patoloji-ders-notlari

Title

Serdar Balcı

Introduction to Pathology

Serdar BALCI, MD

Pathology

Study (logos)

Disease (pathos)

Literally translated, ** pathology __ is the study (__ logos **) of disease ( pathos, __ suffering)__

Study of changes that underlie in disease
- Organs
- Tissues
- Cells
- Genes
- Proteins, enzymes
Changes
- Structural changes
- Biochemical changes
- Functional changes
These changes give rise to signs and symptoms in a patient

Pathology uses

Morphologic techniques
- Macroscopy
- Long live the classic friend!: H&E
Molecular techniques
- PCR, ISH, GWAS, Next-gen Seq
Microbiologic techniques
- Various methods to identify microorganisms
Immunologic techniques
- Immunohistochemistry
And autopsy
- A very informative technique nowadays forgotten

Pathology tries to explain whys and wherefores

What is the morphologic change in the cells, tissues, organs in the disease?
Are these morphologic changes constant, reproducible in certain disease?
What is the cause of this morphologic change?
What is the subcellular mechanism of this morphologic change?
- Electron microscopy
What proteins are involved in the disease?
- Histochemistry, Immunohistochemistry
What effect do these proteins make on morphology?
What is the genetic change causing the change in proteins?

Is there any microorganism around?

Is the changes in morphology caused by microbes constant in certain diseases?

What is the main cause of death in a patient or victim?

What is the mechanism taken place during the death?

How are signs and symptoms related to diseases?
What is the way to cure a patient?
Does the therapy have a rational base?
- Will the anti tyrosine kinase inhibitor be effective in a colorectal cancer patient?
- Does the cancer have K-Ras mutation?

Which disease causes how much survival?

Are the subgroups of diseases differ in terms of survival?

Pathology is the bridge

The bridge between the basic sciences and clinics

The scientific foundation for all of medicine

Did you hear about “evidence based medicine”?

Then we will send you to the clinics

Systemic pathology will be the topic of next year

You should know the roots to understand general pathology

General Pathology

Reactions of cells and tissues to abnormal stimuli and inherited defects
- Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death
- Acute and Chronic Inflammation
- Tissue Renewal, Regeneration, and Repair
- Hemodynamic Disorders, Thromboembolic Disease, and Shock
- Genetic Disorders
- Diseases of the Immune System
- Neoplasia
- Infectious Diseases
- Environmental and Nutritional Diseases
- Diseases of Infancy and Childhood

Systemic pathology

Alterations in specialized organs and tissues that are responsible for disorders that involve these organs
- Blood Vessels, Heart
- White Blood Cells, Lymph Nodes, Spleen, and Thymus
- Lung, Head and Neck
- Gastrointestinal, Liver and Biliary Tract, Pancreas
- Kidney, Lower Urinary Tract and Male Genital System
- Female Genital Tract, Breast
- Endocrine System
- Skin
- Bones, Joints, Soft-Tissue
- Peripheral and Central Nervous System

Types of diseases

Genetic
- Developmental
Infectious
Tumoral
- Benign
- Malignant
Try to learn all diseases in this subgroups and in the clinic try to answer the questions in these four groups:
- i.e. “Tell us the pathologies of ovary”

Underwood’s Pathology: A Clinical Approach , Sixth Edition

Studies of Pathology

Etiology

Pathogenesis

Molecular and Morphologic Changes

Functional Derangements and Clinical Manifestations

Etiology (Why disease arise?)

Origin of a disease

Underlying causes and modifying factors

Etiology or Cause

Genetic
- Inherited mutations
- Disease-associated gene variants
- **Polymorphisms **
Acquired (one occurred after)
- Infectious
- Nutritional
- Chemical
- Physical

Causes and Risk Factors

Alterations in Rb protein function leads to cervical cancer

HPV is the cause of alterations in Rb function

Smoking is the risk factor for cervical cancer

One etiology for one disease?

Yes, Some genetic and infectious diseases
No, in general.
- We are in a multi-factorial world
- Atherosclerosis
- Cancer

Genetic background (susceptibility) + environmental effects

Wheater’s Basic Pathology: A Text, Atlas and Review of Histopathology , Fifth Edition

Pathogenesis (How disease arise?)

Steps in the development of disease

How etiologic factors trigger cellular and molecular changes

How these changes give rise to the specific functional and structural abnormalities

Pathogenesis

How the disease forms in sequence

Figure 10-19, 10-20 from Robbins

Sequence of events in cystic fibrosis and various clinical manifestations

How the cancer forms in sequence

Figure 17-49 from Robbins

Sequence of events in adenoma carcinoma sequence of colon cancers

Molecular and Morphologic Changes

Structural alterations
- in tissues
  - macroscopy
- in cells
  - under microscope
  - H&E or Electron microscopy
Characteristic of a disease
Diagnostic of an etiologic process

Stevens, Alan, MB BS, FRCPath - Core Pathology

Functional Derangements and Clinical Manifestations

Genetic

Biochemical

Structural changes

Functional abnormalities

Clinical features

Course

Outcome

Pathology also deals with Epidemiology

Especially in Cancer Registry

**SEER, Globocan, ICD, SNOMED … **

The founder of modern pathology Dr.Virchow was an active politican in Berlin and dealt with public health

Diagnostic Pathology

Studies nature and progression of disease
Morphologic changes
- Gross
- Microscopic
Chemical alterations
Immunologic properties
Molecular alterations

Wheater’s Basic Pathology: A Text, Atlas and Review of Histopathology , Fifth Edition

Macroscopic examination

Microscopy

Cytology

Cytological preparation of a fine needle aspirate of a breast carcinoma. The specimen consists of dissociated cells with no surrounding tissue.

Immunohistochemistry

Wheater’s Basic Pathology: A Text, Atlas and Review of Histopathology , Fifth Edition

Who is a pathologist?

A person deals with and earns money from pathology

How can one become a pathologist in Turkey?

After you become MD

Take the TUS exam

4 year residency

Are there different kind of pathologist in the world?

Anatomic pathology

Clinical pathology

Molecular pathology

Veterinary pathology

Are there any subspecialities?

Cytopathology

Dermatopathology

Neuropathology

Hematopathology

GI pathology

Surgical pathology

Molecular pathology

….

How will this course go on?

Theoretical lectures

Laboratory hours

How will you be graded?

Committee exams

Laboratory exams

You will be supplied

Notes for laboratory studies

You will get a version of lecture notes

How can I study pathology?

To pass the exams (as a universal rule):
- Check out the lecture notes
  - Do not rely on them, medicine is an ever changing science
- Look for previously and frequently asked questions
To learn pathology