Rosai 2015 javier arias-stella and his famous reaction

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
International Journal of Gynecological Pathology
34:314–322, Lippincott Williams & Wilkins, Baltimore
r 2015 International Society of Gynecological Pathologists
Eponyms and Entities
Javier Arias-Stella and His Famous Reaction
Juan Rosai, M.D. and Robert H. Young, M.D.
Key Words: Arias-Stella reaction—Javier Arias-Stella, M.D.—History of Pathology.
There are many eponyms in gynecologic patho-
logy, most of them ancient. Some refer to normal
structures of the female genital tract (such as
Bartholin, Wolff, Mu¨ ller), some to clinically insignif-
icant non-neoplastic processes (Naboth), and some to
benign primary and metastatic neoplasms of the
ovary (Brenner, Krukenberg). Among them stands
out an eponym that designates a non-neoplastic
lesion that can be easily confused with a malignant
tumor, universally known as the Arias-Stella reaction
(Fig. 1). This essay is devoted to this phenomenon
and to the man whose discovery the eponym
celebrates. The man in question is Javier Arias-Stella
(Fig. 2), a distinguished pathologist from Lima, Peru´ ,
and much of the story recounted here is a synopsis of
an account he wrote himself some years ago (1).
Dr Arias-Stella, a native of Lima (Peru´ ), graduated
from the School of Medicine of the Universidad
Nacional de San Marcos (Lima) in 1951. He began
his training in pathology while still in medical school
by participating in the activities of the Department
of Pathology. Javier took a particular interest in
gynecologic pathology and personally handled most
of the specimens of that subspecialty. One day he
stumbled on an endometrial curettage specimen from
a 24-yr-old woman who had had a hydatidiform mole
expelled 5 mo before, followed by a hysterectomy. On
pathologic examination, the uterine corpus was
involved by an invasive mole (chorioadenoma des-
truens), but the most interesting changes were present
in the endometrium. Most of the endometrial glands
had an unremarkable secretory look, but others were
lined by highly atypical cells with large, hyper-
chromatic, and irregularly shaped nuclei. The ap-
pearance was highly suggestive of a malignant tumor,
but not one that he or his seniors could recognize.
The changes were finally interpreted as most con-
sistent with an early or in situ stage of endometrial
carcinoma, and their presence was not even men-
tioned in the final pathology report. Javier was very
excited by this finding. He looked in all the books and
journals available to him but found nothing similar.
The lesion in question was beginning to recede in his
memory when a second case appeared, this one in a
34-yr-old woman with an ectopic (tubal) pregnancy.
FIG. 1. Arias-Stella reaction. Marked nuclear pleomorphism is
evident.
From the Centro Diagnostico Italiano, Milan, Italy; Department
of Pathology, University of Utah Medical School, Salt Lake City,
Utah (J.R.); and The James Homer Wright Pathology Laboratories
(R.H.Y.), Massachusetts General Hospital, Harvard Medical
School, Boston, Massachusetts.
The authors declare no conflict of interest.
Address correspondence to Robert H. Young, MD, The James
Homer Wright Pathology Laboratories, Massachusetts General
Hospital, 55 Fruit Street, Boston, MA. E-mail: rhyoung@
partners.org.
314DOI: 10.1097/PGP.0000000000000223

The common denominator of these 2 cases was the
presence of viable chorionic tissue, which led Javier
to consider the possibility that the atypical endome-
trial changes were due to hyperstimulation of the
endometrium by chorionic hormones. Another in-
tensive review of the literature was again unsuccess-
ful, but by this time Javier felt that he had something
remarkable in his hands. By then he had graduated
from medical school and was trying to decide on his
immediate future when another fortunate event
presented to him. The Kellogg Foundation was
giving grants to Latin American institutions to allow
promising young physicians (especially pathologists)
to spend some time as fellows in prestigious medical
centers in the United States. Javier applied and got
one such grant. He was given 3 choices where to
spend the 3 yr of his fellowship: Memorial Sloan
Kettering, Johns Hopkins, and Harvard Medical
School. Having been told that the person regarded as
arguably the best surgical pathologist of the time was
Dr Fred Stewart (Fig. 3) at Memorial, he selected
that institution, reasoning that a superb diagnostician
would ﬁnally identify the nature of the mysterious
occurrence that obsessed him.
At Memorial he found a superb department,
populated by luminaries such as Frank Foote (the
second in command), Philip Lieberman (the propo-
nent of the PNET concept), Sophie Spitz (of Spitz
nevus fame), Arthur Allen (Sophie’s husband and an
expert in renal diseases), and several others. Javier
was one of many fellows (Fig. 4) who rotated through
the various subspecialties, while struggling with his
faltering English but holding his own in the
interpretation of the cases as a result of the intense,
largely autodidactic learning he had gone through
during his Lima years. These initial experiences were
very stimulating, however, they did not deviate Javier
from his original goal. He initially had brought with
FIG. 3. Fred Stewart typing his own consultation report, as he
usually did.
FIG. 2. Javier Arias-Stella, MD.
315JAVIER ARIAS-STELLA AND HIS FAMOUS REACTION
Int J Gynecol Pathol Vol. 34, No. 4, July 2015

him to New York the microscopic slides of those 2
enigmatic cases and was waiting for the right
occasion to show them to Dr Stewart to find out,
once and for all, what they represented. Fred Stewart
impressed Javier as a man of few words and a sober,
almost humble attitude. He kept a certain distance
from the fellows, but once he got to know them he
was warm and friendly. His diagnoses were regarded
as the final verdict by the members of the staff and the
many pathologists from the area who came every
morning to show him their problem cases. Usually,
he shared them with Frank Foote, and after a brief
comment he expressed his final opinion. Around
noon the mail arrived, containing a large number of
cases sent in consultation from other states and from
around the world. Stewart looked at every slide of
every case and dictated his reports in letters that, in
addition to the diagnosis and comments, often
contained a good dose of humor and irony, usually
gentle but sometimes biting. An example of the latter
concerned a breast biopsy sent with the statement
‘‘All the pathologists in our community have seen this
case, and we all think this is benign.’’ Stewart’s reply
was ‘‘Your community needs a good pathologist.
This is cancer.’’ This story still circulates widely in the
Department.
The moment finally came, 2 mo after his arrival,
when Javier, confident that he had reached a stage in
which he could understand and be understood in
English, and after having rehearsed his speech on
numerous occasions, knocked at Dr Stewart’s door.
The ‘‘chief’’ was in a jovial mood and welcomed him
with a ‘‘Hello, Javier, what can I do for you?’’
Encouraged by this warm reception, Javier went
directly to the reason for his visit. While he was going
over the clinical history of the first case, Dr Stewart
put the slide under the microscope and looked at it
without saying a word. The same procedure took
place for the second case. Javier was surprised by the
long time it took Dr Stewart to go over the 2 cases.
FIG. 4. Javier Arias-Stella (standing, far right) with the other second-year Memorial Hospital fellows.
316 ROSAI AND YOUNG

He had expected a quick diagnosis by the master
followed by a key reference that he had missed.
Instead, he remained silent for what appeared to
Javier to be an eternity. Then, suddenly, Dr Stewart
put aside all the slides, turned toward Javier and said
‘‘Javier, I don’t knowy I think you have a problem
to study’’ Javier could not believe his ears. While
leaving Dr Stewart’s office, he reasoned that if the
person acknowledged as the pathologist who knew
more than anybody else about tumors and tumor-like
conditions, did not know what the lesion was, he
might be facing a pathologic change as yet unde-
scribed! And if this change, as he suspected, was the
result of chorionic hormonal overstimulation, it had
to be present in analogous cases. He then remem-
bered the ‘‘Special Collection,’’ an archive of
particularly interesting cases selected by Dr Stewart
and other members of the staff and arranged by site
and diagnosis, which was an invaluable source of
training for the fellows and the pathologists who
spent time in the Department as visitors. Javier
searched in the section of the Special Collection on
gynecologic tumors and selected the 20 or so cases in
which viable chorionic tissue and endometrial glands
were present. He then took those slides to the fellows’
room and started looking at the cases of hydatidi-
form mole, choriocarcinoma, and other chorionic
lesions. As he proceeded with his search, a sense of
excitement overcame him when realizing that the
alterations in question were also present in them. In
some instances they were obvious and in others less
evident, but there was no doubt that they were the
same as those of his 2 flagship cases. He then showed
the specimens to Dr Sophie Spitz. She did not utter a
word, but next day she gave Javier a dozen or so cases
of uterine abortion featuring the same changes.
Frank Foote made his contribution to the study by
lending Javier the book by H. T. Deelman Die
Histopathologie der Uterusmucosa, published in Leip-
zig in 1933. In the chapter on uterine atypias, the
author had illustrated similar alterations but had
interpreted them as trivial inflammatory/degenerative
changes of no functional significance. A final biblio-
graphic search in the encyclopedic Henke-Lubarsch
treatise also gave negative results.
There was yet another potential source of material.
It was the place where he had his first medical
experience in Lima, which happened to be a Women’s
Hospital. With the collaboration of 2 of his former
coworkers, he obtained the paraffin blocks of about
200 cases of uterine abortions and a respectable
number of chorionic tumors. Now the problem was
to have them cut and stained, being that the histology
technicians at Memorial were supposed to do only
the routine work assigned to them on a daily basis,
and that any extra work had to be authorized by the
chief technician and charged $1.50 per slide, a
proposition that Javier could not afford. The solution
was to cut and stain those sections himself in the
Histology Laboratory after hours, after having obtained
the permission from the chief technician to do so.
Examination of this material further confirmed the
original postulate that the alterations occurred only in
the presence and functional activity of chorionic
placental tissue. At that point, Javier decided that the
time was ripe for a paper to be written. Helped with the
English grammar and syntax by 2 colleagues, Javier had
the first draft of the manuscript ready in a few weeks.
After some additional fine tuning, the paper was sent to
the prestigious Archives of Pathology, and 6mo later, in
August 1954, it was published in that journal (2). All was
quiet until the spring of 1956, at which time a paper by
Truemer (3) appeared describing the same changes. A
second paper, of much greater significance for Javier,
was published later on that year. The author was a Dr
Jorgensen, from Odense (Denmark), and was entitled
‘‘Sudden natural death owing to ruptured extrauterine
pregnancy. Report of a case with atypical clinical
features with comments on the Arias-Stella phenomen-
on’’ (4). Javier, who by then was back in Lima, could not
believe his eyes. He had done it! A new entity had been
added to the gynecologic pathology repertoire, and that
entity carried his name. His years of compulsive search
were vindicated, and his name was bound to be
incorporated into the Hall of Fame of that specialty.
Upon his return to Peru´ in 1956, Javier had joined the
faculty of the Department of Pathology, first at the
Universidad Mayor de San Marcos and later at the
Universidad Peruana Cayetano Heredia. He became full
professor and chairman in 1969 at the latter institution.
In subsequent years, he probed further into the
frequency and nature of the remarkable pseudomalig-
nant process he had identified. He was able to induce
similar changes in experimental animals and proposed a
pathogenetic mechanism for its development (5). Varia-
tions in the morphologic appearance led to a proposal of
the existence of 5 histologic variants of this disorder,
based on a comparison with the phases of the normal
endometrium and the degree of atypicality present,
namely: (1) minimal atypia [pattern]; (2) early secretory
pattern; (3) secretory or hypersecretory pattern; (4)
regenerative, proliferative, or nonsecretory pattern; and
(5) monstrous cell pattern. Being bothered by errors and
inaccuracies that he believed had been written about

‘‘his’’ reaction during the 4 decades after his original
description, he thought it was time to clarify and update
the matter, which he did in a comprehensive review in
2002 (5).
Other interesting papers have appeared in subsequent
years, further defining and expanding the entity. These
included the description of the reaction in several
extraendometrial sites, particularly the endocervix (6)
but also the fallopian tube (7), endometriosis (ovarian,
peritoneal, subcutaneous, umbilical) (Fig. 5), vaginal
adenosis, ovarian germinal inclusion cysts, paraovarian
and paratubal cysts, and even ovarian mucinous
cystadenomas and luteal cysts of gestation and puer-
perium (5). Finally, and just to prove that little is specific
in pathology, the Arias-Stella reaction was observed in
the endometrium of nonpregnant perimenopausal or
postmenopausal women taking exogenous hormones (8).
The fact that the reaction can also occur in the normal
human gestational endometrium was conclusively dem-
onstrated by Yolanda Oertel (a distinguished Peruvian
cytopathologist) by examining material from the famous
Hertig collection at the Carnegie Institute, the earliest
case being an endometrium lodging a blastocyst having
an estimated age of 17 days (9).
As often happens when the name of an individual is
associated with a specific disorder, Dr Arias-Stella’s
other contributions to pathology have been somewhat
overshadowed by his momentous discovery. This is
unfortunate, because those contributions are numerous,
wide-ranging, and significant. They span a period of
40yr, from a report of 2 fatal cases of the Jarisch-
Herxheimer reaction to penicillin in a patient with
neurosyphilis (written as a medical student) to a
comprehensive study of a disease endemic to his
country, the Peruvian verruca, part of it carried out
in collaboration with his colleagues and friends at
Memorial Hospital and his son, Javier Arias-Stella, Jr,
who is also an accomplished pathologist (10–13).
Parenthetically, a grandson, of the same name, is also
a pathologist and plans to follow in the footsteps of his
grandfather by spending time at Memorial, specifically
as a surgical pathology fellow in a few years time. Other
articles of the senior Dr Arias-Stella have dealt with the
pathology of high-altitude, cardiovascular diseases in
general, and a host of infectious and neoplastic
disorders (14,15). Dr Arias-Stella was also coeditor of
the journal Patologıá and of a textbook on pathology
produced in collaboration with 3 other luminaries of
Latin American pathology: Pelayo Correa, Ruy Perez
Tamayo, and Luis Carbonell. Among his many
professional accolades, he was particularly proud (for
obvious reasons) to be the recipient of the Fred Stewart
Award (see below).
Last, but not least, and in the best tradition of Latin
American medicine, Dr Arias-Stella transcended the
boundaries of his specialty to address the medical,
FIG. 5. Arias-Stella reaction involving ovarian endometriosis. The
patient was pregnant (case courtesy of Dr Robert Soslow, New
York, NY).
FIG. 6. Javier Arias-Stella in his office of Secretary of State for the
Peruvian Government. The man in the portrait is Ramo´ n Castilla,
former President of Peru´ .
318 ROSAI AND YOUNG

social, and political problems of his country. He has
contributed editorials, essays, and articles to numerous
Peruvian periodicals and newspapers, and he has
participated actively in the political life of Peru´ . He
served as Minister of Public Health from 1963 to 1965
and 1966 to 1968, Minister of Foreign Affairs from
1980 to 1983, and Secretary of State for the Peruvian
Government to the United Nations from 1983 to 1985,
interspersed with periods of exile (Figs. 6–8). On 1
occasion, he was offered by his party to run as a
candidate in Peru´ ’s presidential election, an offer he
wisely declined. His elevated status in the country is
best exemplified by the issuing of a Peruvian postage
stamp carrying his likeness (Fig. 9).
This is a remarkable recognition, which may be the
only one ever granted to a surgical pathologist. In going
over the comprehensive 2-volume book on Medicine and
Stamps edited by R. A. Kyle and M. A. Shapiro, Ph.D.,
of the Mayo Clinic (16) one finds a fair number of
pathologists featured, but not a single card-carrying
FIG. 7. Javier Arias-Stella giving a speech at the United Nations as
Secretary of State for the Peruvian Government.
FIG. 8. Javier Arias-Stella greeting President and Mrs Reagan while Secretary of State for the Peruvian Government.

diagnostic surgical pathologist. There are instead micro-
biologists, parasitologists, chemists and biochemists,
physicists, immunologists, and—of course—many
clinicians and surgeons. As for the anatomic pathol-
ogists included in the catalog, their main activity—
concordant with the philosophy at the time—was
that of general pathologists, teachers, and habitues of
the autopsy room [Xavier Bichat, Jean Charcot, Jean
Corvisart (the personal physician of Napoleon);
Camillo Golgi and Santiago Ramo´ n y Cajal (brilliant
neurohistologists but reluctant neuropathologists);
Carl Rokitansky (anatomic pathologist extraordin-
aire, but wedded to the humoral theory of disease);
and—last but not least—Rudolph Virchow (no
comment needed)]. The only individual in this
prestigious list who could be labeled primarily as a
diagnostician was George Papanicolaou (in a stamp
issued by the United States in 1978), but as we all
know he was not a surgical pathologist. Parentheti-
cally, the 2 other medicine-related individuals por-
trayed in Peruvian postage stamps besides Javier are
Daniel Carrio´ n (a medical student who died after
inoculating himself with the extract from a lesion
of ‘‘verruga peruana’’ to prove that it contained
the etiologic agent of Oroya’s fever, now known as
Carrio´ n disease or bartonellosis) and Jose´ Unanue,
anatomist, educator, and a leader of the war of
Peruvian independence from Spain.
To go back to our main subject, we should mention
that Javier never abandoned his pathology practice
while performing the absorbing public duties listed
above. While living in New York in his capacity of
Peruvian ambassador to the United Nations, he
requested and was granted a small office at Memorial
Hospital to review microscopic slides and work on
various projects.
The seminal contribution made by Dr Arias-Stella
brings up the issue of eponymic designations in
medicine in general and in particular in gynecologic
pathology. At present, their use is discouraged for
several reasons, to wit: (1) eponyms are often
inaccurate, in the sense that sooner or later it is
discovered that the entity in question had already
been identified, described, and illustrated by some-
body else. Examples abound: thyroid Hurthle cells by
Askanazy, Rosai-Dorfman disease by Destombes,
medullary thyroid carcinoma by Laskowsky, malig-
nant cells in cytologic preparations of the uterine
cervix (of Papanicolaou’s fame) by Babes (17) and
many others. (2) Obviously, an eponymic designation
does not give a clue as to the nature of a process.
Actually, it represents the total negation of the
proposal made by a John Wilkins in the 17th century
of an ‘‘analytic language.’’ In it, each word was
defined by itself, in the sense that it contained all the
elements of the object being named. This extravagant
concept was further developed by the legendary
Argentinian writer Jorge Luis Borges (18).
As powerful as those arguments are, they need to
be weighed against the following: (1) an eponym is
often the only recognition that the profession grants
to the individuals who went through the effort of
identifying the distinctiveness of a process, sometimes
facing strong opposition and even ridicule from the
authorities in the field, and who had the courage of
putting that proposal in writing for everybody to
judge its merits. We are somewhat skeptical of the
workers who claim a total lack of interest in having
their name attached to an entity in medicine and
other sciences. Morris Kaposi was true to himself
when naming his disease ‘‘Kaposi sarcoma mihi’’
(Kaposi sarcoma of mine), and Santiago Ramo´ n y
Cajal was right (even if overly dramatic) when stating
that ‘‘each idea is a scientific creature, and that the
author of its existence—the one who gave it life at the
FIG. 9. Peruvian postage stamp honoring Javier Arias-Stella,
generically described as ‘‘Investigador.’’ The finger-like drawings
on the back are representations of Inca-like figures.
320 ROSAI AND YOUNG

cost of great hardship—utters the same outraged cries
on seeing his paternity disregarded as would the
mother who has had the life she nourished within her
snatched away’’ (19). (2) It avoids the difficult and
sometimes impossible task of giving the disease a
scientifically accurate designation. A good example is
the Reed-Sternberg cell of Hodgkin lymphoma. Over
the years, a large number of proposals have been made
regarding its nature: histiocytic, reticulum (dendritic),
lymphocytic, epithelial (thymic), and others. If one had
to change the name of that cell each time a new theory
was advanced, that cell would have today a plethora of
undesirable synonyms. Instead, by just leaving the
original name alone, one did not have to worry about
reaching a potentially incorrect conclusion and could
concentrate instead on the markers that identify it
conclusively. Perhaps the time has arrived, judging by
the sophisticated studies that have been carried on it
‘‘proving’’ that the Reed-Stenberg cell is an activated
B lymphocyte (20). Nonetheless, traditionalists that we
are, we will be quite happy if it stays the Reed-
Sternberg cell, just as we hope Dr Hodgkin will always
be honored by ‘‘his’’ disease.
Before we leave the subject of eponyms, we draw the
attention of the reader to 2 works that can be very helpful
in researching the matter. The first is the book Anatomical
Eponyms by Dobson (21). Although the focus is on
anatomy, as anatomy and histology are the bedrocks of
pathology, it contains many names which will be familiar
to the reader. More specific to the subject at hand,
gynecologic pathology, is the wonderful book of Dr
Harold Speert, first published in 1958 but fortunately
republished in expanded form in 1996 (22). The most
recent work is divided into 10 parts and we find Dr Arias-
Stella in the section dealing with menstruation, pregnancy,
and labor and sharing the title of one chapter with Dr
John Bard, who performed the first operation for ectopic
pregnancy and Lawson Tait, one of the great pioneers of
oophorectomy. Dr Arias-Stella is in good company but so
are they! Any lover of the great tradition of gynecologic
pathology will enjoy perusing Speert’s book, which is
lavishly illustrated, an example of that being the frontis-
piece that shows Montgomery Tubercles, Cullen Sign,
and the Schiller Test.
We now return to the person we honor, as his eponym
is one of the better known in surgical pathology.
FIG. 10. Javier Arias-Stella (sixth from the left) receiving, in 1991, the Fred Stewart Award at Memorial Hospital, flanked by the Pathology
staff (others in the picture left to right are Dr Patricia Saigo, Dr Robert Erlandson, Dr Juan Rosai, Dr Victor Reuter, Dr James Woodruff,
Dr Carlos Cordo` n-Cardo` , Dr Paul Peter Rosen, Dr Steven Sternberg, Dr Andrew Huvos, Dr Philip Leiberman, and Dr Marc Rosenblum).

Fundamental to Dr Arias-Stella’s observation was some-
thing that is crucial in the day-to-day life of diagnostic
pathologists, namely not overinterpreting non-neoplastic
lesions as malignant because of an appearance that at first
glance suggests a neoplastic process. Dr Arias-Stella
revisited this topic in another classic contribution, the first
detailed analysis of the now well-known atypical cytologic
changes seen in seminal vesicle epithelium. In a study (23)
conducted both at Memorial Hospital and in Peru´ , he
and his collaborator studied 152 pairs of seminal vesicles
and elucidated in detail for the first time an observation
that had just been touched upon in limited manner by a
few prior workers. Interestingly, the histology textbooks
that the writers consulted at that time did not mention
what is now an established process, in large part dating
back to Dr Arias-Stella’s paper.
In conclusion, of all the many eponyms in pathology,
few relate to such a crucially important phenomenon with
its implications for patient care as does the Arias-Stella
reaction. That the prestigious award named in honor of
Dr Stewart, himself always aware that probably nothing
is more crucial for the diagnostic pathologist than the
benign versus malignant scenario, would subsequently
have Dr Arias-Stella as an awardee (24) (Fig. 10) is most
appropriate, not only because of the deserved nature of
the honor, but its linkage of 2 luminous figures in the
tradition of our discipline.
ACKNOWLEDGMENTS: The authors would like to
express their sincere thanks to Dr Javier A. Arias-Stella, III
for his great help in providing illustrations. Contact with
him was made possible by Dr Jennifer Stall, the Robert E.
Scully Fellow in Gynecologic Pathology at the Massachu-
setts General Hospital, who is also thanked.
REFERENCES
1. Arias-Stella J. A Scientific Discovery in a Developing Country:
An Example for Medical Researchers. Lima, Peru´ : Universidad
Peruana Cayetano Heredia; 2009.
2. Arias-Stella J. Atypical endometrial changes associated with
the presence of chorionic tissue. Arch Pathol. 1954;58:112–8.
3. Truemer KM. Atypical endometrium associated with unsus-
pected tubal pregnancy. Arch Pathol. 1956;61:149–52.
4. Jorgensen JV. Sudden natural death owing to ruptured extra-
uterine pregnancy; report of a case with atypical clinical
features with comments on the Arias-Stella phenomenon. Acta
Med Leg Soc. 1956;9:311–6.
5. Arias Stella J. The Arias-Stella reaction: facts and fancies four
decades after. Adv Anat Pathol. 2002;9:12–23.
6. Nucci MR, Young RH. Arias-Stella reaction of the endo-
cervix: a report of 18 cases with emphasis on its varied
histology and differential diagnosis. Am J Surg Pathol. 2004;
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7. Milchgrub S, Sandstad J. Arias-Stella reaction in fallopian
tube epithelium. A light and electron microscopic study with a
review of the literature. Am J Clin Pathol. 1991;95:892–5.
8. Huettner PC, Gersell DJ. Arias-Stella reaction in nonpregnant
women: a clinicopathologic study of nine cases. Am J Clin
Pathol. 1994;13:241–7.
9. Oertel YC. The Arias-Stella reaction revisited. Arch Pathol Lab
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15. Frenkel JK, Nelson BM, Arias-Stella J. Immunosuppression
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16. Kyle RA, Shampo MA. Medicine and Stamps. Huntington,
NY: Robert E. Krieger Publishing Co; 1980.
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Me´ thode Babes¸-Papanicolaou. Acta Cytol. 2002;45:1–12.
18. Borges JL. El idioma analı´tico de John Wilkins. In: Borges JR,
ed. Obras completas, Emece´ Editores. Buenos Aires: Emece
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19. Ramo´ n Y Cajal S. Advice for a Young Investigator. Cambridge,
MA: The MIT Press; 1999.
20. Marafioti T, Hummel M, Foss HD, et al. Hodgkin and Reed-
Sternberg cells represent an expansion of a single clone
originating from a germinal center B-cell with functional
immunoglobulin gene rearrangements but defective immuno-
globulin transcription. Blood. 2000;95:1443–50.
21. Dobson JA. Anatomical Eponyms. Edinburgh: E&S Living-
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22. Speert H. Obstetric and Gynecologic Milestones Illustrated.
New York: Parthenon Publishing Group; 1996.
23. Arias-Stella J, Takano-Moron J. Atypical epithelial cells in the
seminal vesicle. Arch Pathol. 1958;66:761–6.
24. Rosai J. 14th
Recipient of the Fred W. Stewart Award: Javier
Arias-Stella, MD. Am J Surg Pathol. 1992;16:632.
322 ROSAI AND YOUNG

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