INTRODUCTION TO GENERAL PATHOLOGY

Dr. S.GADIREDDY MD
 BOOKS USED FOR THE CLASS SLIDES/ CLASS MATERIAL

Robbins & Cotran Pathologic Basis of Disease. Kumar.V., Abbas, A.K., Aster, J.C.
10th Edition, 2020, Saunders, Elsevier.

Golgan, E.F. Rapid Review Pathology 5th Ed.

First Aid For USMLE Step 1 2020
Pathoma notes
Pathology Kaplan 2020
Current Medical Textbooks
 TYPE OF MULTIPLE-CHOICE QUESTIONS

ALL EXAM MCQ’S ARE GIVEN FROM POWERPOINT SLIDES

AND

MATERIAL DISUCUSSED IN THE CLASS LECTURES.

ALL ARE CLINICAL BASED WITH ONE BEST ANSWER.

(QUESTIONS WILL BE CLOSELY RELATED TO USMLE STEP 1 / NBME QUESTIONS)

TYPE OF QUESTIONS MULTIPLE CHOICE
NO OF QUESTIONS 50 for Block exam and 30 for Class Quiz exam
DURATION 70 MINUTES AND 45 MINUTES RESPECTIVELY
Block 1 Block 2 Block 3 Block 4
80% from Block 80% from Block 80% from Block 80% from Block
MCQ exam MCQ exam MCQ exam MCQ exam

10% from lab 10% from lab 10% from lab NO LAB activities
activities activities activities OR LAB QUIZ
10% from Quiz 10% from Quiz 10% from Quiz 20% CLASS QUIZ
A B C D
 Pathology

Pathology is study of the structural, biochemical, and functional changes in

cells, tissues, and organs that underlie disease.

Pathology explains the why’s and wherefores of the signs and symptoms
manifested by patients. It thus serves as the bridge between the basic sciences
and clinical medicine.
 Who is Pathologist?
Physician who specializes in the diagnosis and management of human disease by
laboratory methods.
1.The Pathologist uses diagnostic and screening tests to identify and interpret the changes
that characterize different diseases in the cells, tissues, and fluids of the body.
3. Pathologist's function in three broad areas: as diagnosticians, as teachers, and as
investigators.
4. Pathologists in hospital and clinical laboratories practice as consultant physicians,
developing and applying knowledge of tissue and laboratory analyses to assist in the
diagnosis and treatment of individual patients.
5. Graduates in the USA and Canada need 3-4 years of accredited residency training to prepare for a
career in pathology
6. Following residency training candidates requesting certification must pass an objective written and
practical examination
Pathology Residency Program (4 years)

Anatomic and Clinical Pathology

Add another 2 years for subspecialty

Blood Bank
Cytopathology
Dermatopathology
Forensic pathology
Hematology
Medical microbiology
Molecular genetic pathology
Neuropathology
Pediatric pathology
Pathology

Anatomic Pathology Specialty: Clinical Pathology Specialty:

Gross and Microscopic analysis of tissue. •Hematology

•Microbiology
•Immunology
•Clinical Chemistry
•Blood Bank (Transfusion Medicine)
•Laboratory Data Management
•Molecular Pathology
 Anatomic Pathology Specialty

Microtome for Histo-pathology specimen

Carcinoma of the Breast

(Histopathology)

Carcinoma of the Breast

(Gross)
 Clinical Pathology

 Hematology
 Microbiology
 Immunology
 Clinical Chemistry
 Toxicology
• Transfusion Medicine
• Molecular pathologist
Hematopathology
Micro-Pathology
Autopsy

Autopsy provides insight into disease

processes and the influence of therapy on
disease:

 Reveals cause of death

 May detect previously undiagnosed

disorders – information that may benefit
for future diagnosis

 Accuracy of diagnosis
Effectiveness of treatment
 Question Format used in USMLE STEP 1 Pathology

CLINICAL PRESENTATION– clinical symptoms and signs.

ETIOLOGY – cause

PATHOGENESIS – sequence of changes which leads to disease

MORPHOLOGY - gross and microscopic changes

OUT COME: Progression of disease and Prognosis

 Methods used in Pathology to identify disease process

1. Gross examination of organs:

a. Appearance of the organ

b. Any Gross abnormalities

How to determine if there is something wrong with the organ:

a. Size
b. Shape
c. Consistency
d. Color
 A Case Study

A 58-year-old male with a history of smoking for 20 pack/years complains of chronic cough,
chest pain and weakness.

Vital Signs: BP 160/100 mm of Hg, RR 28/min, Temp 99F and PR 84/min

On physical examination, his chest AP diameter is increased, and he has wheezing in the
anterior chest and decreased breath sounds through out lung fields.

Blood studies showed Hb 18 gm/dl and serum calcium levels elevated.

Next step in management?

 Which X-ray is abnormal?

R L
 CT imaging reveals mass
AinCase Study
right bronchus

Frozen section: mass biopsied

and sent to anatomic
pathologist

Microscopic evaluation yields:

Poorly differentiated cells

Extent of disease

Information needed to
determine course of action
Squamous cell carcinoma of the
Lung (Histopathology)
A B

LUNG
GROSS
 Cytopathology

A Case Study in Thyroid Swelling

Patient visited with thyroid mass

Fine-needle aspiration biopsy

Pathologist performs fine- needle
aspiration (FNA) for cytology

Diagnosis based on cells

Surgeon and oncologist determine the

course of action
Fine-needle aspiration biopsy- BREAST
 Which X-ray is normal?

A B
A

The septal muscle bulges into the left

ventricular outflow tract, and the left atrium is
enlarged. The anterior mitral leaflet has been
reflected away from the septum to reveal a
fibrous endocardial plaque(arrow)
 Staining methods most commonly used

• Hematoxylin and Eosin

• Periodic Acid-Schiff (PAS)
• Oil Red O stain
• Prussian blue stain
• Congo Red stain
• Gram stain
• Acid Fast (Ziehl - Neelsen)
• Trichrome
• Reticulin
 Hematoxylin and Eosin

Hematoxylin Eosin

Stains blue to Stains pink to red

purple

Nuclei Cytoplasm
Nicleoli Collagen
Fibrin
Calcium RBC
Thyroid colloid

Other cell proteins

Structures stained by Hematoxylin/Eosin

Infiltrating ductal carcinoma: Acinar cells are poorly

demarcated and increased acinar cells and fibrous
tissue
 PAS stain
Periodic acid-Schiff (PAS) is a staining method used to detect glycogen in tissues.
The reaction of periodic acid selectively oxidizes the glucose residues, creates aldehydes
that react with the Schiff reagent and creates a purple-magenta color.

FATTY LIVER H&E STAIN Glycogen accumulation in the liver H&E stain
Periodic acid-Schiff stain of Periodic acid-Schiff stain with Diastase
Glycogen accumulation in the liver enzyme of Glycogen accumulation in the
liver
 FATTY LIVER: OIL RED O STAIN

H& E Stain- WITHOUT Oil Red O Stain WITH Oil Red O STAIN
 Prussian Blue Stain--for Iron

• Acid solutions of ferrocyanides is added to the tissue. If ferric ion is present in the tissue,
combines with and form ferrocyanide and results in the formation of a bright blue
pigment called Prussian blue, or ferric ferrocyanide.

• This is one of the most sensitive histochemical tests and will demonstrate even single
granules of iron in blood cells.

• Small amounts of ferric iron are found normally in the spleen and bone marrow.

• Excessive amounts are present in hemochromatosis and hemosiderosis

 Prussian blue Stain –staining for Iron

H&E STAIN

higher-power view of liver from this A Prussian blue iron stain demonstrates Hemochromatosis in cardiac muscle
case demonstrates the nodules and the blue granules of hemosiderin in
the brown/black pigment within hepatocytes and Kupffer cells.
liver parenchymal cells (arrows).
Hemochromatosis
 Congo Red stain

Amyloid in glomerulus is stained red Amyloid in glomerulus when viewed

(normal light microscopy) with polarized light- amyloid apple
green birefringence
 Gram stain

Gram-negative Pseudomonas
Gram-positive(Purple)Clostridium
aeruginosa bacteria (pink-red
perfringens in gangrenous tissue
rods).
 Acid Fast stain(Ziehl–Nielsen stain)

Mycobacterium Tuberculosis infection (acid-fast organisms)

Acid Fast stain(Ziehl–Neelsen stain)
 Trichrome (Masson) stain
Detection of collagen, (to differentiate between collagen and smooth muscle in tumors, outline
collagen deposits in diseases such as cirrhosis or various types of fibrosis)

Non-Alcoholic Steatohepatitis Hypertrophic Cardiomyopathy having

showing perivenular fibrosis and interstitial fibrosis (collagen is highlighted
peri sinusoidal fibrosis (blue fibers) as blue)
 Reticulin stain
The reticulin stain is useful in parenchymal organs such as liver and spleen to outline
the architecture

A reticulin stain occasionally helps to highlight the growth pattern of neoplasms.

The staining for reticulin
(arrowheads) is thus very
helpful in delineating the
architecture of normal hepatic
plates and any abnormality
thereof (Picture showing
Normal Liver). A reticulin stain
is very helpful in the diagnosis
of well differentiated
hepatocellular carcinoma
where cells are arranged in
more than two-cell-thick plates.
Hepatocellular carcinoma Hepatocellular carcinoma(Hepatoma),
(Hepatoma), H & E stain Reticulin stain
Bone marrow biopsy in Hairy Cell Leukemia:
Reticulin stain
 Immuno Histo Chemistry

Immunoperoxidase Immunofluorescent

Most frequently used for Anti-cytokeratin Abs Most frequently used for
diagnostic of cancers diagnostic of renal and skin
diseases (autoimmune origin)
Membranous nephropathy:
(1a) H&E;
(1b) Immunoglobulin G
Immunofluorescence

Acute proliferative glomerulonephritis:

(2a) H and E;
(2b) Immunoglobulin G,
Immunofluorescence.
 Immuno- Histostainings

Antibodies Origin of Positively stained

cells
Cytokeratin Epithelial Cells

Vimentin Mesenchymal cells

Desmin Muscle cells

Prostate Specific Antigen Prostate epithelium

(PSA)
Formalin fixed paraffin Meningioma, clear cell type Leiomyosarcoma, Stain
embedded human tonsil Stain with Vimentin with Desmin
stained with Cytokeratin
THE END