“I often think of myself as a medical detective” – Dr Mikkaela McCormack on her role as an Anatomical Pathologist

Anatomical Pathology is the branch of pathology that diagnoses disease by studying organs and tissue, so Anatomical Pathologists need a broad understanding of many body systems and diseases.

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!