Chow, Chung Wo (aka CW)
Born: 14/02/1945
Early Life
CW was born in Kunming, capital city of the Yunnan Province in the South West of China, bordering Burma (now Myanmar) in early 1945, a few months before the end of World War II. His father was lieutenant colonel in the Chinese Nationalist Armed Forces, involved in the antiaircraft artillery service and maintenance of the airfield.
There was panic in the family as it looked likely that CW would be born on Lunar New Year Day. In the tradition of the place where his parents were from it was believed that those born on New Year Day were destined to become beggars. Being a good although rather slow baby, he took his time and arrived in the morning of the second day of the New Year, much to the relief of his mother and particularly his grandmother.
According to his mother, ever since CW was born they had not heard any siren of the bombing raids of the Japanese aeroplanes at all. That was his earliest contribution to world peace.
After the war his father left the armed services and took up a teaching post in Guangzhou in a commercial ship sailing school. That was actually his original job before the war. CW could remember some huge shells that the students of his father brought back from trips to the islands in the South China Sea. In 1949 the Nationalist Army was defeated, and Guangzhou was in utter chaos with all the retreating soldiers. At that time his parents had no idea who the Communists were and what they would do. Father thought the Communists were out to get rich people and the family should be safe as we didn’t have any money. Mother however thought that the chaos was too dangerous. “How bad could these Communists be. They couldn’t possibly be worse than the Japanese. Even they left after a few years. Let’s go to Hong Kong, wait until things have settled down, then we can come home”. So the family bought the train tickets and arrived in Hong Kong on 10th October 1949. Four days later Guangzhou was liberated. The Communists arrived, stayed and are still there 73 years later. The Chow family has not been very good in seeing what lies in the future.
Education and Early Career
CW grew up in Hong Kong and studied Medicine at the University of Hong Kong. Following graduation in 1969 and a year as Houseman (equivalent to Junior Resident) he started training in Pathology at the Queen Mary Hospital. One day in 1972, Alan Williams, Director of Pathology at the Royal Children’s Hospital came up to the department and started talking with the staff. He asked if CW would be interested in seeing some diseases in children, so CW came down to Melbourne in 1973 and spent a valuable year as registrar with Peter Campbell. He returned to Hong Kong in early 1974. In 1975 he did the fellowship examination of the Royal College of Pathologists of Australasia and went to Sydney for the practical and viva. After the examination he came down to Melbourne to say hello to some colleagues and friends. Peter Campbell indicated that he had become head of his own Department, Anatomical Pathology, and asked if CW would be interested in coming back to be a specialist. He was very happy to accept the offer and returned to RCH in April 1976.
Work at RCH
Work at RCH was most interesting but very demanding for a small department as anatomical pathology had to meet the needs of many different disciplines from general paediatric surgery to neurosurgery, orthopaedic surgery, cardiac surgery etc and various medical specialties from oncology to neurology to clinical genetics. In the early days there were many deaths from congenital heart diseases and dissection at autopsy consumed a lot of time. Fortunately Peter Campbell was a very good and patient teacher and he had established an extremely close and cordial working relationship with the clinical colleagues and there were many clinicopathological meetings to discuss various problems and colleagues could learn together. Also these meetings often provided stimulation for clinical research into areas of uncertainty. One area was the anatomical diagnosis of genetic diseases involving the central nervous system which became the title of an MD thesis, encouraged by David Danks, Professor of Paediatrics and Ross Anderson, Consultant Neuropathologist. One topic in the thesis was the morphological diagnosis of X-linked hydrocephalus. The study showed for the first time that the total absence of the pyramidal tracts in transverse sections of the medulla oblongata was an extremely reliable morphological hallmark of the condition in the proper context. Similar to many other genetic diseases the diagnosis was quite quickly overtaken by molecular studies, by identification of mutations in the L1-CAM gene.
Starting from the 1970s there were rapid changes and advancements in the practice of anatomical pathology. Morphology was starting to be combined with chemistry (e.g. enzyme histochemistry), immunology (immunofluorescence and later immunohistochemistry) and molecular biology (e.g. in-situ hybridization). Also histological assessment was being increasingly correlated with the results of other investigations such as cytogenetics and molecular genetics (e.g. PCR, RT-PCR and Anchored Multiplex PCR).
Enzyme histochemistry was fashionable for a while, especially in the study of diseases of the skeletal muscle. It is very little used now, except in the diagnosis of Hirschsprung’s disease. Acetylcholinesterase has been shown by the group at RCH to be the best, easiest and fastest method of diagnosis, providing a very reliable answer in 2 hours. CW still thinks it is more superior to all the other methods of diagnosis proposed so far.
Immunohistochemistry is still widely used, especially in the diagnosis of tumours and kidney diseases.
Cytogenetic and molecular techniques were introduced and developed in various areas at RCH, especially the MCRI. Facilities had been available to help anatomical pathology and there was close collaboration in many areas. Early on cytogenetics provided a lot of very valuable information for the diagnosis of tumours in which the cell of origin and minimum diagnostic criteria were uncertain. One example was Ewing’s sarcoma. Early reports of primary Ewing’s sarcomas of the skin were generally not believed and ignored until it was first shown at RCH that such tumours were associated with the same t(11;22) translocation. More importantly it was shown that such tumours, if relatively small, could be treated and cured by wide local excision without chemotherapy.
Although wonderful, cytogenetics was often considered to be difficult to learn and interpret, labour intensive, expensive and slow, and was gradually replaced by better molecular techniques, such as PCR, RT-PCR and later Anchored Multiplex PCR. The last is particularly useful when only one partner in a fusion gene is known. In 2005 CW noticed that the histiocytes in the liver biopsy from a young infant with hepatosplenomegaly, gross ascites, difficulty in ventilation and pancytopenia with extreme thromobocytopenia were +ve for ALK1 on immunohistochemistry. In situ hybridization showed that the ALK gene was split. The clinical assessment was that the prognosis was poor. As the features reminded CW of a case he received for consultation from Hong Kong a few years earlier, he rang his colleagues at the Queen Elizabeth Hospital who checked their biopsy and the histiocytes were also +ve. Their patient was treated with chemotherapy with marginal improvement, but to their amazement she very slowly and gradually improved with supportive treatment only and recovered a few months later apparently mainly spontaneously. This was also the course followed by the patient at RCH, whose sample was found by colleagues in France to show TPM3-ALK fusion gene. Another case was found in Hong Kong and the small series of 3 cases was published in BLOOD as a novel entity, ALK +ve histiocytosis. However WHO refused to accept this as a new entity. In the following years more cases were collected here and overseas with solitary and disseminated forms in adults and in children, including an intracranial lesion which melted away with targeted anti-ALK therapy using crizotinib. Anchored multiplex PCR had just been developed and a colleague in Singapore analysed these cases and found that the overwhelming majority had KIF5B-ALK fusion. The different fusion gene in our first patient seems to be an outlier. With the publication of this larger series and a highly characteristic, consistent and easy to check fusion gene ALK +ve Histiocytosis was finally accepted by WHO as a distinct entity and numerous reports have appeared since.
CW has always been interested in registrar teaching and has collected a very large system by system collection of teaching material which is still kept within the department. He served as an examiner for the RCPA for 20 years
Chinese Connection
In 2002 the Medical Director of Guangzhou Children’s Hospital visited RCH, and CW was asked if he would be interested to go and assess their Department of Pathology and make suggestions to improve the service. So after 53 years CW returned to China. Following this CW was able to invite four pathologists from Guangzhou, Shanghai, and Beijing to come to RCH and spend 1 year each to receive training in diagnostic paediatric pathology and take part in research and development. In the following years CW visited another 10 Chinese children’s hospitals, to encourage more cooperation with clinicians, more financial support from administration for pathology and the formation of a Cooperative Group of Paediatric Pathologists of Eastern China. CW was appointed as Visiting Professor at the Shanghai Children’s Medical Centre and the Hunan Children’s Hospital. Over the past two decades one could see rapid improvement in their standards, largely due to the fast improvement in their financial situation resulting in more opportunities for education and facilities for special investigations.
Stepping Down
In 2010 having reached the age of 65, CW stood down as department head and started working part time. With the return of an excellent colleague who had finished her training including one year at the Hospital for Sick Children in Toronto, and after a brief period of working together, CW retired in January 2019.
Looking Back
If one can start one’s career after medical school again
1. CW will probably choose clinical work which seems to be more rewarding interacting with patients and parents, especially from seeing cured patients. This was felt very strongly some years ago during a visit to Hanoi, through the kind arrangement and support of Garry Warne. CW was shown a section of the liver from the autopsy of a neonate, who died after severe liver failure, the third consecutive case in the family. After reviewing the whole case the diagnosis of neonatal haemochromatosis (gestational alloimmune liver disease), which the Vietnamese doctors had not heard of, was made. The mother was pregnant again and it was suggested that they should contact Dr Peter Whitington in USA, who was the authority on the condition for help on management. On returning to Hanoi 18 months later the hepatologist said she wanted to show CW a case of neonatal haemochromatosis. He asked to be shown the slides. She said “Not slides, the baby!”. She then brought in the mother holding a lovely healthy bouncing baby. For clinicians this is something which happens almost every day. For a pathologist there was so much more joy in seeing the baby than seeing the slides. Perhaps it was only because of the novelty, or perhaps the grass is always greener next door.
2. If CW does choose to do pathology it would be much better to join a much bigger unit so that there would be more opportunity, time and facilities to do research. Working in a small department and trying to meet the needs of many different colleagues is very interesting and satisfying but it would be more stimulating to have a larger research component.
But such is life. One can’t go back.
CW is married to Christine and they have a daughter Lesley.
.jpg "CWfamily")