IT 1 - Introduction to Anatomical Pathology

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Introduction to Anatomical Patholo

Krisna Murti

Anatomical Pathology, Faculty of Medicine, Sriwijaya Unive


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1. Anatomical (before XIX century)

J. Morgagni !"#$%!&&&'

K. von (o)itans)y !#*+%!#' erformed nearly -*,*** autosies, wrote an

outstanding monograh on diseases of arteries and congenital heart defects

2. Microscopic (XIX century - mid-XX century)

(. irchow !#/!%!0*/' 1 2father of cellular athology3

.!ltramicroscopic (mid-XX century)

".Modern - pathology of a li#ing person

$istorical Periods of Pathology


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Pathology Anatomical Pathology 4 Pathologic Anatom

is fundamental 5iomedical science that studies the struc

5asis of athological rocesses of human disease

%efinition

Anatomical Pathology is a medical la5oratory secialty, w

o5jective is the diagnosis of diseases through the study of 5i

material o5tained from organs or tissues and that may con

cells or fluids.


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1. &he core of pathology'

6he four asects of a disease rocess that form the core of athology7pidemiology

!' 8tiology7 causes of the disease

/' Pathogenesis7 the evolution4mechanisms of its develoment

-' Morhologic changes7 the structural alteration induced in the cells and org

of the 5ody +' 9linical significance7 the functional conse:uences of the morhologic cha

Management

omplications

Pre#ention

&he *cope of Pathology


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2. lassification'

(1) $uman pathology

(2) +perimental pathology

Autopsy

,iopsy

ytology

. Position'Its a bridging discipline in#ol#ing both basic scien

clinical practice


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". &e+t of Pathology'

(1) eneral pathology'

concerned /ith the basic reaction of cells and tissues to ab

stimuli that underlie all diseases

(2) *ystemic pathology '

describe the specific responses of speciali0ed organs and t

to defined stimuli


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&echniues of Pathology

1. $uman pathology

(1) Autopsy

(2) ,iopsy' surgical or diagnostic pathology

() ytology' smear fine needle aspiration

2. +perimental pathology

(1) Animal e+periment' animal model

(2) &issue and cell culture


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Morphological Alteration

Structural alteration of cells or tissues;usually seci

articular diseases

< 9linical symtoms7 alteration of function due to morhchanges

< Morhological alterations of tissues 4 organs cause mof the organs and then raise clinical symtoms


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3bser#ation and 4e/ &echniue of Morp

Gross appearance:si0e shape

/eight

color

consistencysurface

edge of section


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$istologic and ytologic 3bser#atio

most common and basic formalin fi+ed

5 $ (hemato+ylin and eosin) stained

Hemangioma of ventrical


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,iopsy(emoval of tissue from a living su5ject to determine morhological

changes=

AutopsyPost%mortem e>amination of a corse to determine the cause and man

of death and to evaluate any disease or injury that may 5e resent

+perimentModelling of athological rocess on animals and su5se:uent ost%

mortem e>amination

Methods of Pathological Anatomy


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?uring surgery Puncture needle

5iosy'

Asiration

8>cisional

@ncisional Scrae

&ypes of ,iopsies


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Anatomical Pathology

< istoathology< 9ytology

< Bynecology7 aCsmear,

< Don gynecology7 FDA9, sutum, leural effusion, 6ransthora

66E', transthoracal needle asiration 66DA'

< riescoe 9'< istochemistry

< @munohistochemistry

< Molecular


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rganismal

rgan

6issue

9ellular

Ultrastructural Molecular

6e#els of *tudy


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$istopathology

Macroscopic7gross

< ?irect e>amination 5y eyes or 5y touching

< rgans 7

< SiGes 7 enlargement 4 smaller

< 9onsistency 7 soft, hard, solid, fragile

< 9olor 7 ale, yellow, 5rownish


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< Using microscoe

< eled 5y staining for histochemistry or

immunohistochemistry to show secific chemical con

cells or tissues

< 5serve structural alterations in cells 4 tissues due to

articular diseases

Microscopy


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$istopathological Materials

< Eiosy7 e>cise, endoscoy, cystoscoy

< eration 7 aendices, ovary, 5reasts

< 8>tiration 7 Hymh nodes

< 9urettage 7 secific for a5normalities in endometrium

and utery

8g. a5ortus, mola hidatidosa, hormonal a5normalitymalignancies


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Procedures

a. Formalin !*I 5uffer

5. 6he whole tissues rinse in fi>ation volume of formalin!* tissues volume'

c. @f the tissues are too large ;lamellation every ! cm toensure fi>ation enters the tissues

d. Processing;machines


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Processing

< (emoval of alcohol with

2>ylene3 that will 5e misci5le

with the em5eddingmedium

araffin'

< @mregnating with araffin.


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$aemato+ylin-osin *taining (8outine)

Machine

Manual

t l


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ytology

< 9ytos cells' and logos )nowledge'

< 8>foliative cytology7 )nowledge of cells;imortant for diagnosis of diseases 4 malignancies

< Sontan e>foliation occur due to mature cells changed younger cells; the normal 5ehavior of suerficial tissuorgans

* f


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A. *tructure of cells


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ytology

< 9ytology7 to o5serve and e>amine structural alteration of every found

< 6o detect malignancies7 a smear4a test4 aanicolau test4cervica

early detection of cervical cancer

< Benetic disorders

< ormonal disorders

a. Bynecologic7 swa5 of lateral vaginal wall, cervi> and endometriu

5. Don gynecologic7 sutum lung', ascites, leural effusion


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ynecologic

!. ormonal evaluation/. 8arly detection of cancer

-. @nflammation detection

Procedures7%. Hateral wall of vagina !4- inner wall'

%. 9ervi>

%. 8ndometrium


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Pap *mear7er#ical *mear

< 6he e>amination to detect a5normalities of cervi> in a

cervical cancer

< 6a)en from forni> osterior4s:uamo%columnar junction

< fi>ation 7 alcohol 0$I

< Staining 7 Paanicolau

< (eresentative if 8ndocervical cells are resent

< Dot reresentative4inade:uate if 7< 6oo little

< Swa5 is too thic)

< 6oo much 5lood

< @nade:uate fi>ation

< 8ndocervical cells are not resent


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Pap *mear


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4on yne9ologic

!. (esiratory tracts

% sutum

% Eronchial washing

% 66E transthoracic 5iosy'

% 66DA

/. ?igestive tractsendoscoy for stomach-. Urinary tractsurine

+. Pleural cavity, ericard, sinovial, a5domen ascites',

cere5rosinal fluid

:i 4 dl A i ti t l (:4A)


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:ine 4eedle Aspiration ytology (:4A)

< Staining 7 PAP, 8, MBB

< Alications 7 suerfisial and dee organs

< Suerfisial 7 lien, 5reasts, thyroid, eriheral lung, leura, eritoneal,sinovial, tumor

< ?ee organs7 dee lung lesion, liver, )idenys, rostate

Suerficial


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4eedle ,iopsy

?ee

P d


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Procedures

Pap smearFi>ation7 alcohol 0$I

6he swa5 as soon as ossi5le rinse into alcohol 0$I for minim

!rine7fluid from body ca#ities (pleural effusion ascites)

% 9an 5e sent as swa5 of sediment after centrifugation

% Fi>ation7 alcohol 0$I

% r urine4leural effusion4ascites a5out !**%/** cc fi> with alcoho

*putum (s/ab li9e pap smear)

% Fi>ation7 alcohol 0$I, should 5e done for - > in - consecutiv


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-. FDA9 fine needle asiration cytology'

?ry with no fi>ation7 dry the swa5 on the air without fi>ati

to the la5

et Fi>ation7 swa5 rinses into alcohol 0$I for minimal -

send to the la5

:ro0en *ection7;ries oupe7;


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:ro0en *ection7;ries oupe7;

< 8>amination ofhistoathology whilethe atient is in theoeration room

< 6o ensure the

malignancy isresent or not thentheray


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Procedures in sending the specimens

!. Fill in forms comletely/. Send the secimens in ade:uate fi>ation

formalin !*I 5uffer'


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$istochemistry and ytochemistr


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$istochemistry and ytochemistr

PA* staining


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Autopsy

< 9linical autosy is art of athologists duties

< @dentify new diseases

< @dentify etiologies of death

< 8>amination of the correctness of the diagnosis and tre

< 8sta5lish the cause of death

< (esearch

< 6eaching students and hysicians


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6egal Authority of Autopsy

Autopsy is performed mandatory'

Susicion of violent death?eath less then ! day after admission to hosital

?eath during surgery, diagnostic maniulations and

anesthesia

?eath from infection

Susicion of overdose or drug intolerancePregnant women, women in4after child5irth

9hildren under ! year

Autopsy can be not performed on religious ground


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6erminologies

< Alteration of eithelia in malignancy

< ariation in nuclear siGe and forms leomorhism'

< Alteration in nuclear chromatin7 hyerchromatic, vesicular

< @ncrease D9 ratio

< Ducleoli can 5e seen

< 7 Metalasia

< Alteration of a mature cell tye to another tye

8g7 changes of columnar eithelial%s:uamous


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9ont;

< %yplasia' alteration of mature cell tye to disorientation


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ont=

< $yperchromatism' an increase in the histological staining, usuall

nucleus

< $yperplasia' an increase in the amount of organic tissuethat res

cell roliferation

< $ypertrophy'An enlargement of organs due to the increase of ce

Physiology' athletes muscles, regnant uteri

Pathology' hyertensionLcardiac enlargement

ont=
https://en.wikipedia.org/wiki/Tissue_(biology)https://en.wikipedia.org/wiki/Cell_proliferationhttps://en.wikipedia.org/wiki/Cell_proliferationhttps://en.wikipedia.org/wiki/Tissue_(biology)


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< >aryolysis7 6he comlete dissolution of the chromatinof a dying ce

enGymatic degradation 5y endonucleases

< >aryorrhe+is' the destructive fragmentation of the nucleusof a dyi

where5y its chromatin is distri5uted irregularly throughout the cyto

< arcinoma7 Malignant neolasm originated from eithelial

< Py9nosis ' the irreversi5le condensation of chromatinin the nucleu

undergoing necrosisor aotosis

< Polymorphism ' occur when two or more clearly different henotythe same oulation of a seciesL the occurrence of more than on

morhor multile alleles in a single gene

< Pleomorphism7 ccurring in various distinct forms. @n terms of cel

variation in the siGe and shae of cells or their nuclei.
https://en.wikipedia.org/wiki/Chromatinhttps://en.wikipedia.org/wiki/Cell_(biology)https://en.wikipedia.org/wiki/Endonucleaseshttps://en.wikipedia.org/wiki/Cell_nucleushttps://en.wikipedia.org/wiki/Chromatinhttps://en.wikipedia.org/wiki/Cell_nucleushttps://en.wikipedia.org/wiki/Necrosishttps://en.wikipedia.org/wiki/Apoptosishttps://en.wikipedia.org/wiki/Phenotypeshttps://en.wikipedia.org/wiki/Phenotypeshttps://en.wikipedia.org/wiki/Apoptosishttps://en.wikipedia.org/wiki/Necrosishttps://en.wikipedia.org/wiki/Cell_nucleushttps://en.wikipedia.org/wiki/Chromatinhttps://en.wikipedia.org/wiki/Cell_nucleushttps://en.wikipedia.org/wiki/Endonucleaseshttps://en.wikipedia.org/wiki/Cell_(biology)https://en.wikipedia.org/wiki/Chromatin


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:lo/ ytometry (:M)


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:lo/ ytometry (:M)

1. 3ne 9ind of cells5uantitati#e analysis

2. %4A ploidy analysis

. Protein nucleus acid5uantitati#e analysis

". *election of collection of cells

Image analysis (IA)


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4uclei' diameter? circumference? area? #olume? morpho

6aser scanning confocal microscope (6*M)

Ali#ing cell5obser#ation in situ or de#elopment or ua


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@mmunohistochemistry @9'

8lectron microscoy

@n situ hy5ridiGation @S'

Polymerase chain reaction P9('

Modern Methods in Morphology

Immunohistochemical techniues


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@t is 5ased on secific interaction of tissue and cellularantigens with a secially derived anti5odies 5earing the different

la5els.

@mmunohistochemistry @9'

@mmunofluorescence @F'

3pportunities I$

?etermination of cells 5elonging to a articular tissue=

@dentification of individual roducts e. g. a5normal

roteins', routes of cellular and intercellular signals,

synthesis of certain roteins, glyco%and lioroteins

@mmunohistoc

Immunohistochemistry


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Immunohistochemistry

1. Ag-Ab specific reaction

2. Applications

(a) 6ocation analysis

cyto9eratin5cell membrane

(b) linical diagnosis and distinguishing

diagnosis of tumor histogenesis

Immunofluorescence (I:)


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!ltrastructure 3bser#ation


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&M (transmitting electron microscope)

Used to study the details of cell structure, detection of viruses, 5acteria, imm

deosits

+amples of use'

ncology % Eir5ec) granules in histiocytosis

ncology % %discs in rha5domyosarcoma cells

Dehrology % diagnosis of glomerulonehritis

*M (scanning elect

In *itu $ybridi0ation (I*$)


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In situ hybridi0ation (I*$) Method for localiGing 4 detection of secific se:uences of ?DA or (DA in s

4 directly in tissue secimens' in morhologically reserved tissue sections

or cell rearations 5y hy5ridiGing the comlementary strand of a nucleotid

ro5e against the se:uence of interest. @t is 5ased on rincile of comlementary interaction of ?DA or (DA in

secimen with la5elled nucleotide se:uence ro5e'

@f nucleic acids are reserved in a histological secimen, then it can 5e

detected 5y using a comlementary ro5e

Is used for'

?etection of viral genomes

?etection of mutant genes

?etection of active rotein synthesis

unli)e @9 which allows to determine the resence of a rotein'

@9 data validation

Polymerase hain 8eaction (P8)


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Method for detection of secific se:uences of ?DA or (DA in any

5iological samle

P9( is in vitro amlification i. e. increase in the num5er of

coies' of nucleic acids triggered 5y synthetic oligonucleotide

rimers

?ifferences from the in situ hy5ridiGation7

Eecause of amlification it is more sensitive a5out !

million times'

Usually not com5ined with morhology

y ( )

Molecular ,iology &echniue


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Molecular ,iology &echniue

1. Polymerase chain reaction (P8)

2. %4A seuencing

. ,iochip techniue

(1) ene chip (%4A chip)

(2) Protein chip (protein microarray)

() &issue chip (tissue microarray)


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Thank you

Documents

IT 1 - Introduction to Anatomical Pathology