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Introduction to Pathology Pathology:พยาธิวิทยา

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Introduction to Pathology Pathology:พยาธิวิทยา 03/01/57 Introduction to pathology La-or Chompuk, M.D. Department of pathology Naresuan University Pathology: พยาธิวิทยา • Greek: pathos, "feeling, suffering"; and logos, "the study of". • is the study and diagnosis of disease • is the study of the patterns, causes, mechanisms and effects of illness (disease) • is the basis of clinical laboratory medicine 1 03/01/57 Basic studies in pathology • Pathology is best learnt in two stages: 1. General pathology: 2. Systemic pathology: General pathology • is a broad and complex scientific field which seeks to understand the mechanisms of injury to cells and tissues, as well as responding to and repairing injury • Areas of study include cellular adaptation to injury, necrosis, inflammation, wound healing, and neoplasia. 2 03/01/57 Systemic pathology • is a study of systemic change in the diseases divided in organ systems. • CVS, CNS, respiratory, GI, hepatobiliary, KUB, genital, musculoskeletal, hematopathology, endocrine etc. • Characterisitcs of disease: – cause/etiology – mechanisms of development (pathogenesis) – structural and functional features of diseases (pathological and clinical manifestation) – secondary effect (complications and sequelae) – prognosis – treatment – epidemiology 3 03/01/57 Aetiology/causes • Entirely genetic • Multifactorial (genetic and environmental factors) • Entirely environmental; infective agents, chemicals, radiation, mechanical trauma Aetiology • Primary – Essential, idiopathic, spontaneous, cryptogenic e.g. primary HT – Initial stage: primary tumor e.g. lung cancer • Secondary – Disease represents a complication or manifestation of some underlying lesion e.g. secondary HT from renal a. stenosis – Subsequent stage: primary tumor disseminate to cause secondary tumor elsewhere e.g. lung cancer >> liver metastasis 4 03/01/57 General classification of disease • Congenital • Acquried – Genetic – Inflammation/infection – Non-genetic – Trauma – Tumor – Metabolism – Immune – Hemodynamic – Degenerative – Iatrogenic; induced by medical practioner’s words or actions Pathogenesis/ mechanism • Inflammation: a response to microorganisms and others harmful agents causing tissue injury • Degeneration: a deterioration of cells or tissues • Immune reaction: undesirable effects of the body’s immune system 5 03/01/57 Structural and functional manifestations • Symptom (อาการ) : the complaints of a patient • Signs (อาการแสดง): the abnormalities found on examination • Lesions (รอยโรค): the abnormal features • Pathognomonic abnormalities: specifically characteristic of a disease; Reed- Sternberg cells in Hodgkin’s disease Structural abnormalities • Space-occupying lesion (e.g. tumor) – destroying, compressing normal tissues • Deposition of an excessive or abnormal material in organs e.g. amyloid • Obstruction to normal flow within tube e.g. asthma, vascular obstruction • Rupture of a hollow viscus e.g. aneurysm, intestinal perforation 6 03/01/57 Functional abnormalities • Excessive secretion of a cell product e.g. nasal mucous in common cold • Insufficient secretion of a cell product e.g. insulin lack in diabetes mellitus • Impaired nerve conduction • Impaired contractility of a muscular structure Complications/ sequelae • Urinary tract infection >> sepsis • Burn >> scar contracture • Colon cancer >> lung metastasis • Pharyngitis >> post streptococcal glomerulonephritis • Encephalitis >> deafness 7 03/01/57 Prognosis • Course of the disease, the fate of the patient e.g. - The 5-year survival prospects for carcinoma of the lung are about 5% - Lung cancer >> spread to liver, bone, brain >> has 6-month survival prospect • Remission: the process of conversion from active disease to quiescence • Relapse: signs and symptoms reappear Characteristic of diseases; e.g. Boil Lung cancer Cirrhosis Hypertension Etiology S. aureus Smoking HBV ?? Pathogenesis Acute Genetic Imm - react Renin inflammation mutation Manifestation Boil tumor cirrhosis High BP Sequelae Septicemia metastasis Liver failure ICH 8 03/01/57 Pathology disciplines (American) • Anatomical pathology • Clinical pathology • Special pathology; – Forensic pathology – Molecular pathology Pathology disciplines (British) • Histopathology • Hematology • Chemical pathology • Microbiology • Immunopathology • Molecular pathology • Forensic pathology 9 03/01/57 Anatomical pathology • Deals with the tissue diagnosis of disease • Terminology – Biopsy; excision, incision – Necropsy, Autopsy – Fine needle aspiration (FNA) – Needle biopsy – Paracentesis – Thoracocentesis Anatomical pathology • Surgical pathology: – diagnosis of these specimens • Biopsy, Necropsy, Frozen section, Cytology • Autopsy – Special lab: • Special stains: AFB, GMS, PAS, Mucin • Immunohistochemical study (IHC): ER, PR, Her-2 • Immunofluoresence (IF): kidney disease • Electron microscope (EM) • Tissue microarray • Molecular lab: K-RAS mutation 10 03/01/57 Tissue fixation 10% neutral buffered formalin: routine H&E, IHC, PCR from paraffin block Bone: decalcification with EDTA, nitric acid Alcohol and acetone: good penetration, better preserve cytoplasmic enzyme, expensive Glutaraldehyde: electron microscope Volume 10x of specimen Containers 11 03/01/57 Small-sized tissue 12 03/01/57 Large-sized tissue - Bisect with remaining normal orientation Special orientation/margin specimen Label with silk/ ink Diagram with label 13 03/01/57 14 03/01/57 ขอมูลที่จําเปนเพิ่มเติม Bone marrow CBC BM aspiration Flow cytometry Bone and soft tissue Radiologic findings Brain Radiologic findings Surgical pathology • Register • Cutting up/ gross examination • Embedding • Sectioning • Staining; Hematoxylin & Eosin stain (H&E) • Mounting • Analyse • Report 15 03/01/57 16 03/01/57 H & E stain Special lab in surgical pathology • Special stains • Immunohistochemical studies (IHC) • Immunofluoresence (IF): need fresh tissue • In situ hybridization: FISH, SISH, CISH • Tissue microarray • Electron microscope (EM); special fixation; 1% glutaraldehyde, osmium tetroxide 17 03/01/57 H&E H&E H&E PAS; mucormycosis H&E AFB stain H&E GMS stain 18 03/01/57 19 03/01/57 IHC; CD34 IHC; CK IF; Bullous pemphigoid IF; MGN, IgG 20 03/01/57 FISH 21 03/01/57 Tissue microarray • consist of paraffin blocks in which up to 1000 separate tissue cores are assembled in array fashion to allow multiplex histological analysis 22 03/01/57 Tissue microarray TEM; HHV-6 SEM; glomerulus; podocyte 23 03/01/57 Cytopathology – Body fluid • ascites, CSF, pleural fluid, pericardial fluid • Fixation: non, cytolite, 4oC – FNA & Smear: fix in 95% ethyl alcohol – Fine needle aspiration (FNA); thyroid, breast, LN – Smear; nipple smear – Pap smear; cervical cancer screening • Conventional • Liquid base preparation – Cell block 24 03/01/57 Collection of fluid cytology Routine centrifuge 25 03/01/57 Cytocentrifuge Cytocentrifuge 26 03/01/57 Cytoblock/ cell block 27 03/01/57 28 03/01/57 29 03/01/57 Pap smear: conventional 30 03/01/57 31 03/01/57 Autopsy • Determining the cause of death • Audit the accuracy of clinical diagnosis • Education of undergraduates and postgraduates • Research into the causes and mechanisms of disease • Gathering accurate statistics about disease incidence 32 03/01/57 ตรวจแลวอยางถี่ถวน รักษาแลวอยางเต็มที่ บางทียังเอาชนะโรคไมได ขั้นสุดทายจึงตองตรวจศพ เพื่อใหรูแนนอน เอาไวเปนความรู เทียบเคียงกับอาการและการรักษาที่แลวมา สําหรับชวยชีวิตคนอื่นตอไป 33 03/01/57 ญาติสายตรงผูมีสิทธิ์อนุญาตใหผาตรวจศพ เรียงตามลําดับดังนี้ 1) คูสมรสที่ถูกตองตามกฎหมาย 2) บุตรที่บรรลุนิติภาวะ 3) บิดา มารดา 4) พี่ นองรวมบิดามารดาเดียวกันที่บรรลุนิติภาวะ 5) พี่ นองรวมบิดาหรือมารดาเดียวกันที่บรรลุนิติภาวะ 6) ปู ยา ตา ยาย 7) ลุง ปา นา อา หมายเหตุ ผูดูแล ผูอุปการะ นายจาง หรือผูอํานวยการโรงพยาบาล ไมมีสิทธิ์ อนุญาตใหตรวจศพ (ยกเวนบางกรณี) 34 03/01/57 35 03/01/57 36 03/01/57 Clinical pathology • Deals with the laboratory analysis of blood, urine an other body fluids, using the tools of chemistry, microbiology, hematology and molecular pathology • Work with medical technologists, hospital administrations, and referring physicians to ensure the accuracy and optimal utilization of laboratory testing. Clinical pathology • Hematology; CBC, Hb typing etc. • Microbiology; culture • Immunology; Ag-Ab, ELISA, agglutination • Microscopy; Urine analysis, stool analysis • Chemistry; FBS, lipid profile • Molecular lab; DNA • Toxicology • Blood bank 37 03/01/57 Special pathology • General pathology; a pathologists practice both anatomical and clinical pathology • Molecular pathology is an emerging discipline within pathology, and focuses on the study and diagnosis of disease through the examination of molecules within organs, tissues or body fluid 38 03/01/57 Forensic pathology • is the subspecialty of pathology that focuses on medicolegal investigations of sudden or unexpected death. • A consultant in medicolegal cases in OPD/IPD such as rape, homicide, suicide • visit crime scenes or accidents • to testify in court • Lab: toxicology, DNA, x-ray 39 03/01/57 Pathologists duties • work with other doctors,or medical team • to set guidelines and standards for medical laboratory testing that help improve a patient's medical care and guide treatment • ensure the quality and safety of medical laboratories. •lecturer 40 03/01/57 References • ตําราเรียนพยาธิวิทยาทั่วไป ภาควิชาพยาธิวิทยาและนิติเวชศาสตร คณะ แพทยศาสตร มหาวิทยาลัยนเรศวร 2551. • Robbins and Cotran Pathologic Basis of Disease. 8th ed, Philadelphia, Elsevier Saunders, 2010. • JCE Underwood. General and Systemic pathology, 3rd ed. Churchill Livingstone. 2000. 41 .
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