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Hoda's a 'jewel' in Pathology's crown by Cindy Abole Public Relations Since age 11, Rana S. Hoda knew she was going to be a doctor. Dr. Rana Hoda, center, enjoys working with cytopathology fellows Drs. Timothy Kennedy and Joan Cedars. At least that's what her father told his second daughter repeatedly during her early years. Hoda was fortunate to be set on a path that would defy the traditional ways of most Pakistani women.  Through her own courage and supportive upbringing, Hoda was able to break away from suppressed stereotyped traditions of women living in an Islamic state. She was able to enjoy the freedom of pursuing a career that has allowed her to cut her own path through ambitious scientific merits and achievements while balancing her life roles as wife and mother. Since January, Hoda was been the director of MUSC's cytology section and is a fine needle aspiration biopsy specialist, working under the Department of Pathology and Laboratory Medicine.  “Dr. Hoda brings a wealth of experience to our department, having worked with all the giants in the field of cytopathology,” said Janice Lage, M.D., chair of MUSC's Department of Pathology and Laboratory Medicine. “She has a national and international reputation as a leader in the field of cytopathology. She has authored a number of seminal papers in cytopathology literature and contributed to the leading texts in cytopathology.” Growing up in Karachi, Pakistan, Hoda, along with her three sisters grew up to become confident, aspiring and independent professionals, thanks to the guidance of her parents. “My father wanted all of us to be highly-educated professionals,” Hoda said. “At a time when most Pakistani parents were marrying off their daughters, he was busy chalking out our careers. Education was always his prime motivation for us.” After graduating with a degree in biology from the Women's College, she earned her medical degree at Dow Medical College, Karachi University in 1983. In her graduating class few were women. Her first position out of medical school and internship was spent as a medical officer for the Pakistani government's agricultural development bank. Hoda was one of two medical officers who provided basic medical care for ministry staff members and their dependents. Within that year, she was able to identify key public health needs of her patients. She helped establish an immunization program for children and organized a diabetic and hypertension clinic to help patients.  “I never imagined that I would end up here in the United States and doing what I'm doing,” said Hoda, who came to the United States with her husband, Syed, who was beginning a pathology residency at Tulane University in 1985. The pair met in medical school back in Pakistan.  Since Syed's immediate family had already immigrated and settled in Louisiana, Hoda knew the possibility of relocating to the United States was very real. “Moving from one country to another and leaving my immediate family behind was difficult,”  she recalls. “It was a big sacrifice.” But giving up is not part of Hoda's practice. She went on to earn a masters in human genetics from Louisiana State University in 1987. It was also during that time that she gave birth to her son, Raza, in 1988. Hoda's interests in tumor research and genetics led her to a specific path that has helped distinguish her career. An interest in linking basic pathology research and genetics allowed her to complete two residencies with Cornell University Hospital in New York opening up opportunities to work with the field's most distinguished researchers. In 1993, she served a surgical pathology fellowship at Memorial Sloan-Kettering Cancer Center and later completed a one-year cytopathology fellowship at the equally prestigious Montefiore Medical Center, which is affiliated with Albert Einstein Medical College. At Montefiore, she worked under cytopathology pioneer and mentor Leopold G. Koss, M.D. But being a partner in a dual-professional family and working in the same branch of medicine has its ups and downs. At one point in their careers, the Hodas worked in the same pathology department at Cornell's New York Hospital where Syed is a surgical pathologist and director of autopsy service. “It became very challenging to keep our professional and personal lives apart,” Hoda said. “It was not easy. Working under those circumstances can get in the way of either spouse's successes and achievements. Professionally, I think its good for couples working in medicine to have separate workplaces.” It was by coincidence that brought Hoda back south. While working in New York, she met several colleagues who were from Charleston. “I had other options in New York City, before visiting MUSC," Hoda said. “But after meeting Dr. Lage, Dr. Tim Smith and other members of the department staff, I was very pleased with the courtesy they extended to me and impressed by the clinical and academic strength of the department. I thought Charleston was a great place to grow professionally.” Her interests in women's health, especially breast and cervical cancer screenings, supplements her expertise and knowledge in thin-layer Pap testing and needle biopsies. Hoda wants to help educate South Carolina women about the benefits of effective screening tests, while educating clinicians about the advantages of new technologies and diagnostic skills to help improve the quality of Pap tests. Hoda has taken steps to begin expanding cytopatholgy's own offerings, specifically with their  on-sight fine needle (FNA) aspiration service. Needle biopsies are a common procedure and in cases of superficial lesions, the test is performed by a cytopathologist. Deep-seated lesions are studied using radiological-guidance, specifically with an ultrasound and CT. Its purpose is to provide clinicians with a rapid, reliable test for understanding and diagnosing lesions or tumors. According to Hoda, FNA offers more than 90 percent success in diagnostic sensitivity of tumor masses found in the liver, lung, breast, lymph nodes, thyroid glands and other sites of the body. “The presence of a trained cytopathologist during testing can provide clinicians with a clearer diagnosis through enhanced diagnostic sensitivity,” said Hoda. “This collaboration aids in helping to reduce the scheduling of non-diagnostic procedures by providing better service to patients while improving a clinician's quality of work.” In addition, Hoda wants to see more interdepartmental collaboration with family medicine, Hollings Cancer Center, OB-GYN, gastroenterology and other clinical areas. So far, her team has successfully completed preliminart data from a joint study with the Department of Radiology. Its results, among the results of other studies,  have been submitted for the fall meeting of the American Society of Cytopathologists. “As a rising star and expert  in cytopathology, Dr. Hoda brings to MUSC and Charleston a national and international professional outlook and unique combination of useful experiences,” said Tim Smith, M.D., director of anatomic pathology, Department of Pathology and Laboratory Medicine. “She has been educated by two of the giants in cytopathology, Drs. Prabodh K. Gupta (of the University of Pennsylvania) and Koss (of Montefiore Medical Center). Their efforts have obviously found fertile ground.” On May 27, Hoda and MUSC Cytopathology section fellows, Timothy R. Kennedy, M.D., and Joan Cedars, M.D., will present during the annual McKee Memorial Cytology Seminar. The day-long event, which honors the work of former cytopathology director Edward E. McKee, M.D., focuses on educating pathology staff and statewide and regional students regarding new technical procedures, review diagnostic techniques, while reinforcing key benchtop skills. Hoda will speak about special stains and immunocytochemistry in FNA cases, another aspect of cytology testing that aids in diagnosing lesions. At the Department of Pathology's annual farewell party for outgoing residents and fellows, Hoda was presented with the house staff award for excellence in resident training and education. Her dedication to teaching medical students and residents about all aspects of pathology has been continuous throughout her career.  “Dr. Hoda is a gifted pathologist who has devoted herself to the pursuit of excellence in all aspects of cytopathology,” Lage said. “We are extremely fortunate to have recruited someone with her abilities to MUSC. She is a jewel in our crown.”   Commuting professionals: a family affair When cytology director Rana Hoda is not peering into the lens of an Olympus microscope or conferring with other medical colleagues about a special stain, she is commuting between Charleston and New York City. Her purpose is to be with her husband and be a mom to their 11-year-old son, Raza. Commuting is a practice that's not new to the Hoda family.  When Hoda accepted her first job as a cytologist in 1995, she worked at the University of Pennsylvania Medical School in Philadelphia. At the same time her husband, Syed, was working at Cornell's New York Hospital. At home, Raza attended school in Princeton, N.J., a midpoint in the family's daily commute. “For a period of time, my whole family was situated in three different states. Everyone was about 100 miles apart, every day.” But raising children in a dual-professional family which sometimes operate hundreds of miles between parents is not uncommon. For the past year, Pathology chair Janice Lage, M.D., has proved that she can successfully run her department while managing her role as mother to three children in Charleston. Currently, her husband, Mark, a prominent epidemiologist and cancer researcher, is working at the NIH in Bethesda, Md. In less than a month, the Hodas lives will undergo yet another change. Raza will be relocating to the Lowcountry to attend Porter Gaud School and live with his mother.  “With just one child, we always realized that one of us would have to be without our son,” said Hoda. “That's what makes it difficult at times. I know it will be harder on my husband this time.” The couple realized that New York City is not an ideal place to raise their family.  Raza's at an age where he needs more space and openness to try new things and learn to make decisions, she said. It's a period that Hoda can strongly identify with many years ago in a far eastern country thousands of miles away.  “Raza loves Charleston,” she said with a smile. “In some aspects, it reminds him a lot of New York City, minus the big crowds and aggravation. I can see why many transplanted New Yorkers feel much more at home here.”