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IT 1 - Introduction To Anatomical Pathology
IT 1 - Introduction To Anatomical Pathology
Krisna Murti
Anatomical Pathology, Faculty of Medicine, Sriwijaya University
Morgagni (1685-1777)
K. von Rokitansky (1804-1878) performed nearly 30,000 autopsies, wrote an
outstanding monograph on diseases of arteries and congenital heart defects
Definition
Pathology (Anatomical Pathology / Pathologic Anatomy)
is fundamental biomedical science that studies the structural
basis of pathological processes of human disease
2. Classification:
Autopsy
(1) Human pathology
Biopsy
Cytology
(2) Experimental pathology
3. Position:
Its a bridging discipline involving both basic science and
clinical practice
4. Text of Pathology:
(1) General pathology:
concerned with the basic reaction of cells and tissues to abnormal
stimuli that underlie all diseases
Techniques of Pathology
1. Human pathology
(1) Autopsy
(2) Biopsy: surgical or diagnostic pathology
(3) Cytology: smear, fine needle aspiration
2. Experimental pathology
(1) Animal experiment: animal model
(2) Tissue and cell culture
Morphological Alteration
Structural alteration of cells or tissuesusually specific for
particular diseases
Clinical symptoms: alteration of function due to morphological
changes
Morphological alterations of tissues / organs cause malfunction
of the organs and then raise clinical symptoms
Autopsy
Post-mortem examination of a corpse to determine the cause and manner
of death and to evaluate any disease or injury that may be present
Experiment
Modelling of pathological process on animals and subsequent postmortem examination
Types of Biopsies
During surgery
Puncture (needle
biopsy)
Aspiration
Excisional
Incisional
Scrape
Anatomical Pathology
Histopathology
Cytology
Gynecology: papsmear,
Non gynecology: FNAC, sputum, pleural effusion, Transthoracal biopsy
(TTB), transthoracal needle aspiration (TTNA)
Vriescope (VC)
Histochemistry
Imunohistochemistry
Molecular
Levels of Study
Organismal
Organ
Tissue
Cellular
Ultrastructural
Molecular
Histopathology
Macroscopic/gross
Direct examination by eyes or by touching
Organs :
Sizes : enlargement / smaller
Consistency : soft, hard, solid, fragile
Color : pale, yellow, brownish
Microscopy
Using microscope
Helped by staining for histochemistry or
immunohistochemistry to show specific chemical contains in
cells or tissues
Observe structural alterations in cells / tissues due to
particular diseases
Histopathological Materials
Biopsy: excise, endoscopy, cystoscopy
Operation : appendices, ovary, breasts
Extirpation : Lymph nodes
Curettage : specific for abnormalities in endometrium, cervix
and utery
Eg. abortus, mola hidatidosa, hormonal abnormality,
malignancies
Procedures
a. Formalin 10% buffer
b. The whole tissues rinse in fixation (volume of formalin is
10 X tissues volume)
c. If the tissues are too large lamellation every 1 cm to
ensure fixation enters the tissues
d. Processingmachines
Processing
Removal of alcohol with
xylene that will be miscible
with the embedding medium
(paraffin)
Impregnating with paraffin.
Machine
Manual
Cytology
Cytos (cells) and logos (knowledge)
Exfoliative cytology: knowledge of cellsimportant for early
diagnosis of diseases / malignancies
Spontan exfoliation occur due to mature cells changed by
younger cells the normal behavior of superficial tissues /
organs
A. Structure of cells
. A cell is an important structure
. Different forms depending of the functions
. The cell from different tissues / organs has specific behavior
B. Structure of tissues
Cytology
Cytology: to observe and examine structural alteration of every found cell
To detect malignancies: pap smear/pap test/ papanicolau test/cervical smear
early detection of cervical cancer
Genetic disorders
Hormonal disorders
Gynecologic
1. Hormonal evaluation
2. Early detection of cancer
3. Inflammation detection
Procedures:
-. Lateral wall of vagina (1/3 inner wall)
-. Cervix
-. Endometrium
Too little
Swab is too thick
Too much blood
Inadequate fixation
Endocervical cells are not present
Pap Smear
Non Gynekologic
1. Respiratory tracts
- sputum
- Bronchial washing
- TTB (transthoracic biopsy)
- TTNA
2. Digestive tracts endoscopy for stomach
3. Urinary tracts urine
4. Pleural cavity, pericard, sinovial, abdomen (ascites),
cerebrospinal fluid
Needle Biopsy
Deep
Procedures
Pap smear Fixation: alcohol 95%
The swab as soon as possible rinse into alcohol 95% for minimal 30 min
Urine/fluid from body cavities (pleural effusion, ascites)
- Can be sent as swab of sediment after centrifugation
- Fixation: alcohol 95%
- Or urine/pleural effusion/ascites about 100-200 cc fix with alcohol 50% aa
Sputum (swab like pap smear)
- Fixation: alcohol 95%, should be done for 3 x in 3 consecutive days
PAS staining
Autopsy
Clinical autopsy is part of pathologists duties
Identify new diseases
Identify etiologies of death
Examination of the correctness of the diagnosis and treatment
Establish the cause of death
Research
Teaching students and physicians
Terminologies
Alteration of epithelia in malignancy
Variation in nuclear size and forms (pleomorphism)
Alteration in nuclear chromatin: hyperchromatic, vesicular
Increase NC ratio
Nucleoli can be seen
: Metaplasia
Alteration of a mature cell type to another type
Eg: changes of columnar epithelial-squamous
Cont
Dyplasia: alteration of mature cell type to disorientation
Undifferentiated cell: not differentiate not growth to specialized types
Cont
Hyperchromatism: an increase in the histological staining, usually in the
nucleus
Hyperplasia: an increase in the amount of organic tissue that results from
cell proliferation
Hypertrophy: An enlargement of organs due to the increase of cell size
Physiology: athletes muscles, pregnant uteri
Pathology: hypertensioncardiac enlargement
Cont
Karyolysis: The complete dissolution of the chromatin of a dying cell due to the
enzymatic degradation by endonucleases
Karyorrhexis: the destructive fragmentation of the nucleus of a dying cell
whereby its chromatin is distributed irregularly throughout the cytoplasm
Carcinoma: Malignant neoplasm originated from epithelial
Pyknosis : the irreversible condensation of chromatin in the nucleus of cell
undergoing necrosis or apoptosis
Polymorphism : occur when two or more clearly different phenotypes exist in
the same population of a species the occurrence of more than one form or
morph or multiple alleles in a single gene
Pleomorphism : Occurring in various distinct forms. In terms of cells, having
variation in the size and shape of cells or their nuclei.
Immunohistochemical techniques
Immunohistochemistry
It is based on specific interaction of tissue and cellular
antigens with a specially derived antibodies bearing the different
labels.
Immunohistochemistry (IHC)
Immunofluorescence (IF)
Opportunities IHC
Determination of cells belonging to a particular tissue;
Identification of individual products (e. g. abnormal
proteins), routes of cellular and intercellular signals,
synthesis of certain proteins, glyco-and lipoproteins
Immunohistochemistry
1. Ag-Ab specific reaction
2. Applications
(a) Location analysis
cytokeratincell membrane
(b) Clinical diagnosis and distinguishing
diagnosis of tumor histogenesis
Immunofluorescence (IF)
Ultrastructure Observation
Used to study the details of cell structure, detection of viruses, bacteria, immune complex
deposits
Examples of use:
Oncology - Birbeck granules in histiocytosis X
Oncology - Z-discs in rhabdomyosarcoma cells
Nephrology - diagnosis of glomerulonephritis
TEM (transmitting electron microscope)
Is used for:
Detection
of viral genomes
Detection of mutant genes
Detection of active protein synthesis
(unlike IHC which allows to determine the presence of a protein)
IHC data validation
Thank you