20 September 2019: Meet the editor – Dr. Genevieve Crane

Please introduce yourself I am Genevieve Crane, a hematopathologist at Weill Cornell Medicine in Manhattan, NY. I grew up in the mountains of New Mexico, but have lived all over through undergraduate work in Houston, a Marshall Scholarship in London, MD/PhD training in Michigan, residency and fellowship in Baltimore and postdoctoral research in Boston and Dallas.I am enjoying Manhattan for its great mixture of cultures, opportunities and colleagues . . . perhaps some great shopping and food as well!I am named for my grandmother Genevieve, who was always able to find beauty and hope in even the darkest situation. That seems to be valuable in pathology as well as in any situation. I am proud to carry her name, but often go by the nickname, “Eve”. I can frequently be found wearing cowboy boots (yes in NYC), often with my own unique style in clothes created by my mom (who has her own twitter handle @sewing_sixties) based on fashion from the 1960s and 70s.

Why did you become a pathologist?

I have always been fascinated by mechanisms of disease and how normal processes of cell growth, death and differentiation may be altered to play a role in disease. My career choice was also heavily influenced by my father’s battle with a severe and progressive form of multiple sclerosis. It was a diagnosis mostly of exclusion at the time he developed symptoms in 1980. Treatments were also lacking for the majority of his lifetime. This experience instilled in me from a young age the limitations of current medicine and a desire to contribute to medical research. Even being able to slow or halt the progression of chronic diseases would have a tremendous impact. I also remember the stress and uncertainty surrounding his initial diagnosis. It was not due to lack of diligence, but limitations in availability and specificity of the testing at the time. Even if the diagnosis of multiple sclerosis had been more certain, this can show a broad range in severity of symptoms. While perhaps not considered the most exciting aspect of pathology, refining diagnostic criteria is critically important in moving our understanding of disease forward. A careful and consistent definition of a disease entity can help patients and families to cope with illness and create a more meaningful context to assess prognosis and therapy. Building on these criteria, pathologists are then in a unique position to be able to directly observe and integrate morphologic, immunophenotypic and molecular changes, potentially having access to a large number of cases to investigate disease mechanisms.

What do you like most about being a pathologist?

My favorite part of being a pathologist is when the whole puzzle comes together to provide a diagnosis for the patient that can potentially reverse symptoms. This is particularly gratifying when the ultimate diagnosis has resulted from a close collaboration with the clinical team, often reviewing slides and clinical data together at the scope. For example, in critically ill patients who present with symptoms of hematophagocytic lymphohistiocytosis in adulthood, it is typically due to an underlying cause such as infection or malignancy. Expediently identifying the cause is critical to directing therapy in what otherwise may lead to a rapidly progressive and fatal course. My other favorite part of pathology is the online pathology community, which continues to grow on social media. It is a welcoming, enthusiastic group, with the majority incredibly passionate about teaching, learning or just sharing interesting and unusual cases. Many have become close friends, collaborators or coauthors. It is wonderful to have the chance to meet in real life, and the connections have opened a whole world of pathology to me outside my immediate circle of colleagues that I would never have expected.

What is special about your subspecialty?

I enjoy hematopathology because it is an area that perhaps most fully spans my interests from the realm of basic science all the way to clinical medicine. I fell in love with it during my first rotation as an intern at Hopkins, even though I had not expected to specialize in this area. Accurate diagnosis within hematopathology increasingly requires integration of morphologic, immunophenotypic, molecular, cytogenetic as well as clinical data. In addition, our understanding of these entities is rapidly evolving in ways that impact prognosis and direct therapy, opening numerous opportunities for translational research.

How does your typical day go?

I am still working to develop a rhythm for a typical day. I sign out solely hematopathology, where we currently have two clinical services at Weill Cornell: one focusing on bone marrow evaluation and a second on lymph nodes, blood and other tissues. Both tend to be fairly hectic between choosing flow cytometry panels, following up on testing and completing reports in the mornings and evenings with sign out with residents and fellows in the afternoon. The week is also interspersed with multidisciplinary tumor boards, research meetings and teaching. I have some days off from clinical service where I am working to develop a translational research program with interests in immunosuppression-related lymphoproliferative disease and the lymphoma microenvironment.

What is the most memorable experience you’ve had at work?

It is hard to narrow down a single experience. A happy moment was calling to let a physician know that her young patient with massive axillary lymphadenopathy and concern for Hodgkin lymphoma had a diagnosis of cat scratch disease. Additional clinical history had not been given, but the physician quickly followed up to let me know the patient had in fact been fostering feral kittens. Review of subsequent clinical notes revealed the patient was doing well on antibiotics . . . and keeping the kittens’ nails better trimmed!

What most surprised you about being a pathologist?

What surprised me the most was the intense teamwork that goes into the evaluation of every specimen. We are removed from the patients, yet in order to handle the specimen appropriately, especially on the frequently very limited small tissue biopsies, we must be acutely aware of the clinical situation. This is particularly true in hematopathology, where a patient with fevers and lymphadenopathy may have anything from acute toxoplasmosis to Burkitt lymphoma. In some instances, triaging material toward cytogenetics may be critical, other cases may be more informative by flow cytometry, advanced molecular testing or microbial culture. We are in frequent contact with our clinicians and always in close discussion with our technical staff. Details such as fixation time, quality and thickness of tissue sections for morphologic evaluation and optimization of immunohistochemical stains can make a huge difference in arriving more expediently at the correct diagnosis. I do not see pathology as a lonely or reclusive specialty – I am so proud and grateful for the team that I am surrounded by and incredibly reliant upon each day. Is there anything you know now that you wish you had known when you began working as a pathologist?

Residency is a busy and intense time and I think I was often focused on the immediate tasks at hand. I definitely learned a tremendous amount, but looking back, I wish I could have taken even further advantage of teaching from the incredible pathologists who surrounded me at that time such as Dr. Peter Burger in neuropathology and Dr. Elizabeth Montgomery in gastrointestinal and soft tissue pathology. Fortunately, pathology has a culture of continual learning, particularly with opportunities to continue to discuss and interact surrounding challenging cases on social media as noted above. It is wonderful to be able to still interact with former mentors and colleagues in that realm.

What do you think you would be doing if you weren’t doing this?

My undergraduate major was in chemical engineering and I was always fascinated by polymer science. I briefly worked in developing degradable materials for cellular scaffolds and drug delivery and still hold a patent for a modified alginate for controlled drug release. Whether or not a physician, I had hoped to work at the interface between medicine and science to make a difference for patients.

Could you say a few words about your association with PathologyOutlines?

We frequently used PathologyOutlines.com during residency and valued it as a quick and concise method to help develop an initial staining panel for our differentials or refresh our memory of unusual entities, particularly on our surgical pathology rotations where we would see a broad range of material. The resource has continued to grow since that time as a true living textbook, and I am particularly excited about the breadth of excellent authors who have contributed to the sections on hematopathology to continue to build that area. I am also proud to be part of PathologyOutlines.com as it continues to establish itself as one of the most frequently accessed resources for trainees and practicing pathologists around the world.  _______________________________________________________ You can follow Dr. Crane on Twitter @evemariecrane.  She also contributes to the @SocforHemepath account, where she serves on the education and communication committees, as well as acts as the current head of the Video Tutorial subcommittee.