INTRO Flashcards
Father of Modern Pathology
Rudolph Virchow
Refers to the death of the entire body
Somatic Death
Involves examination of dead body
Autopsy
Acquired decrease in tissue or organ size
Atrophy
Study of tumor or neoplasm
Oncology
It is the manner on how the disease developed
Pathogenesis
Release of foul odor due to increase (bacterial decomposition) in saprophytic organ, manifested by greenish discoloration of abdomen due to invasion
Putrefaction
Type of autopsy done in private hospitals to determine cause to death
Routine Hospital Autopsy or Clinical Autopsy
Cell death is due to ischemia
Coagulative
Affected cells can get back to its normal state or condition by using several cellular adaptations mechanism
Reversible Injury
Condensation of nucleus
Pyknosis
Tumor formation; continuous proliferation of abnormal cells
Neoplasia
Cells involved is epithelial cells
Epithelial Metaplasia
Failure of organ to form an opening
Atresia
Due to lack of hormones needed to maintain normal size and structure
Endocrine Atrophy
Happens when limits of adaptive response are exceeded or when the cell is exposed to an injurious agent or stress
Cell Injury
Fragmentation or segmentation of nucleus
Karyorrhexis
Program cell death; cell shrinkage; normal cell death; death of single cell in a cluster of cells
Apoptosis
Cell swelling; the affected cell becomes enlarged
Necrosis
Due to arterial occlusion
i.e. bacterial infection
Dry Gangrene
Destruction of functioning units of tissue
Function laesa
Drying and wrinkling of the anterior chamber of the eye and cornea
Desiccation
Changes that can be noted few hours after death
Secondary Changes
Rigidity; stiffening of muscles
Rigor Mortis
Destruction of cells or tissues
Autolysis
Organs are removed per group
Anton Ghon’s Technique
Involves examination only of a region or few regions of the body
Partial Autopsy
Must be release after 1 week
Autopsy Report
Slowly growing mass
Benign Tumors
Determines the spread of cancer in a patient
Staging of Tumors
Determines the percentage of differentiated and undifferentiated
Grading of Tumors
Retention Period (SPECIMEN): Pathology Blocks
10 years
Must be release 5 - 15 minutes
Frozen Section
Result of biopsy; Must be release after 24 hours
Surgical Pathology
Cadaver is opened from both shoulders down from the xiphoid area and incised down to the pubis
Y shaped incision
Involves examination of the whole body (head to foot)
Complete
All organs are removed at same time
Technique by M. Letulle
(Letulle)
Redness
Rubor
Appears soft and greasy – resembling cottage cheese
Caseous
Tissue reaction to injury
Inflammation
One of the paired organs is removed
Compensatory Hypertrophy
AKA pre-neoplastic lesion or atypical metaplasia
Dysplasia
AKA de-differentiation
Anaplasia
Common term for all malignant tumors (benign or malignant)
Cancer
Too much workload can cause general wasting of tissues
Exhaustion Atrophy
Increase in size is due to an increase in the size of individual cells comprising an organ; NO new cells are produced
Hypertrophy
Structural, biochemical, functional changes
Molecular and Morphologic Changes
Complete non-appearance of organ; absence of organ, did not develop (at birth)
Agenesia
A state that lies intermediate between NORMAL/UNSTRESSED cell & INJURED/OVERSTRESSED cell
Cellular Adaptation
Involves transformation of adult cell to another adult cell
Metaplasia
Involves removal of the entire mass / organ. Most reliable
Excisional Biopsy
Involves removal and examination of tissues sample from a living person to detect malignant / cancerous conditions
Biopsy
Result of PAP’s SMEAR. Must be release after 24 hours
Cytopathology
Blood will clot
Post mortem clotting
Purplish discoloration of skin due to sinking of fluid blood into capillaries of the dependent parts
Livor Mortis/ Lividity/ Post Mortem Hemolysis
AKA Necropsy
Autopsy
Done by government institutions such as NBI for the purpose of prosecution
Medico Legal Autopsy/ Forensic Autopsy
Cause; Either genetic or acquired; Some are idiopathic (unknown cause)
Etiology
Incomplete of defective development of organ
Aplasia
Abnormal growth and differentiation; Variation of size, shape and orientation; A pre-neoplastic lesion
Dysplasia
New growth; Tumor
Neoplasm
Cell injury can be ______ or ______
Reversible or Irreversible
Pain; due to the release of chemical substances
Dolor
Dissection is carried out in its original place
Technique by Karl Rokitansky
Commonly done in children and infants
Straight cut incision
Involves removal of top layer of skin by shaving
Shave Biopsy
Retention Period (SPECIMEN): Cytogenetic slides
3 years
Retention Period (RECORDS): Autopsy Forensic Reports
Indefinitely
What is the benign tumor of BONE?
Osteoma
Poorly differentiated, moderately or well differentiated
Malignant Tumor
Affects group of neighboring cells
Necrosis
Due to the complete digestion of dead cells
Liquefactive
Fat destruction due to release of pancreatic lipases, death of fat tissue due to loss of blood supply
Fat Necrosis
Due to venous occlusion i.e embolism of foot
Wet Gangrene
What are the 2 ultimate goals of inflammation
- To remove injurious agent
- Remove consequences of inflammation
Due to disease (pathologic); accidental and unregulated; ALWAYS PATHOLOGIC PROCESS
Necrosis
Immune reactions in blood vessels; the changes are too small to see grossly
Fibrinoid
Involves removal of part of a mass/ organ, preferred for tumors which cannot be removed completely
Incisional Biopsy
Taking a deeper sample of skin with a biopsy instrument that removes a short cylinder, or “apple core,” of tissue
Punch Biopsy
What is the percentage of differentiated cells in Grade III?
50% - 25%
Retention Period (RECORDS): Cytogenetics Report
20 years
Retention Period (SPECIMEN): Cytogenetic Diagnostic Images
20 years
Involves the examination of surgical specimens removed from the body (biopsy) or sometimes the examination of dead body (autopsy) to diagnose disease and to determine cause of death respectively
Anatomical Pathology
Failure of an organ to reach its normal mature adult size
Hypoplasia
Cells may undergo various adaptations in certain physiologic and pathologic conditions, controlled by complex mechanisms
Cellular Adaptation
Replaces lost cells of the body
Labile Cells
Not capable of replication after maturation
Permanent Cells
Kind of hypertrophy that is due to disease
Pathologic Hypertrophy
Due to disease; may give rise to neoplasm; may be due to stimulation of growth factors
Pathologic Hyperplasia
Persistent or continuous pressure on the organ or tissue may directly injure the cell or may secondarily promote diminution of blood supply
Pressure Atrophy
The decrease of tissue or organ size is due to disease
Pathologic Atrophy
The inactivity or diminished activity/function
Atrophy of Disuse
Will lead to cell death
Irreversible Injury
How many minutes can a hypoxic injury be irreversible for neurons?
3 - 5 minutes
What are the gross changes in reversible injury?
Organ pallor
Increased weight
Cooling of the body; first secondary change to appear
Algor Mortis
What is the most important requirement in autopsy?
Get a consent from the nearest kin of the patient
Cadaver is opened from the midline of the body from the suprasternal notch down to the pubis
Straight Cut Incision
Named by adding suffix sarcoma or carcinoma
Malignant Tumor
No spread or metastasis
Benign Tumor
What is the percentage of undifferentiated cells in Grade I?
0% - 25%
Similar to FNAB but uses a larger needle for larger tissue sample
Core Biopsy
Process of taking pieces of tissues from a dead person for the purpose of examination or investigation
Autopsy
On gross, necrotic material appears like “chalky white precipitates”
Fat Necrosis
Plasma membrane remains intact, the cellular content do not leaked out; there is no leakage of cellular contents/components
Apoptosis
Affected cells can no longer get back to its normal state
Irreversible Injury
Irreversible injury is due to:
- Enzymatic digestion of cells
- Protein Denaturation
A form of incisional biopsy where small pieces of tumor tissues are removed using special forceps. Example: endoscopic biopsy
Bite Biopsy
Multi-disciplinary filed that focuses on disease at the sub microscopic, molecular level
Molecular Pathology
Even the normal function could be affected
Functional Derangement and Clinical Manifestations
The affected organ shows no resemblance to the normal adult structure
Aplasia
Often used as criterion for malignancies
Anaplasia
Involves laboratory analysis of body fluids (blood, urine, CSF etc) and other bodily tissue for the diagnosis of disease
Clinical Pathology
Study of the structural, biochemical & functional changes in cells tissues, organs that underlie disease
Pathology
Does not undergo cell division frequently
Stable Cells
Heat; transfer of internal heat to the site of injury of tissue
Calor
Swelling; due to the extravascular accumulation fluid
Tumor
What are the 5 Cardinal Signs of Inflammation?
- Rubor
- Dolor
- Calor
- Tumor
- Function laesa
Changes that can be noted/observed immediately after death
Primary Changes
The importance of ____ can determine if body position has changed at the scene of death
Livor Mortis/ Lividity/ Post Mortem Hemolysis
Usually done in adult cadaver
Y shaped incision
The organs are removed from the body one by one
Technique by Rudolph Virchow
Best method to preserve vascular supply and relationship between organs
Anton Ghon’s Technique
Retention Period (RECORDS): Clinical Pathology Lab. Reports (results in cc, hema, etc.)
10 years
Retention Period (SPECIMEN): Pathology/Bone Marrow Slides
10 years
Retention Period (RECORDS): Surgical Pathology and Bone Marrow Reports (histopath results)
10 years
Noninvasive to another organ or tissues
Benign Tumors
Loss of membrane integrity
Necrosis
On gross, affected organs is somewhat firm, appearing like boiled material
Coagulative
Microscopically, the affected blood vessels appears thickened
Fibrinoid
On gross, affected organ appears liquefied, creamy yellow because of pus
Liquefactive
Microscopically it appears as amorphous granular debri surrounded by granulomatous inflammation
Caseous
On microscopy, infiltrates of foamy macrophage adjacent to adipose tissues
Fat Necrosis
Affects single cells
Apoptosis
Lysed cells ingested by macrophages
Necrosis
Increased mitochondria membrane permeability, release of proapoptotic proteins and formation of apoptotic bodies
Apoptosis
Consist of vascular responses, migration and activation of leukocytes and systemic reactions
Inflammation
Due to the increase dilatation of blood vessels = ↑ rate of the blood flow on the site of injury
Rubor
What delays stiffness in Rigor Mortis?
Cold Temperature and Obese Individuals
Is autopsy a mandatory procedure? True or False
False. Autopsy is not a mandatory procedure; may or may not carried out
Characterized by “In Situ dissection”
Technique by Karl Rokitansky
“en-bloc” removal of organs
Anton Ghon’s Technique
This method is widely used and usually with some modifications
Technique by Rudolph Virchow
“en-masses/en-lettule” removal of organs
Technique by M. Letulle (Lettule)
Dissection is done inside the body
Technique by Karl Rokitansky
Best for routine inspection and preservation of connections between organs and organ system
Technique by M. Letulle (Lettule)
Tissue/cells are collected using needle and syringe
Needle Biopsy (FNAB - Fine Needle Aspiration Biopsy)
What is the percentage of undifferentiated cells in Grade IV?
75% - 100%
Procedure is simple, inexpensive, least invasive. Hospitalization is prevented. Less complications
Needle Biopsy (FNAB - Fine Needle Aspiration Biopsy)
What are the 2 Value of Grading?
- Guide for Treatment
- Prognostic Guide
Based on the size of primary lesion, extent of spread to regional lymph nodes, presence or absence of metastases
Staging of Tumors
In the TNM Classification what does the T signifies?
Size of Tumor
In the TNM Classification what does the M signifies?
Presence or absence of metastasis
In the TNM Classification what does the N signifies?
Number of lymph nodes involved
What are the 2 parts of Tumor?
- Parenchyma
- Stroma
What is the part of tumor wherein it is the neoplastic cells?
Parenchyma
What is the part of tumor wherein it is the connective tissue framework?
Stroma
What temperature does Algor Mortis progresses?
Happen at rate of 7˚F (‘yung temp. ng body, bumababa every hour)
This is important in establishing time of death?
Algor Mortis
Occurs 6-12 hours after death
Rigor Mortis
Algor Mortis is faster in?
- Cold weather
- Malnourished individuals
It’s purpose is to determine extent of injury leading to the death of a person
Autopsy
Apoptotic bodies ingested by neighboring cells
Apoptosis
Random degradation of DNA
Necrosis
Microscopically cell outlines are preserved
Coagulative
Characterized by softening of necrotic material due to the action of enzymes
Liquefactive
In Fat Necrosis the usually affected organ is?
With increased amount of fat
Ex. Breast
Usually applied to a limb, generally the lower leg that has lost its blood supply
Gangrenous
Due to sudden cut-off of blood supply; usually happens in solid organs (heart, kidneys,
adrenal glands, liver)
Coagulative
Usually seen in tuberculosis (TB)
Caseous
What are the cytoplasmic changes of Irreversible Injury?
- Larger cells “cloudy swelling”
- Increased eosinophilia
Dissolution of nucleus (destruction)
Karyolysis
What are the nuclear changes in Irreversible Injury?
- Pyknosis
- Karyolysis
- Karyorrhexis
What are the microscopic changes in Reversible Injury?
- Cellular swelling
- Fatty degeneration/change
It is considered as point of no return
Irreversible Injury
How many minutes can a hypoxic injury be irreversible for myocardial cells & hepatocytes?
1 - 2 hours
How many minutes can a hypoxic injury be irreversible for skeletal muscles?
Many hours
Happens when cells of DNA and proteins are damaged beyond repair —> cells kill itself by ___ = the affected cell becomes smaller; reduction of cell size
Apoptosis
The plasma membrane is disrupted/ damaged —> cellular contents leaked out = inflammation
Necrosis
Occurs if blood supply to an organ becomes reduced or below critical level; sudden cut-off of blood supply
Vascular Atrophy
Due to lack of nutritional supply to supply normal growth
Starvation or Hunger Atrophy
Occurs as consequence of maturation; normal
Physiologic Atrophy
Irreversible process; transformation of adult cell to primitive or embryonic cell type (adult —> primitive)
Anaplasia
Reversible process; no cell transformation
Dysplasia
Considered as reversible process
Metaplasia
Area of science focusing on all the changes in cells, tissues, organs
Pathology
Frequently dividing
Labile Cells
Replaces injured cells
Stable Cells
Condition in which an orifice or passage in body either closed or absent
Atresia
It’s purpose is to preserve tissues of the dead person for further examination and for further research
Autopsy
It is characterized by abnormal proliferation of cells
Neoplasia
Bleeding from cut surfaces is common
Malignant Tumor
No recurrence after surgery
Benign Tumors
Does not lead to death
Benign Tumors
In Rigor Mortis it starts at _____ hours following death; completes at ______ hours and stiffness remains for _______ hours, persist for ______days
2 - 3 hours; 6 - 8 hours; 12 - 36 hours; 3 - 4 days
What hasten stiffness in Rigor Mortis?
Warm environment and in infants
Invasive to other organs
Malignant Tumor
No inflammatory response
Apoptosis
After irreversible injury
Cell Death
Pathologic cell death
Necrosis
Father of Cytopathology
George Papanicolaou
PAPANICOLAOU SMEAR and STAIN is a screening test for?
Cervical Cancer
Used in Papanicolaou stain in order to stain
the NUCLEUS
Harris Hematoxylin
Considered as the LARGEST and MOST MATURE
but with VERY SMALL nuclei
Superficial Cells
What is the routine tissue adhesive?
Mayer’s egg albumin
2 categories of specimen in Cytology
- Gynecological
- Non-gynecological
Impression smear or Touch smear is also called?
Abraded Cytology
What are the four ways to prepare a smear?
- Streaking
- Spreading
- Pull-apart
- Touch or Impression smear
In cytology, we NEVER used Mayer’s egg albumin. True or False?
True. Because this is INTENSELY STAINED by the COUNTER STAIN used in PAPs and IF this is used, it will take up the color / dye
Stain the CYTOPLASM of MATURE superficial cells
OG 6
Stain the CYTOPLASM of IMMATURE cells
EA 50
What is the second counter stain?
EA 50
What is the first counter stain?
OG 6
It is called Pap Smear because it uses what stain?
Papanicolaou Stain
These are boat shaped cells with a tendency to fold or curl on edges
Navicular Cells
What are the 2 Manner of Reporting Pap’s Smear
- Class System
- Bethesda System
Developed at national Cancer Institute in December 1988
Bethesda System
SMALLER than intermediate cells
Parabasal cells
No longer used, last used December 1988); obsolete
Class System
Currently used/adopted to report the result of PAP smear
Bethesda System
Conclusive for malignant cells
Class V
What fixative for cytologic smear is considered as the BEST but NOT COMMONLY used?
Equal parts of 95% ethyl alcohol & ether
MOST COMMONLY USED FIXATIVE for cytology?
95% ethyl alcohol
Involves examination of cells, specifically cells desquamated or the cells shed from epithelial surfaces
Exfoliative Cytology
Involves microscopic examination of cells taken from different body sites for diagnostic purposes
Diagnostic Cytology
Extra sediments are used for?
Cell Block Technique
SHED TRAUMATICALLY
Basal Cells
FRIED EGG APPEARANCE
Parabasal Cells
Round to oval shaped cells with translucent basophilic cytoplasm due to glycogen accumulation
Pregnancy cells
Parabasal cells are normally found from and increased number in?
Child birth
Abortion
Menopause
Two weeks of age to puberty
Negative for malignant cells
Class I
POLYHEDRAL CELLS with BASOPHILIC and VACULATED cytoplasm
Intermediate Cells
Polyhedral flat cells with small dark pyknotic nuclei (less than 6u)
Superficial Cells
Medium sized cells
Intermediate Cells
Small (13-20u) round, slightly oval cells, with relatively large nucleus occupying half or more of
the cell volume
Basal Cells
Suspicious for malignant cells
Class III
Results in PALE GREENISH BLUE
T. Vaginalis
Results in BLUE
Vesicular nucleus
Results in VIOLET
Mycelia
Atypical cells present, but negative for malignant cells
Class II
Results in DARK BLUE
Bacteria
ROUTINE cytologic fixative
95% ethyl alcohol
Results in OLIVE GREEN with a hint of BROWN and RED
Cytoplasm in EA 36 to 50
Strongly suggestive of malignant cells
Class IV
Cells that shows TRUE ACIDOPHILIA, cytoplasm may be acidophilic or basophilic
Superficial Cells
Results in DARK BLUE to black
Pyknotic nucleus
Results in ORANGE with a hint of GREEN
Cytoplasm in OG 6
A bluing agent
Ammonia water then wash
Using loop needle or applicator stick, spread the specimen in a ZIGZAG manner
Streaking
Spread the specimen by using another or 2 SLIDES, NOT by using loop, applicator stick, or needle
Pull-apart
Preserves intercellular relationship
Spreading
Allow the slide to come in contact with cut surface of tissue
Touch preparation or impression smear
Size and Depth of Tissue Cassette
Size: 2.5 x 4 cm
Depth: 5 mm
Ideal size and thickness of specimen?
Size: 3 x 2 cm
Thickness: 3 - 5 mm
Ideal size of the lung specimen?
1 - 2 cm
What is the purpose of formalin?
PRESERVE and HARDEN
Place the specimen on the slide, and using a loop/applicator or needle, spread the specimen to form OVAL or CIRCULAR smear
Spreading
