Introduction To Anatomic Pathology

Question 1

Pathology is derived from two words?

Answer 1

• Pathos-suffering and
• logos-study

Question 2

Definition of pathology

Answer 2

It can be defined as the science that deals with the study of disease and the body’s response to disease.

Question 3

According to Royal College of pathology, London, pathology is defined as?

Answer 3

•Pathology is the hidden Science at the heart of modern medicine, vital for the diagnosis and clinical management of disease

Question 4

Pathology is a discipline that links ______ and ______

Answer 4

BASIC MEDICINE
CLINICAL PRACTICE

Question 5

Branches of Pathology:
(Hint: there are 4 branches)

Answer 5

•Anatomic Pathology (Forensic Pathology)
•Clinical or Chemical Pathology
•Medical Microbiology
•Hematology and Blood Transfusion

Question 6

Concerning an Anatomic Pathologist:
• Is a ______ physician who examines _____ by the use of morphologic, ______ and ______ techniques to make diagnosis.
• He/she is first and foremost a ______
• undertakes an extra _____ postgraduate
training in ________
• may also undergo additional training(fellowship) to
sub specialize.
• He is responsible for the ______ and _____

Answer 6

•laboratory, tissues, immunologic, molecular
•Medical doctor
•5-6 years, laboratory medicine
• quality assurance and accuracy of laboratory tests

Question 7

Three major services provided in anatomic pathology laboratory:

Answer 7

• Surgical pathology or histopathology
• Cytopathology
• Forensic pathology services

Question 8

Some techniques in histopathology:

Answer 8

Light microscopy
Histochemistry
Immunohistochemistry
Fluorescence microscopy
Electron microscopy
Flow cytometry
Tissue culture

Question 9

Tissue samples are removed by:

Answer 9

Incisional biopsy(trucut biopsy)
Excision biopsy

Question 10

Incisional biopsy involves ____

Answer 10

Removal of small piece of the organ for processing

Question 11

Excision biopsy involves:

Answer 11

open surgery with complete removal of whole lesion/tumour or organ

Question 12

Examples of incisional biopsies:

Answer 12

liver, prostate, breast, kidney, gastrointestinal endoscopic biopsies

Question 13

Examples of excision biopsies:

Answer 13

colonic resection, nephrectomy, mastectomy, prostatectomy, total abdominal hystecterectomy

Question 14

The sample should be immersed in a container big enough to contain it and preservative ____ times the volume of the tissue.

Answer 14

3-5times

Question 15

• The process that ensures that the tissue remains in the state it was before removal from the body is _______

Answer 15

Tissue preservation

Question 16

Major reason for preserving tissue:

Answer 16

• It prevents AUTOLYSIS of tissue by cellular enzymes and DECOMPOSITION by microorganisms.

Question 17

Properties of fixatives:

Answer 17

• Preserve tissue
• Harden tissue to allow thin sectioning.
• Devitalize or inactivates infectious agents (except CJD infection) on glass slides
• Stabilize tissue components and enhances avidity for dyes.

Question 18

Factors affecting fixation:

Answer 18

•Volume
•Time
•Access of fixative to tissues- slicing big tissues helps fixation
•Temperature - room temperature
•Buffer
•pH

Question 19

Requirements of volume of tissue to preservative ratio:

Answer 19

tissue volume(ratio 1:10) is recommended

Question 20

Most commonly used fixative is ____

Answer 20

10% neutral buffered formalin

Question 21

Other examples of fixatives are:

Answer 21

Boiun’s solution
Carnoy solution ( made of picric acid and absolute alcohol)
B-5 solution

Question 22

What fixative is used for for testis, small biopsies?

Answer 22

Bioun’s solution

Question 23

What fixative is routinely used for bone marrow biopsies and lymphoid tissues especially when lymphoma is suspected?

Answer 23

B-5 solution

Question 24

What fixative contains alcohol for rapid processing, dissolves fat and so good for identifying lymph node?

Answer 24

Carnoy solution
(Picric acid + absolute alcohol)

Question 25

In staining using H&E stain- ______ stain blue with _____ stain while ______ stains pink with ____ stain

Answer 25

Nuclei, haematoxylin Cytoplasm, eosin

Question 26

________ is required to further assist in establishing diagnosis.

Answer 26

Special Histochemical Stains

Question 27

Examination of some organs such as the _____, _____ and _____ will usually not be complete without the use of special stains.

Answer 27

Liver Kidney GIT

Question 28

What special stain is used in Mucinous Adenocarcinoma?

Answer 28

Mucicarmine (mucin is the tissue constituent)

Question 29

What special stain is used in disease condition, Necrotizing lesion in glomerulonephritis?

Answer 29

Reticulin stain (Tissue constituent is Fibrin)

Question 30

Congo red is the special stain used in what disease condition?

Answer 30

Amyloidosis (tissue costitient-Amyloid)

Question 31

Chronic gastritis is associated with what tissue constituent? What special stain is used?

Answer 31

Helicobacter Pylori Modified Giemsa stain

Question 32

Tissue constituent-Haemosiderin, Iron is seen in what disease condition? Amd what special stain is used?

Answer 32

Haemochromatosis Perl’s Prussian blue

Question 33

In Liver cirrhosis, what special stain is used?

Answer 33

Masson’s trichome/ Sirus red Tissue constituent- Connective tissue fibers Note: Sirius Red is used for Chronic Hepatitis

Question 34

_________ is a technique in which rapid diagnosis is made from surgical tissue sample with the use of fresh sample.

Answer 34

Frozen section

Question 35

In frozen section, sections are cut using the ____ at ____(temperature)

Answer 35

CRYOSTAT -3 degrees centigrade

Question 36

Uses of Frozen Section:

Answer 36

• For rapid diagnosis to ascertain the presence of diagnostic material in tissues e.g Hirchsprung’s disease, presence or absence of malignancy • Examination of tumour resection margins.

Question 37

Define Immunohistochemistry:

Answer 37

A technique used for the identification of cellular or tissue antigens by means of antigen antibody interactions. It is used for therapeutic,diagnostic and prognostic purposes.

Question 38

Uses of immunohistochemistry:

Answer 38

Diagnosis of undifferentiated tumour • To Predict response to therapy-e.g. Detection of oestrogen/progesterone receptor in breast cancer. Positivity means the patient will respond to treatment by anti-oestrogen drug • To determine the origin of unknown primary tumours • To detect micro-metastasis in lymph node and bone marrow, • To distinguish in-situ tumour from microinvasive cancer. • To detect micro-organisms .e.g. Hepatitis B in liver

Question 39

________ studies individual cell characteristics to make diagnosis

Answer 39

Cytopathology

Question 40

Examples of cytopathology:

Answer 40

Fine Needle Aspiration Cytology (FNAC) of solid masses, breast, liver, lymph node,thyroid etc • Gynaecological cytopathology-Pap smear (slide), liquid based cytology kits • Exfoliative cytology –fluids from ascites, pleural effusion, CSF , joint space, cystic aspirate etc

Question 41

Define a mortuary:

Answer 41

The mortuary refers to a facility (one or more rooms or a building) which is used for the storage of bodies.

Question 42

Services of a mortuary:

Answer 42

1. Body storage 2. Autopsy or Postmortem examination 3. Embalmment

Question 43

Two types of autopsy:

Answer 43

Hospital/Clinical autopsy Coronal/forensic/medicolegal autopsy

Question 44

Hospital/clinical autopsy is that which is done with permission/consent of the ____ or ____

Answer 44

Relatives/next of kin

Question 45

Define coronal autopsy

Answer 45

Coronal autopsy/forensic/medico- legal autopsy is examination performed under the law with the order of the coroner

Question 46

Uses of autopsy:

Answer 46

• To determine cause of death. • Teaching of medical students and nurses • Training of residents. • For clinical audit • To research purpose • Discover “disease of unknown cause”- e.g cancer, SARS, HIV-AIDS • Medico-legal cases to establish justice in the law court, to claim insurance benefit, definite cause of death has to be found.