Introduction to pathology

Yodit Getahun, MD
Pathologist
Course Goals
• To provide students with essential medical knowledge and a broad
understanding of human diseases

• To emphasize “the language of disease” as a necessary foundation for

self education and lifelong learning
Objectives
• To define the keywords and phrases used in the lectures

• To understand the pathogenesis and epidemiology of diseases

• To describe and recognize the major cell and tissue alterations

associated with diseases

• Describe how pathological analysis contributes to disease surveillance

and the evaluation of therapeutic interventions
What’s Pathology
• Pathos means suffering and logos means study

• Pathology is the study of the structural, biochemical and functional

changes in cells, tissues, and organs that underlie disease

• It answers the whys and wherefores of diseases by the use of

molecular, microbiologic, immunologic and morphologic techniques

• Pathology is the base and scientific foundation for all of medicine

Cont’d
• Etiology (Cause) is grouped in to two
1. Genetic – inherited mutations and disease associated gene variants
2. Acquired – infectious, nutritional, chemical, physical
• Pathogenesis :- the sequence of cellular, biochemical and molecular
events that follow the exposure of cells or tissues to an injurious
agent
• Morphologic changes :- structural alterations in cells or tissues that
are either characteristic of a disease or diagnostic of an etiologic
process.
History of pathology
• Rudolf Virchow (1821-1902), a german
physician is the father of modern
pathology.
• Known for the cell theory, cellular pathology,
biogenesis and Virchow's triad.
Branches of Pathology
• Histopathology – microscropic examination of a tissue or a surgical
specimen to diagnose a certain disease.

• Cytopathology - microscopic examination of a single cell to diagnose

a disease.

• Haematopatholgy - is the study of diseases and disorders found in

blood cells and any organs or tissues involved in haematopoiesis
Cont’d
• Forensic Pathology – The application of pathology to legal purposes
• Molecular Pathology - Focused in the study and diagnosis of disease
through the examination of molecules within organs, tissues or bodily
fluids. Also encompasses genetic approaches to the diagnosis and
classification of human diseases
• Chemical pathology (clinical biochemistry)-  involves the biochemical
investigation of bodily fluids such as blood, urine and cerebrospinal
fluid for diagnosis of a disease
General and Systemic Pathology
• General Pathology – focuses on the causes, mechanisms and
characteristics of the major categories of disease
- is the basic reaction of cells and tissue in response to abnormal
stimuli that govern all diseases

• Systemic Pathology – focuses on specific diseases occuring with in

particular organ system
Specimens for diagnosis
• Biopsy -   a sample of tissue taken from the body in order to examine
it more closely and determine the presence or extent of a disease

• Resection specimen - is a therapeutic surgical removal of an entire

diseased area or organ (and occasionally multiple organs) in which the
diagnosis is already known or strongly suspected
Cont’d
• Exfoliative cytology: cells are scraped or brushed off from an epithelial
surface for diagnosis
• Fluid cytology : cells withdrawn with the fluid in which they are
suspended for examination (e.g. CSF, pleural fluid, acsitic fluid)
• Washings: cells flushed out of an organ using an irrigating fluid for
examination and diagnosis (e.g. bronchial wash)
• Fine needle aspiration cytology: is a diagnostic procedure used to
investigate lumps or masses. In this technique, a thin, hollow needle is
inserted into the mass for sampling of cells
• PAP Smear - The Papanicolaou test is a procedure in which a small brush
or spatula is used to gently remove cells from the cervix so they can be
checked under a microscope for precancerous or cancerous process
Autopsy
• An autopsy (post-mortem examination, necropsy, or autopsia
cadaverum) is a surgical procedure that consists of a
thorough examination of a corpse by dissection to determine the
cause, mode, and manner of death
• used to evaluate any disease or injury that may be present for
research or educational purposes.
• The term "necropsy" is generally reserved for animals 
Tools used in diagnostic pathology
• Light microscope - type of microscope that commonly uses visible
light and a system of lenses to generate magnified images of small
objects
Cont’d
• Electron microscope -  is a microscope that uses a beam of
accelerated electrons as a source of illumination and used in the
study of disorders at an organelle level. Also used in demonstration of
viruses in tissue samples
Cont’d
• Immunohistochemistry – is the process of selectively
identifying antigens (proteins) in cells of a tissue section by exploiting
the principle of antibodies binding specifically to antigens in biological
tissues
• Flow cytometry – is a technique used to detect and measure physical
and chemical characteristics of a population of cells or particles. The
sample is focused to ideally flow one cell at a time through a laser
beam, where the light scattered is characteristic to the cells and their
components. Commonly used in the diagnosis of blood cancers
Tissue processing Techniques
• Histopathology
1. Specimen Received
- The surgical biopsy must be put in a 10% Formalin as soon as
possible
Cont’d
2. Gross examination of the specimen
Cont’d
3. Tissue fixation
- The blocks will be put in a fixative (10%Formalin)
- Fixation hardens the tissue
Cont’d
4. Dehydration
- Removes water from the tissue by using a dehydrant Ethyl alcohol

5. Clearing
- It’s the step following dehydration
- By using Xylene the remaining alcohol in the tissue is cleared
- Completely cleared tissue looks almost transparent
Cont’d
6. Infiltration
- Removes the clearing agent
- Paraffin wax is the most widely used infiltrant
- Makes the tissue harder

7. Embedding
- The formation of a “block” making it ready for microtomy
Cont’d
Loading specimens in to a tissue processor Embedding
Cont’d
8. Tissue Sectioning
- The process of cutting tissue in to thin slices using a microtome
Tissue sectioning
Cont’d
9. Slide staining
- Commonly used stain is H & E (hematoxylin and eosin)
Cont’d
10. Cover slipping (mounting)
- The slide must be covered with a thin piece plastic or glass to protect
the tissue from being scratched, to provide better optical quality for
viewing under the microscope, and to preserve the tissue section for
years to come.
Cont’d
Cont’d
Frozen section
•  Is a pathological laboratory procedure to perform rapid microscopic
analysis of a specimen. It is used most often in oncological surgery
• Is used to assess a surgical margin positivity or negativity in a
malignant tumor during surgery
• The surgical specimen is placed on a metal tissue disc which is then
secured in a chuck and frozen rapidly to about –20 to –30 °C.
• The specimen is embedded in a gel like medium called OCT and
consisting of polyethylene glycol and polyvinyl alcohol. Subsequently
it is cut frozen with the microtome portion of the cryostat
• The section is picked up on a glass slide and stained for examination
THE END