Introduction to pathology - Naresuan University · • Surgical pathology: – diagnosis of these...
Transcript of Introduction to pathology - Naresuan University · • Surgical pathology: – diagnosis of these...
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Introduction to pathology
La-or Chompuk, M.D.Department of pathology and
forensic medicine
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Pathology: พยาธิวิทยา
• is the study and diagnosis of disease• Greek: pathos, "feeling, suffering"; and
logos, "the study of".• Learning pathology is separated into two
majors ;– general pathology– systemic pathology
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General pathology
• is a broad and complex scientific fieldwhich seeks to understand the mechanisms of injury to cells and tissues,as well as responding to and repairing injury
• Areas of study include cellular adaptation to injury, necrosis, inflammation, wound healing, and neoplasia.
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Systemic pathology
• is a study of systemic change in the diseases divided in organ systems.
• CVS, CNS, respiratory, GI, hepatobiliary, KUB, genital, musculoskeletal, hematopathology, endocrine etc.
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• Characterisitcs of disease: – cause/etiology – mechanisms of development (pathogenesis)– structural and functional features of diseases
(pathological and clinical manifestation)– secondary effect (complications and
sequenlae)– prognosis– epidemiology– treatment
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Characteristic of diseases; e.g.
Boil Lung cancer Cirrhosis Hypertension
Etiology S. aureus Smoking HBV ??
Pathogenesis Acute inflammation
Genetic mutation
Imm - react Renin
Manifestation Boil tumor cirrhosis High BP
Sequelae Septicemia metastasis Liver failure ICH
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General classification of disease
• Congenital– Genetic– Non-genetic
• Acquried– Inflammation– Trauma– Tumor– Metabolism– Immune– Hemodynamic– Degenerative– Iatrogenic; induced by medical
practioner’s words or actions
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Pathology branches
• Anatomical pathology• Clinical pathology• Special pathology;
– Forensic pathology– Molecular pathology
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Terminology• Biopsy; excision, incision• Necropsy• Autopsy• Fine needle aspiration (FNA)• Needle biopsy• Paracentesis
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Anatomical pathology• Deals with the tissue diagnosis of disease• Surgical pathology:
– diagnosis of these specimens• Biopsy, Frozen section, cytology• Necropsy• Autopsy
– Special lab: • Special stains: AFB, GMS, PAS• Immunohistochemical study (IHC): ER, PR, Her-2• Immunofluoresence (IF): kidney disease• Electron microscope (EM)• Molecular lab: TCR arrangement
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Tissue fixation
10% neutral buffered formalin
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Containers
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Small-sized tissue
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Large-sized tissue
- Bisect with remaining normal orientation
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Special orientation/margin specimen
Label with silk/ ink
Diagram with label
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Surgical pathology
• Register• Cutting up/ gross examination• Embedding• Sectioning• Staining; Hematoxylin & Eosin stain• Mounting• Analyse• Report
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H & E stain
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Special lab in surgical pathology
• Special stains• Immunohistochemical studies (IHC): FISH,
SISH, CISH• Immunofluoresence (IF)• Tissue microarray• Electron microscope (EM)
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PAS; mucormycosis
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EBV: ISH
IHC FISH
SISH
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EM; HHV-6IF; Bullous pemphigoid
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FISH CISH
SISH Tissue microarray
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Cytopathology
– Body fluid; ascites, CSF, pleural fluid, pericardial fluid
– Fine needle aspiration (FNA); thyroid, breast, LN– Smear; nipple smear– Cell block– Pap smear; cervical cancer screening
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Collection of fluid cytology
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Pap smear
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Autopsy
• Determining the cause of death• Audit the accuracy of clinical diagnosis• Education of undergraduates and
postgraduates• Research into the causes and
mechanisms of disease• Gathering accurate statistics about
disease incidence
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ญาติสายตรงผูมสีิทธิ์อนุญาตใหผาตรวจศพ เรียงตามลําดบัดังนี้1) คูสมรสที่ถูกตองตามกฎหมาย2) บตุรที่บรรลุนิติภาวะ3) บดิา มารดา4) พี่ นองรวมบิดามารดาเดียวกันทีบ่รรลุนิติภาวะ5) พี่ นองรวมบิดาหรือมารดาเดียวกันทีบ่รรลุนิติภาวะ6) ปู ยา ตา ยาย7) ลุง ปา นา อา
หมายเหตุ ผูดูแล ผูอุปการะ นายจาง หรือผูอํานวยการโรงพยาบาล ไมมีสทิธิ์อนุญาตใหตรวจศพ (ยกเวนบางกรณ)ี
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Clinical pathology
• Deals with the laboratory analysis of blood, urinean other body fluids, using the tools of chemistry,microbiology, hematology and molecular pathology
• Work with medical technologists, hospital administrations, and referring physicians to ensure the accuracy and optimal utilization of laboratory testing.
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Clinical pathology
• Hematology; CBC, Hb typing etc.• Microbiology; culture• Immunology; Ag-Ab, ELISA, agglutination• Microscopy; Urine analysis, stool analysis• Chemistry; FBS, lipid profile• Molecular lab; DNA• Toxicology• Blood bank
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Special pathology
• General pathology; a pathologists practice both anatomical and clinical pathology
• Molecular pathology is an emerging discipline within pathology, and focuses in the study and diagnosis of disease through the examination of molecules within organs, tissues or body fluid
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Forensic pathology• is the subspecialty of pathology that
focuses on medicolegal investigations of sudden or unexpected death.
• A consultant in medicolegal cases in OPD/IPD such as rape, homicide, suicide
• visit crime scenes or accidents • to testify in court• Lab: toxicology, DNA, x-ray
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Pathologists duties
• work with other doctors,or medical team• to set guidelines and standards for medical
laboratory testing that help improve a patient's medical care and guide treatment
• ensure the quality and safety of medical laboratories.
• lecturer