Valway SE, et al.Transmission of multidrug-resistant Mycobacteriumtuberculosis among persons exposed in a medicalexaminer’s office, New York. Infection Control HospitalEpidemiology 1995; 16:160-165.

15. Weed LA, Baggentoss AH. The isolation ofpathogens from tissues of embalmed human bodies.American Journal of Clinical Pathology 1951; 21:1114-1120.

16.Kappel TJ, Reinartz JJ, Schmid JL, et al. Theviability of Mycobacterium tuberculosis in formalin-fixed pulmonary autopsy tissue: Review of theliterature and brief report. Human Pathology 1996;27:1361-1364.

17.Enforcement procedures and scheduling foroccupational exposure to tuberculosis. OSHA directives CPL 2.106. February 9, 1996.

18.Occupational exposure to tuberculosis. UnifiedAgenda 1218-AB46-2038. OSHA CFR Citation: 29 CFR1910.1035. December 5, 2001.

Book Review continued from pg. 10 Mycobacterium Tuberculosis continued from pg. 18

www.pathologistsass istants.org. 27

EXAM STUDYGUIDES NOW

AVAILABLE

The long-awaited exam studyguides have arrived! The studyguides come in a 50 page spiralbound booklet. The studyguides are available forpurchase bycheck orcredit card;contact the CentralOffice. The fee is$50 for membersand $100 fornonmembers.

THE OTHER CONFERENCES…Marty Stone

U.S. and Canadian Academy of Pathology2004 Annual MeetingMarch 6-12, 2004Vancouver, B.C. Convention CenterContact: www.uscap.org

CLMA/ASCP 2004 Conference and ExhibitionMarch 27-30, 2004Atlanta, Georgia; Georgia World Congress CenterContact: www.clma.org or 610/995-9580

www.ascp.org or 800/621-4142

Surgical Pathology of the GI TractApril 18-22, 2004Santa Fe, New MexicoContact: info@ascp.org or 312/738-1366

Diagnostic Pathology ‘04July 25-30, 2004Banff, Alberta, CanadaBanff Park Lodge Resort Hotel and Conference CenterContact: www.uscap.org

NSH 2004 Symposium/ConventionSept. 18-23, 2004Toronto, CanadaContact: www.nsh.org

CAP ‘04 Pathologists’ MeetingSept. 19-22, 2004Phoenix, ArizonaContact: www.cap.org

2004 ASCP Annual MeetingOct. 7-10, 2004San Antonio, TexasContact: info@ascp.org

Surgical Pathology of Breast and ThoracicTumors and Infectious Diseases, and Non-Gynecologic CytologyOctober 25-28, 2004Kohala Coast, HIContact: scientificsymposiums.com or 925/376-0217

Contact Marty Stone at martystone14@yahoo.comwith any comments/questions about alternatemeetings for PAs.

VOTE AND RENEWin one easy step!!

AAPA Dues Announcements will bemailed in mid-December.

A 2004 ballot for officer and boardpositions will be included.

(Those elected will assume duties onJanuary 1, 2005.)

2004 AAPA DenverRegional Meeting

Saturday, February28, 2004

See inside this issue formore information

and registration form

PRSRT STDU.S. POSTAGE

P A I DDECATUR, IL

PERMIT NO. 180

A . A . P . A

AAPAOffice Enterprises, Inc.Rosewood Office Plaza, Suite 300N1711 W. Country Road B.Roseville, MN 55113

CHANGE SERVICE REQUESTED

A few words about Jim Moore…

Several months ago, I began thinkingabout who should receive the 2003American Association of Pathologists’Assistants President’s Award. Severalnames came to mind, as our organizationhas many dedicated individuals inleadership. However, one person rose tothe top—Jim Moore.

As most of you know, for the past fewyears Jim has been the Acting ExecutiveDirector for the National Commission onCertification of Pathologists’ Assistants.As the lead and catalyst behind a

formidable commission, Jim has taken ourprofession from wondering if we wouldever be certified to wondering how soonwe will be certified. Certainly the workinvolved in the process is worthy ofrecognition. It likely represents the mostwork ever invested in a single AAPAventure. More importantly, it showssomething of Jim’s character. For the pastfew years, Jim has persevered throughdisappointments and controversy,sacrificed to keep time lines, reviewedhundreds of pages of data, and pushed aprocess forward knowing that, in the end,the ultimate decision to proceed withcertification was not his to render. Jim hasbeen an example of service, leadership,commitment, and sacrifice, often shownsimultaneously. All given to benefit theAAPA, our profession, you, and me.

For those of you who could not attendthe 2003 American Association ofPathologists’ Assistants ContinuingEducation and Business Conference in

Arizona, the award was given to Jim inthree parts. First, a plaque was givenwhich reads, “In recognition of leadership,perseverance, and dedication. This awardis given with gratitude, acknowledgingyour efforts to bring certification to ourcolleges, our organization and ourprofession.” I gave this hoping that Jimwould remember how much weappreciate his dedication. Second, Jimreceived a Seiko Kinetic watch. I gave thishoping that Jim would remember howmuch we appreciate his time and energy.Finally, Jim was given a gift certificate to anice restaurant near his home. I gave thishoping that Jim would remember (andperhaps relay to his family and closefriends) how much we appreciate his (andtheir) sacrifice.

Jim, you are a remarkable man. I willnot soon forget your dedication to ourorganization and profession. Thank you.

Jon Wagner, AAPA President

Moore Bestowed Inaugural President’s Award