PATHOLOG

Y
INTRODUCTION
History

Hippocrates (460-370 BC). The great

Greek clinical genius and regarded
as ‘the father of medicine’. He
introduced ethical aspects to
medicine.
Rudolph Virchow
1821-1902
The Father of
Modern Pathology
FATHER OF EXFOLIATIVE CYTOLOGY

George N. Papanicolaou
(1883-1962). American pathologist,
who developed Pap test for
diagnosis of cancer of
uterine cervix.
• Greek word-Pathos-suffering( disease)
-Logos-study
• Definition: study of disease
• It is devoted to the study of the structural &
functional changes in cells, tissues, & organs
underlying diseases.

5
 Definition of pathology…

It is the “Scientific study of disease"

"scientific study of the molecular, cellular, tissue, or
organ system response to injurious agents.“
• Provides an understanding of disease processes
encountered, their causes (aetiology), pathogenesis,
their morphological appearance ,clinical effects (sign
and symptom) and prognosis

6
• Pathology serves as a "bridge" or "link"
between the preclinical sciences (anatomy,
physiology, ……etc.) and the courses in clinical
medicine.
“Your practice of medicine will be as good as
your understanding of pathology.” Sir William
Osler

Clinical

Pathology
Bridging Subject

Foundation
 Ctd…
• Pathology is divided in to :
1. General pathology – deals with basic reactions of
cells & tissues to abnormal stimuli that underlie all
disease.
E.g.. Cell injury and Inflammation, cancer, ageing
2. Systemic pathology – specific responses of
specialized organs & tissues to more or less well
defined stimuli.
E.g.. ischemic heart disease ,Goiter, pneumonia, breast
cancer
9
 The core of pathology
• Pathology gives explanation of a disease by
studying the four aspects of the disease
 1. Etiology
 2. Pathogenesis
 3. Morphological changes
 4. Functional derangement & clinical
significance

10
 Ctd…
1. Etiology
• Cause of the disease
• If the cause of the disease is known it is called
primary etiology
• If the cause of the disease is unknown it is called
idiopathic
• Knowledge or discovery of the primary cause
remains the back bone on which a diagnosis can be
made, a disease understood & a treatment
developed

11
 Etiology: What is the cause?
• Environmental agents:
– Physical
– Chemical
– Nutritional
– Infections Multifactorial:
Diabetes,
– Immunological Atheroscelerosis
– Psychological Hypertension
Cancer
• Genetic Factors:
– Mutations
– polymorphisms
 Etiology
• c

Disease Disease
Disease
Disease
Disease

One etiologic agent-

one disease, as Malaria •One
• Several etiologic
etiologic agent
agents - one
- several
disease, as
diseases, as
diabetes .
smoking.

13
 Ctd…
2. Pathogenesis
• Mechanisms of disease development
• It refers to the sequence of events in the response of the cells
or tissues to the etiologic agent, from the initial stimulus to
the ultimate expression of the disease
• It means the mechanism through which the cause operates to
produce the pathological & clinical manifestations
• It will lead to morphological changes

14
 Ctd…
3. Morphological changes
• Structural alterations induced in the cells &
organs of the body
• Characteristic to the disease or diagnostic to
the etiologic process
• Seen with naked eye or under the microscope

15
 Lymphnode Biopsy

• Diffuse tumour

• Capsule
 Lymphnode Biopsy

• Large cells
• Mitotic figures
 Ctd…
• Both the gross & the microscopic morphologic
changes may only be seen in that disease, i.e.
they may be specific to that disease
(pathognomonic).
– Therefore, such morphologic changes can be used
by the pathologist to diagnose the disease
• In addition, the morphologic changes will lead
to functional alteration & to the clinical signs
& symptoms of the disease

19
 Ctd…
4. Functional derangement & Clinical
manifestations
• Functional consequences of the morphologic
change
• The morphologic changes influence the
normal function → determine the clinical
feature
• Also the course & prognosis of the disease

20
• The morphologic and functional changes
together with results of other investigations
help to arrive at an answer to what is wrong
(diagnosis), what is going to happen
(prognosis), what can be done about it
(treatment), and finally what should be done
to avoid complications and spread
(prevention)
 Subdivisions and diagnostic modalities
• Most are based on morphologic changes
• Diagnostic techniques:
1. Histopathology
2. Cytopathology
3. Hematopathology
4. Microbiology
5. Immunopathology
6. Chemical pathology
7. Medical genetics/Cytogenetics
8. Molecular pathology
9. Autopsy pathology

22
 Histopathology
• Studies the tissue under the microscope
• Tissues are obtained by biopsy
 Biopsy – tissue sample from living person
• Biopsy – Incisional
- Excisional
• Tissue examined grossly (macroscopically) &
microscopically
• It is usually the gold standard for pathologic
diagnosis

23
• Once the tissue is removed from the pt, it has
to be immediately fixed by putting it into
adequate amount of 10% formalin
• Then the tissue is processed to make it ready
for microscopic examination.
• The whole purpose of the tissue processing is
to prepare a very thin tissue which can be
clearly seen under the microscope
 Ctd…
• The Hematoxylin/Eosin stain is usually
abbreviated as H & E stain. It is routinely used.
• It gives the nucleus a blue color, the
cytoplasm & the extracellular matrix a pinkish
color

25
 Lymphnode Biopsy

• Diffuse tumour

• Capsule
 Lymphnode Biopsy

• Large cells
• Mitotic figures
 Cytopathology
• Study the cells
• Used in:
Screening for early detection of precancerous
lesions and cancer
Diagnosis of benign tumors and symptomatic
cancer
Diagnosis of inflammatory condition, infectious
Surveillance of pts treated with cancer

29
 Ctd…
• Its advantage:
• Cheap
• Takes less time
• Needs no anesthesia
Cytopathological methods:
1. FNAC
2. Exfoliative cytology
3. Abrasive cytology

30
 Ctd…
1. FNAC
• Easy in superficial organs
• May need guidance in deep seated mass
2. Exfoliative cytology
• Evaluate cells that shed spontaneously into body
fluids or secretion
3. Abrasive cytology
• Cells are dislodged from skin or mucous membrane
by various tools

31
 Hematopathology

• A method by which abnormalities of the cells

of the blood & their precursors in the bone
marrow are investigated
• To diagnose the different kinds of anemia &
leukemia.

32
33
 Microbiological examination

• This is a method by which body fluids, excised

tissue, etc… are examined by microscopical,
cultural, serological techniques to identify
microorganisms responsible for many diseases

34
 Autopsy pathology
-Autopsy pathology is an examination of the dead
body to identify the cause of death
-The tissue sample taken from a dead person is
called autopsy
-This can be for
-- forensic or
-- clinical purposes- ‘the dead teach the living’.
-Most disease diagnosis is based on combination of
the above methods
35
 Diseases
• Disease is defined as any alteration from the normal
function/structure of an organ system

• “Expression of discomfort due to structural or functional

abnormality”

 Causes of disease
 Environmental
 Genetic or
 Both
36
 Disease Types:
• Inflammatory / Neoplastic / Degenerative
• Acute / Chronic
– Acute – short days to weeks.
– Chronic – long – months to years.
• Congenital / Acquired
• Mild / Moderate / Severe
• Genetic / Environmental
• Environmental agents:
– Physical
– Chemical
– Nutritional
– Infections Multifactorial:
Diabetes,
– Immunological Hypertension
Cancer
– Psychological
• Genetic Factors:
– Mutations
– polymorphisms
TRAUMA!
Electrical burn
 Course of disease
• Exposure ---biologic onset---clinical onset—
permanent damage ---death.
• Course of a disease without any intervention
is called natural course (history) of disease
 Ctd…
The course of disease (natural history) is shown
with a simplified diagram as follows
Incubation period
Exposure →biological onset →clinical onset
↑ ↓
Latency period permanent damage
↓
death

44
 Out come of diseases

• Resolution can occur leaving no sequelae

• The disease can settle down, but sequelae are
left, or
• It may result in death

45
 Death-Clinical & biological death
• Clinical death is the reversible transmission
between life & biological death.
• Clinical death is defined as the period of
respiratory, circulatory & brain arrest during
which initiation of resuscitation can lead to
recovery
 Signs indicating clinical death
• The pt is with out pulse or blood pressure, breathless
& is completely unresponsive to the most painful
stimulus.
• The pupils are widely dilated
• Some reflex reactions to external stimulation are
preserved. For example, during intubations,
respiration may be restored in response to
stimulation of the receptors of the superior laryngeal
nerve, the nucleus of which is located in the medulla
oblongata near the respiratory center.
• Recovery can occur with resuscitation

47
 Biological death
• Biological death (sure signs of death), which
sets in after clinical death, is an irreversible
state of cellular destruction
• It manifests with irreversible cessation of
circulatory & respiratory functions, or
irreversible cessation of all functions of the
entire brain, including brain stem

48
Immediate postmortem changes in biological
death
Rigor mortis – contraction of muscle—stiff limbs
Livor mortis – bluish discoloration on dependent
part of the body
Algor mortis – cooling of the body
Pallor mortis-paleness in the first 15-120mins
Autolysis – degradation of the body

49
THANK
YOU