Thursday, June 9, 2016

Featured Neuropathologist: Roger McLendon, MD

Today I feature the inimitable Dr. Roger McLendon, director of neuropathology at Duke University. McLendon has made major contributions to the field in the area of molecular characterization of gliomas. He has also demonstrated a commitment to professional service, including his current work on the Neuropathology Committee of the College of American Pathologists. Check out this interview with one of the most influential neuropathologists practicing today.....

Roger McLendon, MD

1.    Why did you decide to become a neuropathologist?

When I was in college, I asked a buddy of mine who was in vet school what course should I take that would help me out in med school.  His answer was neuroanatomy.   I did not have a course available in neuroanatomy at Emory, so I went over to the med school and talked with a guy working in pain fibers.  He had a great project (using the old Fink-Heimer silver stain) that got me interested in the anatomy of the brainstem.  I followed that experience up in med school with a project working in muscle enzyme histochemistry with Dale Sickles.  I found the use of stains to identify things not seen before to be an exciting way to spend a career.  I have followed those experiences up with immunohistochemistry and FISH to see things in brain tumors.

2.    Name some important professional mentors. Why were they important to you?

Obviously my Duke colleagues and teachers have had huge impacts on my career.  I was tremendously fortunate to land at Duke at the same time as Drs. Stephen Vogel, Peter Burger, Darell Bigner, Doyle Graham, Barbara Crain, Edward Bossen, and Gordon Klintworth.  While I was at Duke, my co-fellows were Doug Anthony, Rod McComb, Gerald Campbell, and Sebastian Alston and visiting fellows included H.K. Ng and Felice Giangaspero.  Each one of these neuropathologists pushed each other to think clearly, regardless of age or faculty status, in a gentle and collegial fashion.  However, the opportunities that Darell Bigner made available to me have pushed my career far beyond my own early goals and to him I owe the biggest thanks.

3.    What do you predict the practice of neuropathology will be like 50 years from now?

In brain tumor surgery, it is undoubted that advances in microelectronics and photonics will allow greater localization and visualization of tumors and normal anatomy.  As a result, we will be receiving better characterized tumor samples that we will be expected to handle in more stringent fashions.  Fresh tissues will be submitted directly to pathology labs for culturing, cellular subset detection and quantitation, and tumoral microenvironmental analysis.  In the past, pathology has been ahead of therapeutics by 20 or more years because we could detect differences in tissues that no drugs could exploit.  However, I think that the largest advances will come in biological therapeutics that will push pathology to better understand the biological differences to be exploited in the tumor. As I discuss later on, the problem in diagnostic pathology will be in staying current with the rapidly changing “core knowledge”.  These issues will be have to be addressed by large group practices of neuropathologists who can provide consultations in all things neuropathologic.   In this way, esoteric testing will be made financially feasible, particularly among rare diseases. 

4.    What advice would you give to a pathology resident interested in doing a neuropathology fellowship?

If you want to have a successful academic career, be ready to give up on 75% of what you learn in your fellowship.  To succeed, you must focus; to focus in the future will mean going far beyond the confines of traditional pathology to learn new techniques in cell culture, -omics, microenvironmental manipulation including stem cells, and electronics that will be needed to measure and manipulate these factors.  I would be shocked to think a successful academic neuropathologist would be able to compete in the research arena and still sign out brain biopsies, muscles, nerves, eyes, and dementia autopsies.  However, outstanding diagnosticians will not got the way of the dinosaur.  We will still need outstanding, broadly trained diagnosticians, but I fear that what will be  considered to be “core knowledge” for the discipline may become overwhelming and yet, rapidly modified.  Keeping up will be a challenge. The challenge for departments will be to make room/share facilities for enough diagnostic pathologists who can handle each of these areas well

5.    What advice would you give to a neuropathology fellow about to embark on a search for his or her first job?

I recently heard a story about people planning their retirements.  The study said that a majority of people planning to retire focused on money issues while a majority of people who had been retired for 5 or more years focused on social issues.  In other words, happiness is ultimately not found in a paycheck, but in the people around you and the issues you are working on.  Therefore, look very closely at the people you will be working with.  I have been extremely fortunate to work with a great group of neuropathologists here at Duke who focused on areas that I was happy to let them focus on.  Christine Hulette loves dementia work, Anne Buckley loves muscles and nerves as well as ultrastructural studies and Tom Cummings is just a brilliant consultant in brain biopsies, eyes, and bone/soft tissue.  They have left me with time and energy to work with the Duke Brain Tumor Center researchers, the Brain Tumor Biorepository, and to look at brain biopsies.  Also get a chance to meet the clinicians you will be working with.  I once interviewed at a major medical center where the chief of oncology told me he had no interest in neuro-oncology (something important to know!)  Along these lines, I have had wonderful relationships with our neurosurgeons and neuro-oncologists and look forward to their continued success.

6.    In what city would you like a future American Association of Neuropathologists meeting to be held, and why?

The first issue you have to deal with is a June meeting and its weather.  Then you have to have a place that you can fly to relatively easily.  Then my choice leans heavily to being able to see a baseball game.  Finally food choices are important and having a wide variety of fish, fowl, and beef choices.  From this it comes down to either Denver or Tampa (Tropicana Field is enclosed) and my preference would be Tampa, because of its proximity to beaches, great airport, indoor baseball, and excellent restaurants.

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