Robert E. Scully, MD

Robert E. Scully, MD, one of the foremost pathologists of the last half century, died on October 30, 2012, after a short illness. His contributions to pathology would have merited the words in memoriam, but the fact that his first articles appeared in the Archives, and that he was a long time member and strong supporter of the College of American Pathologists, only increases the appropriateness of this tribute in this journal.Dr Scully was a native of Pittsfield, Massachusetts. He was born on August 31, 1921. He was an alumnus of the College of Holy Cross in Worcester, Massachusetts (1941), and later became a trustee of the college. He graduated from Harvard Medical School (1944). He trained in pathology at the Peter Bent Brigham Hospital, Boston Lying-In Hospital, Free Hospital for Women, and Children's Hospital, all in Boston, Massachusetts, and at Pondville Cancer Hospital in Norfolk, Massachusetts. One year was then spent teaching at Harvard Medical School under the direction of Tracy B. Mallory, MD, who was chief of pathology at the Massachusetts General Hospital (MGH) in Boston. Toward the end of that year, a position on the faculty of the MGH became available, and Dr Mallory offered it to Dr Scully, who accepted. From 1952 to 1954, Dr Scully served in the Medical Corps of the United States Army in Japan during the Korean War. He then rejoined the staff of the MGH, where he practiced for the remainder of his career, a span of more than 50 years.Dr Scully excelled as a pathologist's pathologist and author and teacher. His diagnostic skills were legendary, the most difficult diagnosis sometimes being made with remarkable speed and seeming ease. Although known best outside the MGH for his work on gynecologic and testicular pathology, he could be shown a specimen from any organ and render a definitive interpretation.His academic productivity was remarkable. Dr Scully's first articles, in the Archives in 1948, heralded a major interest in gonadal pathology but also a prodigious academic output that lasted almost 60 years, his last peer-reviewed article being published in 2006. While a resident, he reviewed all testicular tumors seen up to that time at the Peter Bent Brigham Hospital; two articles resulted. He would travel to a patient's home to obtain follow-up, this showing evidence of his thoroughness. Further work on testicular pathology included the first English-language article on spermatocytic seminoma and description of the large cell calcifying Sertoli cell tumor. His schema for classifying precursor lesions of testicular germ cell tumors is largely that being used today. He also coauthored a book on testicular tumors. An important article to both urologic and gynecologic pathology was that describing the postoperative spindle cell nodule. Dr Scully and Juan Rosai, MD, had independently recognized that operative procedures could elicit an exuberant spindle cell proliferation likely to be misdiagnosed as sarcoma, and when they realized they had a shared experience, they reported their cases as a group.It is within the broad field of gynecologic pathology that Dr Scully's greatest legacy lies. It includes observations on the complicated pathology of intersex. Early in his career, he described (1953) the remarkable entity gonadoblastoma, and his expanded experience in a later and exhaustive study (1970) left little for others to add. If one had to pick one area above all others where his astute eye recognized distinctive features, it would be in the area of ovarian tumors. The list of entities he described is remarkable: juvenile granulosa cell tumor, sclerosing stromal tumor, retiform Sertoli-Leydig cell tumor, small cell carcinoma of the hypercalcemic type, luteinized thecoma associated with sclerosing peritonitis, and Müllerian mucinous borderline tumors. He wrote a series of definitive articles on sex cord–stromal tumors, and metastatic tumors to the ovary. One of the latter that should be highlighted is mucinous tumors of the appendix and ovary coexisting with pseudomyxoma peritonei. He had long felt that the appendix was the primary site of disease in these cases, provided evidence for it, and lived to see his theory accepted as correct by most authorities.His diligence is seen in a 2006 publication on the Krukenberg tumor, almost 6 decades after his first article. He was aware that the morphology of the tumor was more complex than the signet ring cell picture that dominated most textbooks. A detailed analysis of 120 cases proved the point. At the time of this study, Dr Scully was no longer coming to work. One of us (R.H.Y.) had the honor of bringing all 120 cases to his home, where he reviewed (at the age of approximately 84 years) every single case and made detailed notes on many of them.With Philip B. Clement, MD, he described the uterine Müllerian adenosarcoma and later published the largest study of the subject. He described the uterine tumor that resembles ovarian sex cord–stromal tumors. He was concerned that highly cellular leiomyomas were prone to be misdiagnosed as endometrial stromal tumors. One of us (E.O.) had the honor of working up the cases of that variant of leiomyoma and issuing guidelines to resolve that differential diagnosis. He was the lead pathologist in describing the association between in utero exposure to diethylstilbestrol and the subsequent development of clear cell carcinoma of the vagina and cervix in daughters of the women who took the drug.By the mid 1960s Dr Scully had attained a position of eminence in gynecologic pathology. As the years went by his stature only increased, and he was the preeminent expert in the field for the last 4 decades. When Dr Scully was granted honorary fellowship of the Royal College of Pathologists, the eminent British pathologist Professor Harold Fox referred to him in a tribute as “the unquestioned doyen of gynecological pathologists.” Dr Fox stated that “his prodigious literary output has been characterized by conceptual originality, clarity of thought and scientific rigour.” Dr Scully overall had 503 contributions in his curriculum vitae, including 320 original articles, 146 review articles, 4 books, a number of publications of the World Health Organization, 12 essays of historical nature, and a number of editorials.For decades Dr Scully reviewed cases at a double-headed microscope with residents, fellows, and visitors from far and wide. He travelled to numerous countries to lecture and give seminars. He was active in Harvard Medical School postgraduate courses, initially one on endocrine pathology, then for many years one on gynecologic and obstetric pathology, and then on general surgical pathology under the codirection of himself and his close friend, Austin L. Vickery, Jr, MD, and Robert T. McCluskey, MD, who was chief of pathology at the MGH. Another undertaking of educational nature was his work for the Case Records of the MGH, published in the New England Journal of Medicine, which he edited for a record 27 years. One of us (E.J.M.) had the privilege of being the associate editor for 20 of those years and can personally attest to Dr Scully's legendary expertise as an editor and writer. All his coauthors became well aware of this when manuscripts submitted to him were returned with numerous changes, which could be discouraging but on reflection were clearly of benefit to the final article.Dr Scully had a great interest in and knowledge of the history of pathology. Late in his career he found time to devote to it. With Dr Vickery he authored the chapter regarding pathology at the hospitals of Harvard Medical School in the book Guiding the Surgeon's Hand, edited by Dr Juan Rosai. Dr Scully also authored or coauthored 4 chapters in the book Keen Minds to Explore the Dark Continents of Disease, a history of pathology at the MGH and published in 2011.Dr Scully was an extremely fair and generous individual and had broad interests, although pathology certainly was his passion. As an example, he had long felt that the late William Ober, MD, with whom he had been a resident at the Boston Lying-In Hospital, was underappreciated. He wrote a lengthy essay on Dr Ober's life, published in Seminars in Diagnostic Pathology in 2008, including discussion of Dr Ober's articles on individuals from the world of music, art, and literature. Conversations with us while that essay was in progress made it clear to us how much Dr Scully had studied the humanities.Dr Scully was active in many societies, but particular note should be made here of his long-term membership in the College of American Pathologists (CAP). He served as a member of the CAP Cancer Committee for 2 decades, retiring in 1999. He was the senior author of 4 of the gynecologic cancer protocols published under the CAP's auspices: ovary (1995), vagina (1999), fallopian tube (1999), and peritoneum (2001). He also served as a member of a workshop on the classification of endocrine tumors of the cervix (1997).Dr Scully received many diverse and high honors. He was a Maude Abbott Lecturer of the United States & Canadian Academy of Pathology (USCAP). He received an honorary degree from his alma mater, the College of the Holy Cross, received the Fred W. Stewart Award of Memorial Sloan-Kettering Cancer Center, the Distinguished Pathologist Award of the USCAP, and an honorary fellowship of the Royal College of Pathologists. He served as a president of the New England Society of Pathologists. A Harvard Medical School Professorship in his name was endowed near the end of his career. Shortly before his death, Dr Scully was given the Lifetime Achievement Award by the Massachusetts Medical Society, the first pathologist to receive that honor.After his retirement, Dr Scully's influence continued to impact the department. He remained in contact with many of his former colleagues, several of whom visited him and had dinner with him on a regular basis. He had a microscope at the ready in his living room and would be brought cases of particular interest for his opinion until the last year of his life.In addition to his professional abilities, Dr Scully's cordial and unassuming approach with members of our own department, as well as the numerous pathologists from around the world who trained with him or relied on him as a consultant, made him a role model. When Dr Scully retired, the then chief of pathology, Robert B. Colvin, MD, said as follows: “Apart from his professional accomplishments, Dr Scully's personal attributes include a humility that few with his immense stature in medicine would have. That so many both senior and junior members of the department, medical staff, diverse members of our support staff, and countless people with whom Dr Scully has interfaced, sometimes only slightly over the years, have the affection for him they do is the most overt example of his human qualities. He set a standard for members of our department for the future.” He will be missed, but his memory will remain vivid, and his influence as a giant in the field will continue long into the future.Dr Scully is survived by 2 nieces and a nephew, and by several grandnieces and grandnephews, to whom he was devoted as they were to him.

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