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Borges AM. Juan Rosai: A tribute. Indian J Pathol Microbiol 2020;63:367-8
Juan Rosai - A tribute
“Much of my life has been consumed by pathology.”
Juan Rosai, surgical pathologist par excellence, started life as Giovanni Rosai, on August 20, 1940, in a town called Poppi in Tuscany, Italy. His parents migrated to Argentina and his name changed to Juan, the Spanish version of Giovanni. He died in his beloved Italy on July 7, 2020, after a long illness.
Dr. Rosai began his professional career as a medical student in Buenos Aires, where he came under the influence of Prof. Eduardo Lascano, a pathologist who was “a very inspiring man who convinced me that pathology was the scientific basis of medicine…….to the point that for the rest of my years as a medical student I was spending most of my time in the pathology department.” A fortuitous meeting with Dr. Lauren Ackerman in Buenos Aires led to a residency at Barnes Hospital in St Louis, Missouri. He was entranced by the discipline of Surgical Pathology which was not practiced in quite the same way by pathologists in Europe and South America. He never looked back. He spent 35 years in the United States at Washington University School of Medicine, with his mentor Dr. Ackerman, followed by consecutive appointments as Professor and Director of Anatomic Pathology at the Universities of Minnesota and Yale. The culmination of his career in the United States was his appointment as the James Ewing Alumni, Professor and Chairman of Pathology, at Memorial Sloan Kettering Cancer Center in New York.
“I have been very lucky in my life, in the sense that many things have happened at the right moment,” he told an interviewer, once. However, it takes talent, passion, and a prepared mind to turn good fortune into great achievements, and Dr. Rosai did not lack these gifts. He was also endowed with a deeply curious and an acutely questioning mind. A good surgical pathologist must possess that intangible “eye” which is difficult to define. This he had in spades. These attributes, combined with the versatility of pathologists of his generation, made him a formidable diagnostician. The entities he was able to recognize and describe are the stuff of legend. The eponymous Rosai–Dorfman disease, desmoplastic small round cell tumor, spindle cell epithelial tumor with thymus-like differentiation of the thyroid, and sclerosing angiomatoid nodular transformation of the spleen  are the most well recognized of his prolific output of scientific publications. He was one of the few exceptions to the oft repeated adage, “what the mind does not know the eye does not see.”
When asked what area of surgical pathology he was most passionate about, he replied “… my real specialty, if you want to call it such, is oncologic pathology.” His forte, if indeed there was one he would choose above others, was the thyroid. Along with E. D. Williams, he was part of the international group of pathologists who investigated the spurt of thyroid tumors in children that followed the Chernobyl accident. He was the Editor-in-Chief of the 3rd Series of the Atlas of Tumor Pathology of the AFIP and the author of the AFIP Fascicles, Tumors of the Thymus, and Tumors of the Thyroid.
Dr. Rosai edited Ackerman's Textbook of Surgical Pathology until the tenth edition in 2011. It was the standard reference for diagnostic pathologists across the globe. It was also one of the first textbooks to include guidelines for gross examination and minimum requirements for reporting. The popularity of the textbook under his editorship was very much the result of the personalized way in which it was written. Common diagnostic difficulties were dealt with crisply, with common sense solutions.
Besides being a prolific writer, Dr. Rosai was a great teacher. His surgical pathology seminars on diverse subjects were always oversubscribed. They were a regular feature at USCAP, IAP, and other international meetings. He visited India over two decades ago at the invitation of Dr. Arun Chitale. The audience in Mumbai was spellbound. I had the pleasure of visiting him when he was Chairman of the Department of Pathology at The Institute of Cancer in Milan. He presided like a maestro over a medusa-headed microscope, engaging in a discourse with his students and associates over his consult cases. As if on cue, the relevant literature would pop up on a large screen at the click of a mouse. Juan Rosai was not above being a consummate showman! His entire collection of digitized and annotated 35 mm Kodachromes has been generously donated by him to the IAP for the benefit of pathologists all over the world. This will remain an invaluable treasure trove of images, cases, and the wisdom of a master.
Rosai was once asked whether an individual could be a good surgical pathologist as well as a research scientist. He replied, “I have seen some people who seem to be able to do both, but they are the exception.” He was advised as a young pathologist to get some experience in bench work in basic science. He spent a short while at the NIH, however decided that his first and only love was surgical pathology. He was often asked about the future of surgical pathology in the era of molecular pathology. He believed that morphology would stand the test of time. He wrote, “… the challenge of any new technique, whether molecular-based or not, is to show that it can provide information of prognostic or therapeutic significance that goes above and beyond that already provided by the standard technique.” How true.
Rosai's first taste of surgical pathology was in St Louis under one of the giants in the field, Dr. Lauren Ackerman. At that time, pathology as practiced in Argentina and in many parts of the world was largely an attempt to understand the underlying mechanisms of disease. For most pathologists, diagnosis was just a by-product of “real” pathology. In America, however, a breed of pathologists had grown up around diagnostic pathology that dealt with the practical needs of surgeons. These pathologists were the founders of surgical pathology. The young Rosai was fascinated by this story. His lifelong interest led to a book on the history of surgical pathology in America called Guiding the Surgeons Hand. It is a fascinating read on the evolution of the major departments of surgical pathology and the giants who bestrode their halls. The history of medicine and pathology were his abiding interests. He spent many pleasurable hours rifling through catalogs and browsing in stores that sold old books and manuscripts on the subject. Being fluent in Italian, Spanish, and English was an advantage that he exploited for his voracious reading habit, although, by his own admission, he preferred to read poetry in Italian. It touched his soul in a way that Spanish and English never did.
Juan Rosai combined his love for history and pathology by arranging on two occasions (2004 and 2010), a unique multidimensional experience for pathologists, a pilgrimage that followed the medieval pilgrim route, the Camino de Santiago (the way of St. James) to Santiago de Compostela in Northern Spain. Talks on history, travel, and a variety of pathology subjects were held at towns along the route. Those who walked or rode the tour bus along the Camino have reported being overawed by the experience. A similar event was organized in the Holy Land in 2013, which began in Amman, Jordan, and culminated in Jerusalem.
Juan Rosai went back to his roots. He spent the last years of his life in Milan with his spouse Maria Theresa Carcangiu, practicing diagnostic surgical pathology at the Center for Oncologic Pathology Consultations, at the Centro Diagnostico Italiano. Milan, he told me, was a great city for opera and football, both of which he was passionately fond. He passed away after a long illness leaving behind footprints that few will be able to fill adequately. He will be remembered as a professionally versatile surgical pathologist, an erudite speaker, and a consultant's consultant, who touched the lives of countless pathologists who looked to him for help and leadership.
A legend has truly passed.
| References|| |
Conversations with Pathologists; 12 March, 2008.
Rosai J, Dorfman RF. Sinus histiocytosis with massive lymphadenopathy. A newly recognized benign clinicopathological entity. Arch Pathol 1969;87:63-70.
Norton J, Monaghan P, Carter RL. Intra-abdominal desmoplastic small cell tumour with divergent differentiation. Histopathology 1991;19:560-2.
Chan JK, Rosai J. Tumors of the neck showing thymic or related branchial pouch differentiation: A unifying concept. Hum Pathol 1991;22:349-67.
Martel M, Cheuk W, Lombardi L, Lifschitz-Mercer B, Chan JK, Rosai J. Sclerosing angiomatoid nodular transformation (SANT): Report of 25 cases of a distinctive benign splenic lesion. Am J Surg Pathol 2004;28:1268-79.
Rosai J. The continuing role of morphology in the molecular age. Mod Pathol 2001;14:258-60.
Anita M Borges
S L Raheja Hospital, Mahim, Mumbai, Maharashtra; Centre for Oncopathology, 3rd Floor, Rectifier House, 570 Naigaum Cross Road, Wadala, Mumbai, Maharashtraa
Source of Support: None, Conflict of Interest: None