Recent Advances in Endocrine Surgical Pathology

Abstract

The field of surgical pathology constantly evolves, particularly in regards to the understanding of tumour genetics, biomarkers, diagnostics and treatment. This has been evident in the field of endocrine surgical pathology, where there has been an explosion in the knowledge of genetics. None of the importance of the morphology has been diminished however. The 200 year old technique of morphology is able to provide prognostic and diagnostic information but can reliably predict the presence or absence of particular genetic abnormalities which is particularly useful in the setting of resource restrictions.

This thesis is subdivided into three main sections, pertaining to the organ of the endocrine system being discussed. The three chapters are linked by the overarching theme of the importance of morphology in tumour classification and genetic expression.

In the opening chapter, the significance of morphology is demonstrated in PitNET classification in regards to GATA3 expression, and is established in treatment options in regards to PD-L1 expression.

The second theme in this thesis explores the advances in thyroid and parathyroid pathology. Specifically, the value of morphology is demonstrated in the analysis of BRAFV600E mutations in papillary thyroid carcinoma (PTC), and also in the prognosis of PTC with tall cell morphology. The parathyroid is reviewed in the context of morphology and hereditary disease.

Thirdly, the thesis then examines the role of morphology in the adrenal gland, specifically in regards to phaeochromocytoma, and then is further investigated in regards to the link between morphology and SDH deficiency in phaeochromocytoma/paraganglioma.

In summary, through the studies and reviews born of this thesis, which have been submitted and published in peer-reviewed international pathology journals, the recent advances in endocrine surgical pathology are discovered and the vital link between tumour genetics, prognosis, diagnosis and morphology is emphasised.