Pathology

| Department Overview |--------------

The predecessor of the Department of Pathology of Huashan Hospital—the Surgical Pathology Room of Huashan Hospital—was established in 1960. At the beginning, it mainly relied on the Department of Pathological Anatomy of Shanghai First Medical College. During this period, renowned professors including Gu Suiyue, Ying Yueying, Chen Zhongnian, and Zhu Shineng successively came to the hospital to preside over its work.

In 1979, the Department of Pathology of Shanghai First Medical College sent Chen Changchun and Wang Hong to rebuild the Pathology Room of Huashan Hospital. In 1980, Zhang Luo, and in 1987, Wang Hong, successively became the earliest formally established physicians of the Pathology Room of Huashan Hospital.

In 1992, the hospital combined the Surgical Pathology Room, Neuropathology Room, and Dermatopathology Room to form the Department of Pathology of Huashan Hospital, with Professor Qiu Bingsen as Director and Professors Zhang Fulin and Fang Jun as Deputy Directors.

In June 1998, it was combined with the Department of Pathology of Shanghai First Medical College, with Hu Xiqi, Xu Zude, and Zhu Hongguang successively serving as Directors of the Department of Pathology.

In 2015, the Neuropathology Room was formally merged into the Department of Pathology of Huashan Hospital. Professor Tang Feng served as Director and Professor Wang Yin as Deputy Director. Under the leadership of the hospital Party Committee and leaders at all levels, the discipline has developed vigorously, forming a favorable pattern of coordinated, integrated development of medical care, teaching, and scientific research.

In 2019, the department ranked third in the Research Competitiveness Ranking of Pathology Departments of Shanghai tertiary Grade A hospitals. In 2020, it was nominated 14th in the National Pathology Specialty Reputation Ranking, and it is also one of the first national-level standardized training bases for clinical pathologists and national-level specialty bases for standardized resident training (Clinical Pathology). In 2021, it was rated a National PQCC Demonstration Laboratory.

For a long time, Huashan Pathology has received strong support and assistance from peers throughout China. Academician Bian Xiuwu was appointed Honorary Professor of the Department of Pathology and regularly participates in MDT activities. In recent years, through the joint efforts of all department personnel and the support and guidance of various experts, the discipline has developed vigorously, and it is hoped that it will reach an even higher level in the future.

| Talent Team and Hardware and Equipment |--------------

At present, the Department of Pathology of Huashan Hospital has 29 physicians and 19 technical personnel, distributed among the Main Campus, Hongqiao Campus, Pudong Campus, and Baoshan Campus. Among them, 13 have senior professional titles (5 with full senior titles and 8 with associate senior titles), 11 have doctoral degrees, and 14 have master's degrees. Department members serve as committee members of various subspecialty groups and as young key personnel at the national and Shanghai municipal levels. Director Tang Feng serves as a member of the Pathology Branch of the Chinese Medical Association, Chair of the Pathology Branch of the Shanghai Medical Association, and Deputy Chair of the Professional Committee of Difficult Tumors of the Chinese Medical Education Association.

The Department of Pathology possesses fully automated tissue processors, cryostats, paraffin microtomes, fully automated immunohistochemical staining machines, fully automated staining and coverslipping machines, light microscopes, fluorescence microscopes, ten-headed microscopes, fully automated network scanning microscopes, and other instruments and equipment. The pathology reporting and image analysis system allows all pathology records since 1999 to be accessed and printed at any time. The projects currently performed by the department include paraffin sections, special stains, immunohistochemical staining, intraoperative rapid frozen sections, cytological diagnosis, and molecular pathological diagnosis. A comprehensive diagnostic platform integrating pathological morphology, immunohistochemistry, and molecular pathology techniques has been established. The annual number of routine external examination cases is nearly 100,000; more than 15,000 rapid frozen-section diagnoses are performed annually; several hundred types of special stains and immunohistochemical stains can be performed; molecular pathology testing is also performed, with approximately 10,000 cases annually; and several thousand difficult pathology consultations are accepted annually.

The department is currently actively preparing to establish a telepathology consultation center. Once completed, it will not only be able to accept telepathology consultations from hospitals at all levels, but will also be able to transmit controversial pathology slides to internationally renowned pathology diagnostic centers for remote consultation.

| Discipline Characteristics and Work Achievements |--------------

Department personnel participated in the compilation of such expert consensuses as the "Expert Consensus on the Pathological Diagnosis of Neoadjuvant Therapy for Breast Cancer," the "Clinical Practice Guidelines for the Pathological Diagnosis of Melanoma (2021 Edition)," the "Expert Consensus on the Pathological Diagnosis of Laryngeal Precancerous Lesions and Invasive Carcinoma (2021 Edition)," the "Chinese Anti-Cancer Association Guidelines for Central Nervous System Lymphoma," the "Chinese Anti-Cancer Association Guidelines for Pediatric Germ Cell Tumors," and the "Chinese Expert Consensus on the Diagnosis and Treatment of Candidiasis," making their due contribution to the standardized development of pathology in China.

I. Medical Work

Based on the advantageous clinical disciplines of a general hospital and the work characteristics of the Department of Pathology itself, multiple pathology subspecialties have been established. The key subspecialties under focused development and with distinctive features are:

(1) Central nervous system disease subspecialty: The Departments of Neurology and Neurosurgery of Huashan Hospital are nationally renowned clinical specialties, with outstanding achievements in the diagnosis and treatment and scientific research of central nervous system tumors and difficult and complex diseases in neurology and neurosurgery. At present, the Department of Pathology has authority in the diagnosis of nervous system diseases. The teams of Professors Wang Yin, Chen Hong, and Xiong Ji perform approximately 3,000 consultations nationwide each year and also have considerable research strength. In recent years, they have received funding from the National Natural Science Foundation of China and published multiple SCI papers.

(2) Digestive system disease subspecialty: ① Liver diseases: The Department of Infectious Diseases of Huashan Hospital is a leading discipline nationwide and treats large numbers of patients with difficult and complex liver diseases. The Department of Pathology of our hospital has authority in the pathological diagnosis of chronic liver diseases such as viral hepatitis, autoimmune hepatitis, drug-induced hepatitis, and alcoholic hepatitis. Professors Hu Xiqi and Du Zunguo receive approximately more than 1,000 cases of pathology consultations and inquiries concerning patients with chronic liver diseases from throughout the country. The Department of Pathology also has a traditional advantage in the diagnosis of liver tumors. In terms of scientific research, it has obtained National Natural Science Foundation of China projects over the years and has also published SCI articles. ② Pancreatic diseases: Relying on the strong development of the Pancreatic Surgery Department of Huashan Hospital, the Department of Pathology has distinctive features and certain advantages in the pathological diagnosis of pancreatic tumors, the pathological diagnosis of pancreatic biopsy specimens, and cytological diagnosis.

(3) Breast and thyroid disease subspecialty: The volume of breast surgery and the number of breast cancer patients treated rank among the highest of the major hospitals in Shanghai. The Department of Pathology has also established a professional group for the breast disease subspecialty. Director Tang Feng, a member of the Breast Oncology Group of the Oncology Pathology Committee of the Chinese Anti-Cancer Association, serves as the group leader. Its diagnoses are authoritative, and it has the capability to test various breast cancer-related indicators, providing a guarantee for individualized treatment of breast cancer patients by clinical departments. In recent years, our department has obtained multiple National Natural Science Foundation of China projects related to breast tumors and has published a series of SCI articles, developing its own distinctive features and advantages in this field. Over the past 5 years, the construction and development of the thyroid FNA cytopathology subspecialty has been mainly undertaken by Professor Bao Yun and has received recognition from physicians in the relevant clinical departments.

(4) Skin disease subspecialty: The Department of Dermatology has more than one million outpatient visits each year, more than 10,000 skin surgical biopsy cases, and approximately more than 1,000 consultation cases. It possesses abundant clinical resources. Director Tang Feng serves as Deputy Head of the Dermatology Group of the Pathology Branch of the Chinese Medical Association and has considerable authority in the pathological diagnosis of skin diseases and skin tumors.

(5) Hematolymphoid neoplasm subspecialty: In recent years, the incidence of hematologic malignancies has increased year by year, and the number of patients treated by the Department of Hematology of Huashan Hospital has also increased annually. The Department of Pathology has responded to this trend and established a subspecialty in the pathological diagnosis of hematolymphoid neoplasms more than 10 years ago. It has developed its own distinctive features in the diagnosis of lymphomas and the pathological diagnosis of bone marrow biopsy specimens.

In 2016, the Department of Pathology accepted the task assigned by the hospital's Medical Affairs Department, "Accelerating the Continuous Improvement of Pathology Report Issuance (PDCA)," and improved the pathology operating procedures. From 2016 to the present, the 3-day issuance rate for pathology reports at Huashan Hospital has exceeded 85% each year, far surpassing the requirement of the Shanghai Pathology Quality Control Center that pathology reports be issued within 5-7 days.

II. Scientific Research

Over the past 10 years, the department has led a total of 10 National Natural Science Foundation of China projects (including General and Young Scientists' Fund projects) and 6 Shanghai municipal projects. Its main research areas include the pathogenesis and invasion mechanisms of breast, pancreatic, and central nervous system tumors; the relationship between drug resistance and infiltrative metastasis; and the role and function of miR-194 during the repair of chronic HBV liver injury. It also participated in receiving the Second Prize of the National Science and Technology Progress Award.

The department ranked third in the 2019 Research Competitiveness Ranking of Pathology Departments of Shanghai tertiary Grade A hospitals. It compiled the medical works "Histopathology of Skin Tissue," "Modern Dermatology," "A Series of Pathological Studies of Hepatitis B," "A Series of Clinical and Pathological Studies of Chronic Hepatitis, Cirrhosis, and Liver Cancer in Infants and Children," "Hu Xiqi's Illustrated Liver Diseases—Clinical Pathological Diagnosis and Differential Diagnosis of Difficult Liver Diseases," and "Principles and Techniques of Modern Histochemistry."

III. Educational Work

The Department of Pathology of Huashan Hospital is one of the first approved clinical pathology training bases. The Huashan Hospital Clinical Pathology Base integrates the resources of the clinical pathology service of Huashan Hospital and the Department of Pathology of Fudan University, providing trainees at the base with training in basic pathology and clinical pathology at all levels. It also collaborates with the Departments of Pathology of Children's Hospital Affiliated with Fudan University and the First Maternity and Infant Health Hospital Affiliated with Tongji University, achieving comprehensive coverage of internal medicine, surgery, obstetrics and gynecology, pediatrics, dermatopathology, and neuropathology. Physicians who complete standardized resident training and remain in this Department of Pathology automatically enter a 3-year specialist physician training program. From the recruitment of the first cohort of trainees nationwide in 2010 through August 2023, the department has trained a total of 62 residents, with 15 residents currently in training and a 100% completion qualification rate; it has trained a total of 11 pathology specialists, including those currently in training. As a master's and doctoral degree-granting site affiliated with Fudan University, it has trained 11 doctoral students, including those currently enrolled, and 20 master's students, including those currently enrolled, since the department was established. In addition, the Department of Pathology of Huashan Hospital has accepted and trained a total of 26 advanced trainees from Qinghai, Jilin, Sichuan, Yunnan, and other regions throughout China, contributing to the improvement of diagnosis and treatment standards in primary hospitals in remote areas. Each year, it successfully holds 3 national continuing education courses: Central Nervous System Disease Pathology, Liver Disease Pathology, and Breast Disease Pathology, providing the latest and most accurate information on theoretical and technical advances in the relevant specialties.

IV. International Exchange and Cooperation

The Department of Pathology of Huashan Hospital has conducted multiple friendly mutual visits with numerous international medical institutions. Director Tang Feng spent 1 year as a visiting scholar at MD Anderson Cancer Center in the United States, specializing in breast pathology. Many young and middle-aged physicians have successively visited Harvard Medical School (MGH), the Eppendorf Medical Center of the University of Hamburg in Germany, Aichi Medical University in Japan, and other institutions as visiting scholars. Academic leaders visit each other to provide guidance, young professionals are regularly sent abroad for study and exchange, and emphasis is placed on talent development.

| Development Goals |--------------

Although the construction of the pathology discipline at Huashan Hospital has made substantial progress with the support of its existing platforms and resources, there is still room for improvement before it becomes an outstanding first-class discipline. First, breakthroughs should be made in the discipline's areas of professional distinction, with a focus on developing strong subspecialty directions that meet international standards. A smart pathology system should be developed to achieve the transformation from an "image" model to a "digital" model, with informatization as the primary focus and AI technology as the future. At the same time, talent development should be strengthened, academic research should serve as the guide, and interdisciplinary integration and innovative integration should be carried out. On the basis of consolidating the discipline's professional characteristics, the three major platform-construction areas of the discipline should be further developed, strengthened, and expanded, including molecular pathology, cloud pathology, and artificial intelligence.

Professor Hu Xiqi teaching a liver study course

2015.6.26 Professor Ralph H. Hruban, Director of the Department of Pathology at Johns Hopkins Hospital in the United States, visited Huashan Hospital,

Professor Tang Feng, Director of the Department of Pathology, and Professor Hruban signed a cooperation intention agreement between the two departments

Fully automated immunohistochemical staining machine

National PQCC Demonstration Laboratory