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Pathological processes > Introduction to pathology > Flashcards

Introduction to pathology Flashcards

1
Q

Pathology superheros

A

Rudolf Virchow

Robert Hook

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2
Q

Rudolf Virchow

A
  • Pope of medicine
  • Discredited the theory of the 4 humours
  • All cells come from cells
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3
Q

Robert Hooke

A

• Cell named after monks cells

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4
Q

what is disease?

A
  • Pathological condition of a body part, an organ or system characterise by an identifiable group of signs or symptoms
  • Can be manifested in a single organ or whole person
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5
Q

Disease can be considered to be a consequence of

A

failed homeostasis

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6
Q

what is pathology?

A

Pathos= suffering, logos= study

  • Branch of medicine concerned with disease and understanding the process of disease
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7
Q

pathology attempts to

A
  • to explain why patients experience symptoms and guides treatment
    • Involves diagnosis
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8
Q

cellular pathology

A
  • examine organs, tissues and cells for diagnosis and to guide treatment- often cancer work
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9
Q

cellular pathology includes

A

histopatholgoy and cytopathology

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10
Q

histopathology

A

core biopsies, cancer resection speciments, exised kin lesion and endoscopic biopsies

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11
Q

cytology

A

Disaggregated cells ratehr than tissie

fine need aspirate of breast, thryoid, saliavry glands, lungs, effusions, cervical smears, sputum and urine

*faster, cheaper, safer and less invasive than histology*

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12
Q

cytopathology

A
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13
Q

neuropathology

A

confided to brain, spinal cord, nerves and muscle

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14
Q

forensic pathology

A
  • medicolegal investigation of suspicious or criminal deaths, attend crime scenes, perform detailed autopsies and act as expert witnesses in court
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15
Q

chemical pathology (clincial biochemistry)

A

Biochemical investigations of disease, e.g. endocrinology, diabetes, lipidology, thyroid disease, inborn errors of metabolism

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16
Q

haemotology

A

Diseases of the blood (including leukaemias), blood clotting, blood transfusion and bone marrow transplantation

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17
Q

immunology

A

Diseases of the immune system, e.g., allergy,

autoimmunity and immunodeficiency

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18
Q

medical microbiology

A

Disease-causing microbes including advice on antibiotic usage

19
Q

importance of microscopic diangosis

A
  • Definitive diagnosis
  • Before major surgery to remove a lesion a microscopic diagnosis is required
    • Guides the type and extent of surgery
20
Q

how do we arrive at a diagnosis

A
  • Pattern recognition
  • Histologist asks herself?
    • Is this normal?
    • Is this inflammatory or neoplasticism?
    • Benign or malignant
    • Is this primary or a metastasis?
21
Q

When its cancer, what else can histopathologists tell us?

A
  • Type of cancer
  • Grade of cancer
  • Stage of cancer
  • Completeness of excision and if margins are involved, which ones
  • Likely efficacy of further treatments (molecular pathology HER2, ER/PR, EGFR, PDL1 status)
  • All of which influence decisions on further treatment and management
22
Q

preparing a specimen: problems

A
  1. autolysis
  2. choosing the right bits fo tissue
  3. getting the tissue hard enough to be able to cut very thin slice
  4. getting the tissue into a peice of wax that can be cut
  5. cutting very thin section
  6. colouring the tissue so it can be seen under a microscope
  7. preservign and protecting the slice of tissue
23
Q

Problem 1: Autolysis

A
  • Tissue autolysis (self-digestion) begins when blood supply is cut off
  • Destroys cell and tissue architecture
24
Q

to prevent autolysis

A

fixation

  • Hold tissue ‘suspended in animation ‘
  • Formalin (formaldehyde in water)
  • Penetration at approx 1mm/hr
  • Usually fix for 24-48hours
25
Q

role of fixatives

A
  • Inactive tissue enzymes and denature proteins
  • Prevent bacterial growth
  • Harden tissue
26
Q

Problem 2: Choosing the rights bits of tissue

A
  • Usually the next day the specimen is examined and cut up by a pathologist
  • Samples are taken and placed into a cassette
    • Same size as stamp
    • May need to take 30 or more
    • Cassettes have holes in
    • Placed in racks in formalin
27
Q

Problem 3: Getting the tissue hard enough to be able to cut very thin slice

A
  • Have to remove water first
  • Dehydration using alcohol in a vacuum so water is drawn out of cells
  • Then replace with alcohol with xylene which can mix with wax
  • Operate overnight
28
Q

Problem 4: Getting the tissue into a piece of wax that can be cut

A
  • Tissue taken out of the cassettes by hand and put into metal blocks
  • These are filled with molten paraffin wax and the body of the cassette is placed on top
  • The wax is allowed to harden and the metal tray is removed
29
Q

Problem 5: Cutting very thin sections

A
  • Very thin(3-4microns) sections are cut from the block using a microtome
  • Sections must be so thin that we can see through them with a microscope
30
Q

Problem 6: Colouring the tissue so it can be seen under a microscope

A

Staining: usually with H&E

31
Q
  • Haemotoxylin
A
  • stains nucleic acid purple
    *
32
Q
  • Eosin
A
  • stains protein and cytoplasm pink
33
Q
A
34
Q

Problem 7: Preserving and protecting the slice of tissue

A

Mounting: mounting medium is applied to the slide

  • Coverslip is put on top
  • Mounting medium dries and hardens, preserving the tissue and attaching the coverslip
35
Q

Problem 8: Making a diagnosis

A

Now the slides are ready to be looked at under a microscope by a pathologist

36
Q

Frozen section

A
  • Used intraoperatively
  • Method of hardening tissue quickly
  • Not routinely used as morphology not as good as in paraffin sections
  • Takes 10-15 minutes from receiving specimen in lab to giving a results
  • Aim to establish presence and nature of lesion and influence the course of the operation
  • 96% accuracy
37
Q

Immunohistochemistry

A

Demonstrates substances in/on the cells by labelling them with specific antibodies

38
Q

what enzyme is the antibody conjugated with which catalyses a colour producing reaction

A

peroxidase

  • highlights the susbtances with a brown colour
39
Q

which substances can be demonstrated by immunohistochemistry

A

Any substance that is antigenic can be demonstrated

  • Contractile protein actin- identifies smooth muscle cells
  • Cadherins (cell adhesion molecules)- deficient in some carcinomas
  • Hormone receptors e.g. ER, PR
  • HER2 receptors- growth factor receptor, predicts response of breast cancer to Herceptin
  • Microorganisms e.g. HPV, Herpes simplex
40
Q

Cytokeratins

A
  • Family of intracellular fibrous proteins
  • Present in almost all epithelia
  • At least 20 known
  • Markers for epithelial differentiation and show tissue-specific distribution in epithelia
41
Q

cytokeratins can give information about

A

primary site of carcinoma

42
Q

Molecular pathology

A

Studies how diseases are caused by alterations in normal cellular molecular biology.

  • Due to altered DNA, RNA or protein
43
Q

Molecular pathology: pathology due to altered DNA

A
  • In situ molecular tests show how DNA is altered in cells
    • E.g. fluorescence in situ hybridisation (FISH) to test for gains of additional copies of Her2 gene in breast cancer
  • Sequencing of DNA purified from tumour can show if mutation is present in a particular gene (e.g. if certain mutations in EGFR gene are present in lung cancer then the tumour is likely to respond to anti-EGFR treatments e.g. erlotinib
  • Next generation sequencing enables many genes to be tested simultaneously for mutations
44
Q

molecular pathology: mRNA expressing profiling methods demosntrate

A

mRNA expression profiling methods demonstrate the level of activity of a large number of genes simultaneously – microarray

  • mRNA ‘signatures’ can predict how tumours are likely to behave
    • e.g. the risk of breast cancer spread/ recurrence after surgery

Pathological processes (19 decks)

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