Robert E. Scully, M.D., Emeritus Professor of Pathology at Harvard Medical School and on the faculty of the Massachusetts General Hospital (MGH) for over 50 years, one of the foremost diagnostic pathologists, and in the opinion of most, the leading gynecologic pathologist of the last half century, passed away on October 30, 2012.Dr. Scully was a long-time member of The Society of Gynecologic Oncologists, and one of the few pathologist members. He was fully cognizant that patient care was the ultimate responsibility of the pathologist and opinions should be rendered with full awareness of what might, or might not, be done by a treating clinician as a consequence of the report. He always stressed the importance of the clinical background and its potential impact on the pathologic interpretation. He was active in the International Federation of Gynecologists and Obstetricians (FIGO), serving on its gynecologic-oncology committee.One of Dr. Scully's earliest significant contributions to clinical care was in the 1960s. FIGO had been working on a classification of ovarian tumors, and when the World Health Organization (WHO) decided also to do so, they encouraged those who worked on the classification of ovarian tumors under Dr. Scully's leadership to follow the initial approaches of the FIGO group. Although Dr. Scully placed his own stamp on that classification, he was aware that, as he said elsewhere, “Alteration of its classification and nomenclature by another international organization would result in considerable confusion.” He always cautioned against change for the sake of change. Therefore to the extent possible, he followed the lead of the luminaries in the FIGO group such as Dr. Hans-Ludwig Kottmeier, chief of the gynecology service at the Radiumhemmet in Stockholm, Dr. Lars Santesson, Dr. Gunnar Teilum, and Dr. Howard C. Taylor.Dr. Scully worked at the MGH with a legendary early figure of gynecologic-oncology, Dr. Joseph Meigs, and knew well most of the eminent gynecologic-oncologists of subsequent generations. Mention should be made of his friendship and work with Dr. Arthur L. Herbst on the well known diethylstilbestrol story. The classification of ovarian tumors by the WHO under Dr. Scully's direction was a great improvement over earlier ones, and remains the foundation for the current scheme. He continued to participate in WHO activities in later years, guiding the next ovarian tumor classification and that of all female genital tract neoplasms published in the 1990s.Although remembered primarily for his contributions to gynecologic pathology, Dr. Scully was a classically trained general anatomic pathologist with considerable experience with autopsy pathology and all areas of surgical pathology. Anyone who looked at cases with Dr. Scully quickly became aware that they were sitting with one of the great practitioners of surgical pathology. His eye was legendary not only because of the speed with which he would make difficult diagnoses but because of his great attention to detail and preparedness, if necessary, to study a very difficult case relentlessly, making sure he left no stone unturned in arriving at the correct diagnosis.Dr. Scully published over 320 original papers; within that body of work are descriptions of many new entities, including juvenile granulosa cell tumor, sclerosing stromal tumor, small cell carcinoma of hypercalcemic type, and müllerian adenosarcoma. He also wrote two Armed Forces Institute of Pathology fascicles on the ovary. For three decades in the middle to later years of his career when he was busy with routine work, a heavy load of consultation cases, and writing many original papers, Dr. Scully also was initially associate editor and then for 27 years editor of the Case Records of the MGH. Dr. Scully nonetheless was a man of wide interests, following sports, particularly his beloved Boston Red Sox, and the wider world, with an interest in politics and the arts.Dr. Scully will be remembered by all who worked with him for not only his remarkable talents as a physician but also his personal qualities. One could not wish for a better mentor. He was gentle and never expressed exasperation, although surely he must have been on occasion, as few if any could match his standards. He was simply loved by all who became close to him, and many pathologists from diverse countries have remarkable affection for a person who represented all that is best about humanity.Dr. Scully received too many awards to mention, but the Fred W. Stewart Award of Memorial Sloan Kettering Cancer Center in New York and Honorary Fellowship in the Royal College of Pathologists are among the highlights. In May 2012, he was the first pathologist to receive the Lifetime Achievement Award of the Massachusetts Medical Society. A named Professorship of Pathology in his honor was instituted at Harvard Medical School in the mid-1990s. Dr. Scully, along with the great German pathologist Dr. Robert Meyer, will be considered by many to stand above all others in the field of gynecologic pathology.Dr. Scully was born on August 31, 1921. His father died of pneumonia three months later, so he was brought up solely by his mother, a schoolteacher. Dr. Scully graduated from the College of the Holy Cross in Worcester, Massachusetts in 1941 and then from Harvard Medical School in 1944. He trained in pathology primarily at the then Peter Bent Brigham Hospital. In 1950, Dr. Tracy B. Mallory, the then Chief of Pathology at the MGH recruited him to join his faculty. He took that position in 1950, but spent two years abroad serving in the United States Army during the Korean War, returning to the hospital in 1954. From then on, Dr. Scully worked amazingly hard for the rest of his career until in his mid-80s his health made it impossible for him to work. Dr. Scully suffered a massive stroke four days before he died, did not regain consciousness, and died peacefully at the MGH. Robert E. Scully, M.D., Emeritus Professor of Pathology at Harvard Medical School and on the faculty of the Massachusetts General Hospital (MGH) for over 50 years, one of the foremost diagnostic pathologists, and in the opinion of most, the leading gynecologic pathologist of the last half century, passed away on October 30, 2012. Dr. Scully was a long-time member of The Society of Gynecologic Oncologists, and one of the few pathologist members. He was fully cognizant that patient care was the ultimate responsibility of the pathologist and opinions should be rendered with full awareness of what might, or might not, be done by a treating clinician as a consequence of the report. He always stressed the importance of the clinical background and its potential impact on the pathologic interpretation. He was active in the International Federation of Gynecologists and Obstetricians (FIGO), serving on its gynecologic-oncology committee. One of Dr. Scully's earliest significant contributions to clinical care was in the 1960s. FIGO had been working on a classification of ovarian tumors, and when the World Health Organization (WHO) decided also to do so, they encouraged those who worked on the classification of ovarian tumors under Dr. Scully's leadership to follow the initial approaches of the FIGO group. Although Dr. Scully placed his own stamp on that classification, he was aware that, as he said elsewhere, “Alteration of its classification and nomenclature by another international organization would result in considerable confusion.” He always cautioned against change for the sake of change. Therefore to the extent possible, he followed the lead of the luminaries in the FIGO group such as Dr. Hans-Ludwig Kottmeier, chief of the gynecology service at the Radiumhemmet in Stockholm, Dr. Lars Santesson, Dr. Gunnar Teilum, and Dr. Howard C. Taylor. Dr. Scully worked at the MGH with a legendary early figure of gynecologic-oncology, Dr. Joseph Meigs, and knew well most of the eminent gynecologic-oncologists of subsequent generations. Mention should be made of his friendship and work with Dr. Arthur L. Herbst on the well known diethylstilbestrol story. The classification of ovarian tumors by the WHO under Dr. Scully's direction was a great improvement over earlier ones, and remains the foundation for the current scheme. He continued to participate in WHO activities in later years, guiding the next ovarian tumor classification and that of all female genital tract neoplasms published in the 1990s. Although remembered primarily for his contributions to gynecologic pathology, Dr. Scully was a classically trained general anatomic pathologist with considerable experience with autopsy pathology and all areas of surgical pathology. Anyone who looked at cases with Dr. Scully quickly became aware that they were sitting with one of the great practitioners of surgical pathology. His eye was legendary not only because of the speed with which he would make difficult diagnoses but because of his great attention to detail and preparedness, if necessary, to study a very difficult case relentlessly, making sure he left no stone unturned in arriving at the correct diagnosis. Dr. Scully published over 320 original papers; within that body of work are descriptions of many new entities, including juvenile granulosa cell tumor, sclerosing stromal tumor, small cell carcinoma of hypercalcemic type, and müllerian adenosarcoma. He also wrote two Armed Forces Institute of Pathology fascicles on the ovary. For three decades in the middle to later years of his career when he was busy with routine work, a heavy load of consultation cases, and writing many original papers, Dr. Scully also was initially associate editor and then for 27 years editor of the Case Records of the MGH. Dr. Scully nonetheless was a man of wide interests, following sports, particularly his beloved Boston Red Sox, and the wider world, with an interest in politics and the arts. Dr. Scully will be remembered by all who worked with him for not only his remarkable talents as a physician but also his personal qualities. One could not wish for a better mentor. He was gentle and never expressed exasperation, although surely he must have been on occasion, as few if any could match his standards. He was simply loved by all who became close to him, and many pathologists from diverse countries have remarkable affection for a person who represented all that is best about humanity. Dr. Scully received too many awards to mention, but the Fred W. Stewart Award of Memorial Sloan Kettering Cancer Center in New York and Honorary Fellowship in the Royal College of Pathologists are among the highlights. In May 2012, he was the first pathologist to receive the Lifetime Achievement Award of the Massachusetts Medical Society. A named Professorship of Pathology in his honor was instituted at Harvard Medical School in the mid-1990s. Dr. Scully, along with the great German pathologist Dr. Robert Meyer, will be considered by many to stand above all others in the field of gynecologic pathology. Dr. Scully was born on August 31, 1921. His father died of pneumonia three months later, so he was brought up solely by his mother, a schoolteacher. Dr. Scully graduated from the College of the Holy Cross in Worcester, Massachusetts in 1941 and then from Harvard Medical School in 1944. He trained in pathology primarily at the then Peter Bent Brigham Hospital. In 1950, Dr. Tracy B. Mallory, the then Chief of Pathology at the MGH recruited him to join his faculty. He took that position in 1950, but spent two years abroad serving in the United States Army during the Korean War, returning to the hospital in 1954. From then on, Dr. Scully worked amazingly hard for the rest of his career until in his mid-80s his health made it impossible for him to work. Dr. Scully suffered a massive stroke four days before he died, did not regain consciousness, and died peacefully at the MGH.

120 Krukenberg tumors were analyzed with emphasis on their wide microscopic spectrum and resultant problems in differential diagnosis. The patients ranged from 13 to 84 years (average, 45 years) with 43% of them under 40 years. Abdominal swelling or pain usually accounted for the clinical presentation, but 17 had abnormal vaginal bleeding, 4 had virilization, and 4 had hirsutism without virilization. Ascites was present in 43% of the cases. Sixty-three percent of the tumors were documented to be bilateral, but both ovaries were not always removed or rigorously examined microscopically. The mean diameter of the tumors was 10.4 cm, and they typically had intact, bosselated external surfaces without adhesions. The sectioned surfaces were typically solid and firm to edematous to gelatinous; one third of the tumors also had cysts. Microscopic examination showed great variation from case to case and within individual neoplasms. Multiple nodules separated by normal stroma were seen in small neoplasms and focally in many larger ones. The tumors were often more cellular at their periphery and edematous to gelatinous centrally. An irregular distribution of cellular and less cellular areas often imparted a pseudolobular pattern. The cellularity of the stroma ranged from densely cellular to paucicellular; the latter regions ranged from edematous to mucoid. The overall morphology varied according to the prominence of signet-ring cells, extracellular mucin, edema, and various epithelial patterns. Signet-ring cells were numerous in most neoplasms (and by definition occupied at least 10% of the neoplasm) but were often absent or inconspicuous in significant areas of them. The signet-ring cells typically had modest but sometimes copious amounts of pale to basophilic cytoplasm; occasionally, it was eosinophilic. The signet-ring cells varied widely in their arrangement, growing singly, in clusters, forming confluent masses or pseudo-tubular arrays or lining part of all of a true tubule. Small glands and tubules were common, often resembling microcysts (when the lining cells were flattened) or Sertoli tubules; mucinous glands and cysts and medium-sized to large intestinal-type glands were also relatively common, particularly the latter. Extracellular mucin was often conspicuous and, when associated with scant acellular collagenous stroma, gave a distinctive appearance referred to by us as “feathery degeneration.” Stromal luteinization was present in the tumors of the 8 pregnant patients and was seen in 14% of the nonpregnant patients. Unusual features that complicated the microscopic picture included diffuse sheets or other arrangements of mucin-free indifferent cells, squamous cells, clear cells, transitional cells, and corded, trabecular, and insular patterns. Vascular space invasion was common. Two thirds of the primary carcinomas were detected synchronously with, or subsequent to, detection of the Krukenberg tumor compounding the diagnostic difficulty posed by the cases. Two thirds of the primary tumors were in the stomach; other primary sites in order of frequency were appendix, colon, breast, small intestine, rectum, gallbladder, and urinary bladder. Our observations emphasize that the microscopic spectrum of the Krukenberg tumor is broader that often presented in the literature, in particular tubules, glands, and cysts often being present, and the wide pathologic differential diagnosis is discussed.

Presentation of Case A 61-year-old man was admitted to the hospital because of transient quadriplegia and apnea. The patient had been well until the morning of admission, when stiffness and pain developed in his neck after he turned his head. The pain was followed by numbness and “electric” sensations in his arms and legs. Within 10 minutes, his arms and legs became paralyzed, and he was unable to speak. Emergency medical technicians found him apneic, pulseless, and unresponsive. Cardiopulmonary resuscitation was successful after one minute. On arrival at a nearby hospital, he was able to move his arms and legs. . . .