LEGENDS

Isabell Sesterhenn, MD
Fathollah Keshvar “Kash” Mostofi, MD

An Interview with Isabell Sesterhenn, MD

Dr. Mostofi (center left) and Dr. Sesterhenn (center right) teaching at the AFIP, circa 1985. The other two physicians are identified as Dr. Davidson and Dr. Wagner, both uroradiologists.

This issue’s Legend, Dr. Isabell Sesterhenn, represents the continuity of a group of highly eminent pathologists who were part of the Armed Forces Institute of Pathology (AFIP) and not only developed the field of Genitourinary (GU) Pathology, but also taught it to generations of urologists. Dr. Sesterhenn is a very modest individual who attributes all of the credit for this work to her well known associates, and therefore felt it was not appropriate for her to claim the honor of being a “Legend”. She was, however, willing to be interviewed by a Guest Editor of The Canadian Journal of Urology (CJU), Dr. Gabriel Haas. The result is a highly personal and moving account of what has been considered by many to have been the Golden Age of Uropathology. This is the story of great scientific accomplishments, discoveries, and education at an iconic place that has been the premier institute for pathology, of past and present, consisting of a superb team led by the late Fathollah Keshvar “Kash” Mostofi.

CJU: Please tell us about your background and how you came to be associated with Dr. Mostofi and the AFIP?

Dr. Sesterhenn: I never imagined myself becoming a GU Pathologist, nor coming to the USA to work. I grew up in Cologne, Germany and attended medical school there and in Vienna, Austria. During my residency I spent an elective year at the Max Planck Institute for Neuropathology in Cologne. Following 3 years of training in pulmonary medicine, I settled in the field of pathology at the invitation of the Chief of Pathology at the City Hospital of Cologne. In 1974, as part of my training, I signed up for a course in Neuropathology at the AFIP, but in order to make the best of my 3 weeks at the Institute, I registered for another subject where I felt I had neither the experience nor the knowledge; and this was a course in GU Pathology. On my first day at that course, I entered an auditorium full of urologists, and they were all whispering in excited anticipation that as usual, “the Great Man” is running late. I soon found out, as he rushed into the classroom in an impressive white coat and an impeccable bow-tie, that “the Great Man” was Dr. Mostofi. As there were only two female students taking the course, Dr. Mostofi inquired about our specialties: one urologist and one pathologist.

He invited me to come up to the department and look at the wealth of archived materials. At the end of 3 weeks, he and Col. Davis offered me a position in the department, which I first declined, only to accept a year later. My main intent was to come and stay for only 2 years, in order to take advantage of the unparalleled tissue collection of the AFIP and to learn from the most outstanding teacher and professional visionary I have ever known.

CJU: What can you tell us about the AFIP and the program organized there by Dr. Mostofi?

Dr. Sesterhenn: The Army Medical Museum was founded in 1862 during the Civil War by President Lincoln’s Surgeon General (Brigadier General William Hammond) to collect “all specimens of morbid anatomy surgical or medical, which may be regarded as valuable; together with projectiles and foreign bodies removed, and such as matters as may prove of interest in the study of military medicine or surgery”. The mission of the AFIP has been to provide clinical consultation, education, and research in all aspects of pathology. During World War II, the Director, Colonel James E. Ash, decided to create subspecialty departments to cover all areas of pathology in depth. For each organ system, he recruited outstanding young pathologists, all of whom became legends in their fields and contributed to developing the AFIP as the premier center for clinical consultation, which in turn led to the organization of the largest tissue repository in the world. Dr. Kash Mostofi was born in Persia in 1911 as the son of a prominent urologist. He came to the USA in the 1930s and studied Medicine at Harvard Medical School. He was recruited from the National Cancer Institute, where he was a special research fellow in experimental pathology following his service in the military, and was ordered to lead the Department of GU Pathology. Dr. Mostofi realized from the onset that the only way to make progress in pathology was to understand the needs of his clinical counterpart, the urologist, and attended the annual AUA meetings. He came to build a program of excellence in uropathology, an opportunity that he characterized as “The Sky is the Limit”. In a course of 15 years, he recruited other famed pathologists such as Dr. Tatiana Antonovych who started the new section of Nephropathology. Colonel Charles J. Davis, who joined in 1972, became his Deputy Chairman. Both were highly respected contributors to the success of AFIP, but deceased in the heights of their career. Much of the learning from this great resource were documented in the more than 200 articles, and 15 books he authored, including the famous Fascicle on Tumors of the Male Genital System (1973), the Atlas of Kidney Biopsies (1980). He was not only interested in neoplasms but also inflammatory conditions, congenital diseases and Comparative Pathology

CJU: What were Dr. Mostofi’s most significant contributions to the field of pathology and urology?

Dr. Sesterhenn: There are so many, it is hard to know where to begin. Dr. Mostofi single-handedly brought GU pathology home for pathologists and urologists alike. He was Head of the World Health Organization (WHO) International Reference Center for Urological Tumors. His classifications of tumors of the urinary bladder, testis, prostate and kidney were adopted by the WHO and published in several languages. When he became Secretary of the International Association of Medical Museums (IAMM), with less than 100 active members, he studied its constitution and reactivated it throughout the world as the International Academy of Pathology (IAP) with the first postgraduate education program for physiscians. In this capacity, he met and established close contacts with pathologists in all continents on both sides of the Iron Curtain. The United States Canadian Division (USCAP) is now the largest of the IAP Division and the largest Pathology Society. At one of the USCAP meetings, Dr. Mostofi established the International Society of Urologic Pathology. He also cared about non urological causes such as the formation of the Pediatric Pathology Club. His broad interest and foresight is evident, considering the fact that Dr. Mostofi initiated the Joint Committee on Aviation Pathology. He served as Secretary of the Committee from 1954-1960, designing a wide-ranging program for comprehensive examination of aircraft accidents and to collect information for aircraft safety. He started and directed the famed uropathology course that almost all urologists took prior to their Board Examination from the 1960s until the late 1990s. This made Kash Mostofi a household name among all urologists and generations attribute their understanding of the pathological basis of urological disease to him. Because he continued to believe that the only way to really understand the educational and clinical needs of urologists is to attend their congresses, he became a constant fixture at all the major national and international meetings. He was a very thoughtful and passionate speaker whose lectureships and visiting professorships were enjoyed worldwide. He held academic appointments in several prestigious universities, leadership roles in many professional societies, and received the Distinguished Executive Rank Award from the US President Ronald Reagan. He also received the Presidential Honor Award from the American Urological Association and the Presidential Award from the American Foundation for Urologic Diseases. He was a leader, a scientist and an educator in addition to being an outstanding clinician. His motto was to “never stop learning” and he was dedicated to help patients by constantly upgrading and improving knowledge and scientific inquiry. When he passed away from the complications of prostate cancer at age 91, on April 6, 2003, the world lost a great visionary, scientist and teacher, and I lost a mentor and friend!

CJU: What became of the AFIP?

Dr. Sesterhenn: Dr. Mostofi anticipated the closure of the AFIP in his last publication, an Editorial in Human Pathology (34:203): “The Armed Forces Institute of Pathology in Jeopardy - Who Should Care?”. The AFIP permanently closed its doors as a consequence of the Base Realignment and Closure Act (BRAC) of 2005. Recognizing the value and uniqueness of the AFIP, Congress directed the Department of Defense to maintain the three core functions of the AFIP: Consultation, Education and Research. This resulted in the formation of the Joint Pathology Center (JPC), which now handles consultation cases coming from the military, Veterans’ Administration and other Government Agencies. The vast tissue resources of the AFIP are housed at the JPC and continue to fuel new discoveries.

CJU: Can you share some of your memories of Dr. Mostofi and life at the AFIP?

Dr. Sesterhenn: Dr Mostofi was a truly legendary figure in the field of pathology and a very complex personality. He was a serious and strict disciplinarian who demanded perfection from everyone around him, most of all, from himself. He expected all of us to report to work by 7 am in the mornings and leave only late in the evening. During the mornings we would be engaged in diagnostic activities, with the highlight of the day the review of challenging cases with Dr. Mostofi and Colonel Davis. These two worked together like a finely tuned orchestra; challenging each other, sharing excitement over unusual cases, seeking novel diagnoses, and pushing the frontiers of knowledge. It was always very interesting to interact not only with visitors from all over the world but also meet Dr. Mostofi’s friends from the urology and pathology communities, for example the lively conversations with Dr. Coffey, Dr. Ian Thompson, Dr. Schroeder, Dr. Patrick Walsh and Dr. McLeod. Yet, Dr. Mostofi insisted that work must also be fun. He enjoyed life to the fullest, and shared his gusto for science and passion for his work with everyone he encountered. He cared deeply about his colleagues and fellow human beings, and was known to give the coat from his back to someone in need—literally. He made incredible, life-long impressions on every one he came in contact with. His durable legacy is the advancement of knowledge in genitourinary pathology, his ability to influence and teach generations of urologists and pathologists, and having been one of those who built a world-class institution which became a highly esteemed resource for clinicians, researchers and scientists alike.

CJU: How have you carried on Dr. Mostofi’s legacy?

Dr. Sesterhenn: Dr. Mostofi is irreplaceable. I am a staff pathologist at the JPC. I enjoy tremendously to learn from and work with the excellent team at the Center for Prostate Disease Research (CPDR), searching for better diagnostic modalities, and a more accurate understanding of the cellular and molecular basis of urological diseases with the likes of Dr. David McLeod, Dr. Inger Rosner, Dr. Shiv Srivastava, Dr. Albert Dobi, Dr. Gyorgy Petrovics, and a team that Dr. Mostofi would be very proud of!

Isabell Sesterhenn, MD Staff Pathologist

Joint Pathology Center

Silver Spring, MD, USA

Dr. Kash Mostofi, circa 2000.

© The Canadian Journal of Urology™; 21(3); June 2014 7258