HISTOPATH LEC - LESSON 3 (AUTOPSY) Flashcards
a surgical procedure to obtain tissue from a living organism for its microscopical examination, usually to perform a diagnosis.
Biopsy
Indications of Biopsy
- Inflammatory changes of unknown cause that persist for long periods
- Lesion that interfere with local function
- Bone lesions not specifically identified by clinical and radiographic findings
- Any lesion that has the characteristics of malignancy
lesion is totally red or has a speckled red appearance
Erythroplasia
lesion is ulcerated or presents as an ulcer.
Ulceration
lesion has persisted for more than two weeks.
Duration
lesion exhibits rapid growth
Growth rate
lesion bleeds on gentle manipulation
Bleeding
lesion and surrounding tissue is firm to the touch
Induration
lesion feels attached to adjacent structures
Fixation
four major types of biopsy
- cytology,
- aspiration biopsy,
- incisional biopsy,
- and excisional biopsy
typically used as an adjunct to, not a substitute for, incisional or excisional biopsy procedures
Oral Cytology
allows examination of individual cells, but cannot provide the histologic features crucial for an accurate and definitive diagnosis.
Cytology
Developed as a diagnostic screening procedure to monitor large tissue areas for dysplastic changes.
Oral Cytology
Lesions that lend themselves to cytologic examination may include:
post-radiation changes, herpes, fungal infections, and pemphigus
Advantages of Oral Cytology
Cytology may be helpful when large areas of mucosal change are noted, or in areas with difficult surgical access.
Disadvantages of Oral Cytology
- Not very reliable with many false positives.
2. Expertise in oral cytology is not widely available
the use of a needle and syringe to remove a sample of cells or contents of a lesion.
Aspiration Biopsy
The inability to withdraw fluid or air indicates that the lesion is what
probably solid
Indications of Aspiration Biopsy
- To determine the presence of fluid within a lesion
- To a certain the type of fluid within a lesion
- When exploration of an intraosseous lesion is indicated
A radiolucent lesion in the jaw that yields straw colored fluid on aspiration is most likely what
cystic lesion
The aspiration of blood might indicate what
vascular malformation
The intent of this type of biopsy is to sample only a representative portion of the lesion.
incisional biopsy
well suited for diagnosis of oral manifestations of mucocutaneous and vesiculoulcerative diseases, such as lichen planus, pemphigus, etc.
Punch Biopsy
This is done by applying Firm pressure with a circular brush is applied, rotated five to ten times, causing light abrasion.
Brush Biopsy
Disadvantage of using punch biopsy
difficult to obtain adequate, representative tissue deeper than the superficial lamina propria .
Biopsy report includes
- the name of the clinician,
- date the specimen was obtained
- pertinent characteristics of the specimen.
Indications of Incisional Biopsy
- Whenever the lesion is difficult to excise because of its extensive size
- In cases where appropriate excisional surgical management requires hospitalization or complicated wound management.
Indications of Excisional Biopsy
- Should be employed with small lesions. Less than 1cm
- The lesion on clinical exam appears benign.
- When complete excision with a margin of normal tissue is possible without mutilation.
autopsy is also known as
post mortem examination, necropsy or obduction
a medical procedure that consists of a examination of a dead body to determine the cause & manner of death & to evaluate any disease
autopsy
autopsy is performed by a specialized doctor medical called
pathologist
it determines the cause, mode and manner of death or to evaluate any disease or injury that may be present for research or educational purposes
autopsy
“autopsy”
to see for oneself
“necropsy”
seeing a dead body
Purpose of Autopsy (7)
Autopsies are performed for either legal or medical purposes. Autopsies can be performed when any of the following information is desired:
- Determine if death was natural or unnatural
- Injury source and extent on the corpse
- Manner of death must be determined
- Time since death
- Establish identity of deceased
- Retain relevant organs
- If infant, determine live birth and viability.
Autopsy is performed in certain cases such as (5)
- Committed suicide
- Unknown cause of death
- Unknown dead bodies
- Homicide (The killing of one human being by another)
- The organs are tissues of the body are examined to established the exact cause of death , to learn more about a disease
External examination of dead body without incisions, fluids can be collected with the helpof needle.
Post mortem
Rules of Medico - Legal Autopsy (9)
- Authorization.
- Identification.
- Visit of scene of crime.
- History of the case.
- Verification of the injuries noted by the police.
- Examination.
- Notes.
- Preservation of viscera and other tissue.
- List of artifacts.
Types of Autopsy (6)
- Postmortem examination
- Psychological autopsy
- Medical /clinical/ pathological / hospital autopsy.
- Virtual Autopsy
- Anatomical autopsy
- Medico legal autopsy
Carried on a patient who dies in a hospital
medical / academic autopsy
Objectives of Medical / Academic Autopsy
- To determine the cause of death.
- To confirm or establish the clinical diagnosis
- To evaluate the effects of treatment given during life.
- Performed by a pathologist’ with consent of relatives.
performed to study normal structure of human body.
anatomical autopsy
Anatomist and medical students perform this.
anatomical autopsy
undertaken on alleged cases of suicide to know about the mental status of deceased at the time of death.
psychological autopsy
Psychological autopsy is performed to know about :
- Background of person
- His habits ,mental status, personality, character.
- Relation to others
Examination of external surfaces of corpse by inspection incision without giving examination.
postmortem examination
Essential examination of dead body, to rule out or establish foul play in death.
medico - legal autopsy
It is performed in pursuance of law to establish the cause and manner of death and also to establish or rule out foul.
medico - legal autopsy
Three main types of medico - legal autopsy
- Forensic
- Clinical/Academic
- Coroner’s
No family permission is required to complete this type of autopsy
forensic
carried out when the cause of death may be a criminal matter such as accident or burns.
forensic
usually performed in hospitals for research & study purposes
clinical / academic
To complete this type of autopsy, permission from the deceased’s legal next of kin is needed
clinical / academic
type of autopsy involves cases where no medical cause of death is readily available
coroner’s
Long term storage of dead bodies temperature and purpose
- 20 C; for preservation
Short term storage of dead bodies temperature and purpose
+ 4 C; for autopsy purpose
This incision / approach approach is most often used in forensic autopsies so as to allow maximum exposure of neck structures for later detailed examination.
y - shaped incision
This incision made from the tips of both shoulder, in a horizontal line across the region of the collar bones to meet at sternum in the middle.
t shaped
a plastic or rubber brick placed under the back of the body, causing the arms & neck to fall backward while stretching & pushing the chest upward to make it easier to cut open
body block
Post mortem signs of death
pallor mortis, algor mortis, rigor mortis livor mortis
Post mortem signs of death occur in the first _________ after death.
24 to 48 hrs
the first sign of death
pallor mortis
post mortem sign of death. the heart stops beating, the circulation of blood throughout the body decreases
pallor mortis
second sign of death
algor mortis
post mortem sign of death. not an accurate way to back calculate the time of death
algor mortis
third sign of death
rigor mortis
means stiff death
rigor mortis
post mortem sign of death. contraction of the muscles in the body after death
rigor mortis
fourth sign of death
livor mortis
this color develops because of hemoglobin forms deoxyhemoglobin
purple
can be very useful for determining time of death
livor mortis
the process of breakdown of proteins and liquefaction of most organs
putrefaction
process by which organic substances are broken down into simpler forms of matter.
decomposition
process is completed when all soft tissues have been eliminated, leaving only disarticulated bones.
skeletonization
Characteristics of lesions that raise the suspicion of malignancy (7):
Erythroplasia Ulceration Duration Growth rate Bleeding Induration Fixation
