A case for integrated morphomolecular diagnostic pathologists.

In 2001, at the turn of the century, the view of the future of surgical pathology was not an optimistic one. Dennis Heffner (1 ), in a very lucid account of surgical pathology’s past, present, and future, pointed out that surgical pathology has never achieved fully recognized status, and that this suboptimal recognition is likely to decrease further. Failure by surgical pathologists to acknowledge this tendency, Heffner warned, will essentially perpetuate it. In the same year, just a few months earlier, Juan Rosai (2 ) argued in favor of the continuing importance of morphology in daily diagnostic practice. These defensive and (to a certain extent) pessimistic articles were primarily prompted by the stated opinion of the director of the National Cancer Institute at the time (http://grants.nih. gov/grants/guide/rfa-files/rfa-ca-98-027.html), to the effect that morphological classification of tumors lacks accuracy in prediction of behavior, prognosis, and response to treatment, a viewpoint that was perceived by many as a nice way to thank surgical pathologists for the services rendered to date and open the door to a molecular taxonomy of neoplasias.