Introduction to Pathology

Dr Samarendra S Mutum Pathology department, PPSP, USM

 PATHOLOGY: the science that studies disease It is derived from the Greek words: - Pathos:suffering/disease & Logos: science - Pathologist one who studies disease Types of Pathology / Pathologist: Anatomic Pathology Surgical Pathology & Autopsy (morbid anatomy) deals with the examination of human tissue removed at biopsy taken from living patients or at autopsy by naked eye or gross & microscopic examination (morphology) for evidence of disease

Clinical pathology (Laboratory medicine) Medical biochemistry : blood & body fluids Microbiology : microorganisms Haematopathology : blood, bone marrow etc. Immunopathology : blood, body fluids Blood banking & transfusion medicine Forensic pathology : study of human body/ tissues to determine the cause of death & provide evidence of criminal involvement in injury or death Experimental pathology : basic scientific research into cellular processes

 The 4 aspects of disease process that form the main core of Pathology include 1.Aetiology or cause: -Intrinsic or genetic -Acquired : infections, nutritional, chemical, physical -Idiopathic : the cause is unknown -Iatrogenic : (Iatro-physician / medicine,genicarising) - related to a prescribed treatment -Nosocomial- disease acquired from hospital environment

2.Morphological changes: structural alterations in

cells or tissues that characterise the disease or are diagnostic of the aetiology - diagnostic pathology. Limitations of morphology in diagnosis has led to the use of molecular biologic & immunological approaches. Molecular analysis e.g.DNA microarrays are now available

3.Functional derangements & clinical manifestations: The nature of the morphologic changes
& their distribution in organs / tissues influence normal function & determine the clinical features , disease course & prognosis .Concept of molecular pathology: all forms of organ injury start with molecular or structural alterations in cells -Virchow

4.Pathogenesis ( patho-disease, genesisarising) It is the sequence of events in cellular or tissue response to the aetiologic agent from the initial stimulus to the ultimate expression of the disease, the mechanism & how they develop. The study of pathogenesis remains one of the main domains of pathology. Disease explained in terms of time : acute disease of sudden onset & short duration of symptoms; chronic -disease of long duration

 SURGICAL PATHOLOGY : Tissue from patient for establishing a) tissue diagnosis, b) give prognostic information and c) provide insight into aetiology & pathogenesis - Paraffin section : involves fixation of tissue, tissue selection (block taking), decalcificationfor bone & calcified material, tissue process-ing, paraffin embedding & paraffin block, section cutting in microtome & section staining - Frozen section : when the assessment of the lesion will alter immediate management of the case.Report given by pathologist in 15-20 mts

Surgical pathology contd.

- Histochemistry: Different intra or extracellular components e.g. glycogen, mucin, iron, calcium, melanin, reticulin fibres, amyloid etc. are stained differently with certain stains - Immunohistochemistry: It makes use of labelled antibody to bind to specific antigen in the tissue sections & this is visualised by a chromogen & the antigen identified - Electron microscopy: For studying the ultrastructure of intra & extracellular components e.g. in the diagnosis of tumours, routine renal biopsy etc

Molecular pathology - In-situ hybridisation: Labelled single strands of nucleic acid binds to complementary strand : applied to DNA or RNA allowing identification of particular DNA or RNA nucleic acid sequence e.g bacterial, viral in tissue section. CYTOPATHOLOGY: examination of cells in smears/scrapes of exfoliated cell or material aspirated from solid tissue: Gynaecological & Non-Gynaecological. Papanicolaou stain (alcohol fixed),May-Grunwald-Giemsa for (airdried)& Haematoxylin & eosin stain are used

MORBID ANATOMY Perfomance of autopsy to determine the exact cause of death or elucidate the disease process associated with the individuals death - Hospital post-mortem: To study the disease process in whom the cause of death is known. It requires the written consent from the next of kin - Medico-legal post-mortem: To investigate deaths that are suspected of being unnatural

Traditionally, the study of pathology is divided into: General Pathology - focuses on cellular and tissue responses to pathologic stimuli Systemic pathology examines the particular responses and specific disease processes in specific organs

 Pathology bridges basic science and clinical practice and is involved in the study of the structural & functional changes in cells, tissues & organs in disease. By employing morphologic, microbiologic, immunologic & molecular techniques pathology attempts to explain the signs & symptoms in disease (clinico-pathological correlation) and provides a sound foundation for clinical care & therapy Pathology is the basis of all medical practice Our clinical practice is only as good as our understanding of pathology- Dr William Osler, father of modern medicine

Reference

Pathology for the health professions: Ivan Damjanov, 3rd edn., Elsevier Saunders,2006 Robbins and Cotran :Pathologic basis of disease : Kumar - Abbas - Fausto, Elsevier Saunders 7th edn.,2005