On a Mission to Educate

Why pathology?

Pathology derives from the combination of the Hellenic words: “pathos - πάθος” meaning suffering, and the ending “- logy” deriving from “logia” – λέγειν” meaning the study of a certain science. It’s the basis of medicine, the study of the essential origin and nature of diseases, based on the structural and functional changes produced by them.

I first used a microscope as a first year medical student. During my biology lab work, I had to observe a specimen of Borrelia obermaier, a spirillum species causing relapsing fever, transmitted by bedbugs. I was deeply impressed, entering a wonderful microcosm, and I felt that I was ready to explore it. When I began clinical courses I realized that through pathology you can have a deep insight into the causal factors and explore the mechanisms of disease. Pathology is the ultimate tool to prove the truth, the final diagnosis that, as a rule, cannot be disputed. These thoughts led me, without any hesitation, to start my residency in pathology. Two years after I had completed my specialty I was able to support my PhD thesis defense. Meanwhile, I was involved in several research projects and started publishing my results.

How did you get to where you are now?

After 10 years practicing diagnostic pathology, during which time I obtained enough experience as a solid morphologist, I decided to dedicate myself to endocrine pathology, with an additional interest in neuropathology and neuroendocrinology. As soon as I received a fellowship from the Hellenic National Health System, I joined my mentor professor Kalman Kovacs at the University of Toronto. On returning to Greece, I was able to establish the National Pituitary Reference Center at the Department of Pathology, “G. Gennimatas” General Hospital of Athens, and I was appointed Research Associate by the Laboratory of the University of Athens. I also visited the Mayo Clinic in Rochester, Minnesota twice, to get experience in neuropathology alongside Bernd Scheithauer. My collaboration with Scheithauer and Kovacs continued for 16 years. In 1993, I received funding support from the Medical Research Council of Canada and the next year I was appointed as Visiting Professor by the University of Toronto.

My interest in neuroendocrine tumors and the investigation of their immunoprofile led to the establishment of a reference database. As a result, I was appointed as Research Associate by the Department of Pathophysiology at the University of Athens.

What areas of research have most interested you during your career?

I mostly focused on pituitary tumors, and contributed to book chapters and to the WHO classification of endocrine tumors. My work included pharmacodynamics experiments on octreotide effect of dispersed tissue cultures of somatotroph adenomas and investigation of their somatostatin receptors, in relation to clinical treatment. I would count recognition of double and multiple pituitary adenomas as one of my most important contributions. I would also consider my studies on apoptosis in pituitary adenomas important, because at the time this process was not recognized, so this was pioneering work. I was able to describe in detail the spectrum of apoptotic processes at histologic and electronic microscopic levels. Finally, my systematic investigation of null cell adenomas gave me the chance to prove that the substantial majority of these tumors represent gonadotroph adenomas.

As President Elect of the International Academy of Pathology, what do you see as the key issues facing the field?

The International Academy of Pathology is the largest pathology society with approximately 20,000 members and 52 divisions worldwide. I served for the last 10 years as Vice President for Europe, and I have seen a wide diversity of education levels in pathology among countries. Some countries are underserved in pathology and they deserve support; education needs to be improved upon as much as possible. A crucial way to offer assistance is through ambassadors, an idea that was introduced three years ago by Kristin Henry, former President of the academy – these are highly respected pathologists who are also experienced teachers. They are often invited by under-resourced divisions or countries which have not yet formed a division for the sole purpose of education. I had the chance to undertake a mission as IAP ambassador in separate visits to Turkey and Georgia. I found this extremely important with high participation, enthusiasm and active discussion. So, I am committed to expanding these activities and aim to recruit internationally recognized tutors who will offer education to countries that need it.

How can the education issue be addressed in the long term?

I want to motivate pathologists from countries, such as Turkey, Georgia and Serbia, to form their own national divisions. In this way, they can seek funds from the Education Committee of the International Academy of Pathology (where I have continuously served for the last six years) and plan their own scientific events. Without doubt, congresses, slide seminars, long and short courses are all very important for education. But we have to ask ourselves: do all pathologists have the opportunity to attend if they are to pay their own travel and accommodation expenses? How do we help people from disadvantaged countries? Certainly, the Education Committee helps young pathologists to participate in the international congresses by providing a number of bursaries. But I think we can do better. I believe it is time for an educational revolution, to give power to all and make education possible everywhere. We are now living in the Internet era, with a tremendous number of applications and facilities available to us. We must open more education channels and take advantage of the benefits this offers.

Telepathology, including digital images, virtual microscopy, teleconferences and real-time broadcasting of scientific sessions would help pathologists from all countries to participate in the educational activities of the IAP, without having to travel. Webinars should be planned and made available with a reasonable range of time zones with the presenter, for free. This gives pathologists the chance to attend meetings and to actively participate in discussions.

The first priority of the Academy is education, and the challenge for global pathology in the years to come is to harmonize it.

How does the IAP encourage collaboration?

Organizing scientific events is very important; they motivate pathologists to meet colleagues from other countries and start collaborations. The IAP Assemblies may also play an important role in promoting collaborative activities of pathologists within a certain geographic area. Another important factor is the formation of Schools of Pathologists that organize annual programs and provide educational support – The Education Committee of the IAP allocates a lot of funds to these educational activities, which also encourage pathologists to meet and collaborate.

How will the role of the pathologist evolve in the next 10 years?

Multidisciplinary collaboration with biologists, chemists and other scientists has become very important. Molecular pathology is expanding rapidly, and in most instances is mandatory for clinical practice. But molecular testing alone, without the use of morphology, may be misleading and result in inappropriate treatment. The pathologist should be the leading scientist coordinating clinical investigation and research, both to reduce budgets and to ensure best clinical practice.