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Joint Pathology Center celebrates century of helping military docs confirm diagnoses

Pamela Baker (left), 88th Diagnostics and Therapeutic Squadron cytology technician, prepares the staining of a patient's tissue sample, while Maj. Luisa Watts (right), 88 DTS pathologist shows 1st Lt. Jeffrey Davey (center) her findings on a screen that connects to the microscope inside the operating room at Wright-Patterson Air Force Base Medical Center, June 26, 2017. Watts examines the tissue sample under the microscope to make a diagnosis of the patient's condition. (U.S. Air Force photo by Michelle Gigante) Pamela Baker (left), 88th Diagnostics and Therapeutic Squadron cytology technician, prepares the staining of a patient's tissue sample, while Maj. Luisa Watts (right), 88 DTS pathologist shows 1st Lt. Jeffrey Davey (center) her findings on a screen that connects to the microscope inside the operating room at Wright-Patterson Air Force Base Medical Center, June 26, 2017. Watts examines the tissue sample under the microscope to make a diagnosis of the patient's condition. (U.S. Air Force photo by Michelle Gigante)

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Falls Church, Va. — As a young pathologist 40 years ago, Dr. Isabell Sesterhenn helped doctors diagnose disease. She was essentially “the lab” you hear about where a biopsy or tissue sample is studied to determine what the disease might be. But back then, the information she had within arm’s reach was limited.

“There were cases, for example, of testicular tumors,” said Sesterhenn. “As a general pathologist, you might see just 60 cases in a lifetime. But later when I came for training to the Armed Forces Institute of Pathology, the forerunner to today’s Joint Pathology Center, within one week, I looked at 500! So when I went back home, it was a piece of cake to diagnose a tumor.”

Sesterhenn is now a staff pathologist at the Joint Pathology Center located near the campus of Walter Reed National Military Medical Center in the suburban Washington, D.C., area. While doctors and local pathologists are the first ones who diagnose a disease, the center serves as the secondary consultative service for military and Department of Veterans Affairs pathologists, and other federal organizations. She said other pathologists and medical doctors in the Military Health System and researchers from the world of academia have a wealth of information to help draw conclusions.

“In the center, you see a lot of variation of specific tumor types,” said Sesterhenn. “With the new methodologies we have now, we learn very subtle differences we might have overlooked or didn’t understand before.”

To say the collection is big is an understatement. “We have the world’s largest collection of pathology specimens,” said Army Col. Clayton Simon, Joint Pathology Center director and a doctor himself. “We have more than 4 million cases, 55 million pathology slides. The next largest collection is, maybe, 800,000 slides.”

This expansive knowledge database gives doctors and pathologists a wide-ranging resource to make better diagnoses.

“Now we’re able to look at specific proteins and genetic changes in some cancers to refine the diagnosis and customize patient care,” said Sesterhenn. “That’s not necessarily unique to the center, but here we can do this more thoroughly than other places because we have greater numbers of different variants of the same tumor.”

It also helps young doctors gain more confidence in their own diagnoses.

“Nearby Walter Reed and the Uniformed Services University of the Health Sciences sends residents, students, and fellows to train under our pathologists so they can see some of the more difficult cases,” said Simon.

Although tracing its origins all the way back to the Civil War as part of the Army Medical Museum in Washington, the center celebrates its 100th anniversary as a tissue repository this month.

“A lot of our specimens came from the Spanish Flu from the early 20th century, doing autopsies on soldiers and casualties from World War I,” said Simon. “So all of the pathology specimens collected before 1917 in the museum got put into the repository, giving us some specimens more than 100 years old.”

The information today’s pathologists are able to use from these 100-plus-year-old specimens, along with the specimens still being collected – some from all over the world – help in modern countermeasures to lethal pathogens still out there. Without giving specifics for security reasons, Simon explained they’ve been able to counter a possible bioweapon.

“We don’t normally see people infected by these bacteria,” he said. “We were the only place in the world that had tissue infected by this bacterium, a specimen that went back more than 50 years. A researcher was able to use our sample to target the antigens to start developing a vaccine against it.”

The center helps with other areas of military medicine, such as traumatic brain injury research. The expansive collection of brain tissue samples helps them better understand the changes associated with blast injuries and head trauma more common in military members than their civilian counterparts.

“This time of pathology is very exciting, because we are switching over from a purely descriptive diagnosis to trying to understand what we see,” said Sesterhenn, pointing out how modern technology is unlocking the secrets hidden in the long history of the registry samples. “We have specimens that span all ages, races, and geographical origins. The diseases might look alike, but their causes may have evolved. The repository offers a unique resource to explore morphologic and genetic changes over a century.”

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