We asked Dr Mikkaela McCormack, an Anatomical Pathologist in one of Victoria’s busiest labs, what led her into Anatomical Pathology and why she loves her job.

What made you decide to become an Anatomical Pathologist?

I first developed an interest in forensic pathology in high school, fuelled by my need to know the ‘whys’ of everything, combined with a strong scientific curiosity, a compulsion to problem solve, and a desire to help people.

I studied medicine and law at university, and after completing my final year elective at the Victorian Institute of Forensic Medicine I set my sights on specialising in forensic pathology.

I’d heard the best grounding for becoming a great forensic pathologist was being a good anatomical pathologist, so I made this my goal.  As I trained in both however, I realised that what had really enamoured me with pathology was the opportunity to give answers to questions in an engaging and intellectually interesting way.  Anatomical pathology allowed me to do this in a more wide-ranging fashion and working with living patients meant I could potentially have a positive impact on their lives.

What does a typical day look like for you?

On any given day I will ‘see’ 30 to 80 patients – well, I will see their tissue specimens under my microscope! I analyse their slides and provide their referring doctors with written reports outlining my diagnosis.

Most can be given answers based on simple histology sections, but many will require additional testing of antibodies, special staining techniques or increasingly, genetic testing that I will also need to interpret.

This is interspersed with various other responsibilities including guiding trainees on dissecting and sampling specimens, discussing difficult cases with colleagues (good pathologists are collaborative pathologists), attending multidisciplinary cancer meetings on complex patients, speaking with general practitioners, medical specialists and occasionally patients regarding their results, and working with clinical and academic colleagues on research projects.

I am also involved in business strategy, innovation and marketing for our organisation, which further fuels my enthusiasm for the profession.

What makes your job satisfying?

My work provides me with an endless and wide-ranging supply of questions to answer and problems to solve, to help patients from all walks of life.

I often think of myself as a medical detective; I find and decipher the clues within patients’ specimens and I use my knowledge and experience to solve the mystery of what pathological process was occurring in that tissue.

My answers need to be of the highest standard and dependability as they will direct other medical specialists in how to manage and treat those patients; they can be the difference between life and death.  This motivates my practice as a pathologist, and the knowledge that what I do positively affects people’s lives in a meaningful way is what makes my work satisfying – even if most of them aren’t aware of my existence!

Our specialty is in a constant state of fast-paced change, as we learn more about diseases thanks to scientific and technological advances. This requires constant learning and improving across multiple medical specialist areas. I also get to work collaboratively with other specialties, research institutions and industries to drive research, innovation, scientific discovery and the delivery of up to date and accessible medicine.

This is all incredibly exciting and makes it very easy to remain engaged in my career!

What are the most common conditions and samples that you deal with?

The nature of anatomical pathology means I work across multiple body systems, so on any given day I may diagnose a range of benign and neoplastic diseases within almost any organ, including breast, skin, lung, liver, bone, lymph node, gastrointestinal system or gynaecological system.

It is also important however, to foster a greater level of expertise within a smaller number of sub-speciality areas.  I am our laboratory’s main breast pathologist; I am involved in the daily diagnosis and management of benign and malignant breast disease and I also participate in multi-institutional breast cancer research.  My other areas of interest are in skin (neoplastic, inflammatory skin conditions and alopecia), urology (most commonly prostate specimens), and gastrointestinal and thyroid pathology.

What is the most unusual diagnosis you have made since working in pathology?

As a trainee, I examined a set of lungs from a young transplant patient suffering from a rare condition called lymphangioleiomyomatosis (LAM lung disease), which causes muscle cells in the lungs to multiply abnormally. This results in the formation of many large cysts, which can rupture and cause serious complications. The lungs also contained several small nodules, and when I examined them they showed features of a second disease, angiomyolipoma (AML).

These two diseases are classically found in patients with a genetic condition called tuberous sclerosis, but AML almost always occurs in the kidney. At that time the phenomenon of these small tumours also occurring in the lungs had not even been described in the literature.

What is your most memorable moment working in pathology?

Undertaking my first autopsy would have to be the moment in my career that holds the most meaning for me.  It is in some ways the most intimate and intrusive procedure we perform in medicine, and I felt the gravity and respect that comes with that. Whilst I don’t perform autopsies these days, I think that was the moment I first understood what it truly meant to be a pathologist.

What advice would you give to students or young people considering pathology careers?

Pathology is a slightly mysterious area of medicine, including for medical students and other doctors. The only way to know if you’d be interested in a career in pathology is to spend time within real pathology laboratories – meet the pathologists, scientists and support staff, ask them for honest answers to hundreds of questions about working in the laboratory. Observe, experience and get involved in the tasks that are part of the job. Then ask yourself if you could do those things for at least the next 5-10 years!

The post “I often think of myself as a medical detective” – Dr Mikkaela McCormack on her role as an Anatomical Pathologist first appeared on Know Pathology Know Healthcare.

Many of us are familiar with the breathalyser test used by police to check the blood alcohol level of drivers. Drug and alcohol tests are also common in many industries such as mining and aviation for safety reasons. Sport is another area where pathology results from drug tests are vital to maintain a fair playing field.

However, the area where pathology plays its most starring role in criminal cases is forensic pathology.

Crime scene investigation

Although forensic pathology makes up a small proportion of the profession, it receives possibly the most attention via TV crime dramas and real-crime shows.

Crime scene work is usually slower and more painstaking than TV producers would have us believe, but it is true that DNA evidence has transformed criminal investigations in the last 30 years.

Testing blood from crime scenes first began in the early 1900s but testing was limited and could only establish the ABO blood type of a sample. This meant it could be used to rule out suspects with a different blood type but could not accurately identify who the blood came from.

‘DNA fingerprinting’ was first developed by Professor Alec Jeffreys in Leicester, UK in the early 1980s. The technique used photographic film and radioactive probes on blood samples to create a picture of a person’s DNA.

The process was not created specifically for legal cases but once discovered, it was clear that the technique had some very important applications; these included paternity testing and crime scene investigation.

Prof Jeffreys and his team needed to establish if DNA fingerprinting could be used as evidence in criminal cases; “I spent the next two days cutting myself and leaving blood marks round the laboratory. Then we tested those bloodstains and found that their DNA was intact.” ¹

The first use of the technology was in a legal case that proved the parenthood of a child returning to the UK from Ghana; the DNA evidence meant he could be united with his family. The second DNA fingerprinting case freed an innocent man and put a double-murderer in prison.

DNA amplification has expanded the possibilities of using crime scene DNA by allowing genetic data to be extracted from very small samples. Using polymerase chain reaction (PCR) a small amount of DNA can be replicated many times to produce a sample large enough to be analysed.

Autopsies

Forensic pathologists also perform autopsies that are vital in determining the cause of death when a person dies in unexpected or suspicious circumstances, or when human remains are discovered.

For criminal cases, an autopsy may be observed by police who will then feed information back to colleagues in the interrogation room. This real-time delivery allows the police to use the information immediately while questioning suspects.

Identifying a cause of death helps police ascertain if a crime has taken place, but it is also important for public health. Information provided by forensic pathologists to the coroner identifies hazards in the community that might be prevented, saving future lives.

Autopsies are also important during disease outbreaks and to identify who has died and who is still missing during natural disasters.

Most pathologists do not usually meet their patients or patients’ families but forensic pathologists have a different relationship with those they are helping, working directly on the patient’s body and sometimes meeting the family of the deceased.

¹ https://www.theguardian.com/science/2009/may/24/dna-fingerprinting-alec-jeffreys

The post Forensic pathology: when the lab meets the law first appeared on Know Pathology Know Healthcare.