Basic pathology

Dr. Mishaal
• Introduction
 Objectives:
The student should:

A.Have an idea about Historical background and development of pathology.

B.Discuss the important concepts of disease in pathology
C.Understand the meaning of the terminology used during the study of a
disease like etiology, pathogenesis, morphology, prognosis, etc.
D.Understand the role of pathology and its various sub-specialities in the
diagnostic process with special emphasis on histopathology and cytology.
E.Understand the role of diagnostic pathology in disease management.
F.Be aware of some of the principle techniques used in pathology like light
microscopy, cytology, immunohistochemistry and molecular pathology.
G.Have a basic knowledge of the definition of autopsy and its indications.
 History
Religious beliefs and magic to rational approach (prehistoric time to
AD1500)

• Greeks:
- Asclepios, Apollo
- Socrates, Plato,
- Aristotle
- Hippocrates
 History
Religious beliefs and magic to rational approach (prehistoric time to
AD1500)

• Romans: Celsus, Galen

• Indians: Dhanvantri, Charaka, Sushruta
• Europe ( Middle ages): Theory of vitalism
 History
Religious beliefs and magic to rational approach (prehistoric time to
AD1500)

• Islamic civilization era: rational and holistic and

experimental approach:
- Avicenna
- Al-razi
- Alzahrawy
(The medicine was non-existent and it was found by
Hippocrates, dead and made a live by Galen,
dispersed and collected by AL-Razi, incomplete and
completed by Avicenna.)
 History
Religious beliefs and magic to rational approach (prehistoric time to
AD1500)

• Islamic civilization era:

 History
Human Anatomy to Era of Gross Pathology (AD1500-1800)

• Renaissance:
- Leonardo da Vinci
(1452-1519)
- Vesalius (1514-
1564)
- Fallopius (1523-
1562)
 History
Human Anatomy to Era of Gross Pathology (AD1500-1800)
• Leeuwenhoek (1632-1723)
• Malpighi (1624-1694)
• Morgagni (1682-1771)
• Pott (1714-1788)
• Hunter (1728- 1793)
• Hodgkin
• Xavier Bichat, RTH Laennaec
• Rokitansky
 History
Human Anatomy to Era of Gross Pathology (AD1500-1800)
 History
Human Anatomy to Era of Gross Pathology (AD1500-1800)
 History
Technology Development & Cellular Pathology (1800-1950)
• Louis Pasteur
• Hansen
• Ehrlich
• Gram
• Romanowsky
• Koch
• May-Grunwald and Giemsa
• Leishman
• Feulgen
• Rudolf Virchow
 History
Technology Development & Cellular Pathology (1800-1950)
 History
Technology Development & Cellular Pathology (1800-1950)
Pathology- History
 Virchow’s Hypothesis
• Ruldolf Virchow (1821-1902), German pathologist,
father of modern pathology has stated the cellular
pathology concept;
“All diseases are…reducible to disturbances, either active or
passive, of large groups of living units whose functional
capacity is altered in accordance with the state of their
molecular composition and is thus dependent on physical
and chemical changes of their contents.”
-Virchow, Cellular Pathology, 1855

• Implication: diseases can be defined by observing

morphologic changes in cells
 History
• Pathology, and consequently medicine, has been
revolutionized by the application of microscopy to the
study of diseased tissues from about the year 1800 AC.
Before this, it was postulated that diseases are
spontaneously generated, independent of any external
causes or other influences. This attitude seems
unreasonable to us today, but at that time nothing was
known of infectious agents (such as bacteria and viruses,
etc.) or cancer causative agents (such as ionizing radiation
and carcinogenic chemicals, etc.).
• The primitive light microscope of Rudolf Virchow (1821-
1902), enabled him to see changes in diseased tissues at a
cellular level. His observations have had a profound
influence on the understanding of many diseases.
 History
Modern pathology Surgeon-pathologists to Surgical
Pathologists.
Surgical pathology and cytopathology era

• Surgeon doubling up as pathologist from19th

century up to mid-20th century
• Famous surgeon pathologists during this era:
James Ewing, Stout, Ackerman, Pierre Masson,
Willis
• Cytopathology : Papanecolau
 History
Modern pathology Surgeon-pathologists to Surgical Pathologists.
Surgical pathology and cytopathology era
 History
Modern pathology Surgeon-pathologists to Surgical Pathologists.
Surgical pathology and cytopathology era
 Introduction
• Cells in normal conditions can alter their
functional state in response to modest stress
( changes) and undergo adaptations (physiological)
in response to modest stress (changes) to maintain
the steady state (homeostasis)
• In the normal state the body maintains continuous
monitoring, adjustments and adaptations
(homeostatic mechanisms) to the internal
environment (internal milieu) and external
environment from the first to the last hours of life
to maintain normal physiological state
(homeostasis).
 Normal homeostasis
• Normal homeostasis is the steady (stable) state in
which sells and tissues found normally.
• It is achieved by adequate response to internal
environment (internal milieu) and external
environment changes. This is done mainly by :
1- Genetic programs for:
–metabolism
–proliferation
–differentiation & specialization
2- Constraints of neighbouring cells and matrix
play main role
 Introduction
• The failure of these homeostasis maintaining
mechanisms and (physiological) adaptations leads
to disease (pathology).
• In more excessive physiologic stresses, or adverse
stimuli or injurious agents, the cells response to
stimuli result in :
- Adaptation (pathological adaptation)
- Cell injury and degeneration ( reversible or
irreversible)
 PATHOLOGY
• (As is our pathology so is our practice.)
• (What the pathologist thinks today, the
physician does tomorrow.)
• Sir William Osler
 Pathology
• (Withoutpathology, there is no
medicine!) Birger Fredrik Motzfeldt Laane. M.D.
Physician and Consultant Pathologist
 Pathology
• Pathology definition: is the study of diseases by
scientific methods.
• Pathology is literally the study (logos) of suffering
(pathos).
• The ultimate goal of pathology is the identification
of the causes of disease, a fundamental objective
that leads the way to disease treatment and
prevention.
• Disease : abnormal variation in structure and/or
function of any part of the body.
 The Tree of Medicine
• Pathology is the scientific
basis for clinical medicine
• Pathology gives clinical
purpose to basic sciences
and scientific research
• the approach to the patient’s
illness clinically is based on
the following sequence of
steps: Diagnosis (Patient's
history, Examination,
Investigations), Treatment &
prognosis
 Pathology
• In the pathology of any given disease there are structural
changes of the relevant tissues that are reflected as
functional disturbances, which in turn are perceived as
clinical features.
• The range of the structural changes varies from those
affecting sub-cellular organelles (molecular pathology) up
to alterations seen by the naked eye (gross pathology).
• Pathology is a dynamic science in that its contents are
continuously subject to changes, revisions and expansions.
This is because there are always new findings that shed
more light on, add or modify an already established
knowledge of various diseases.
 pathology
Therefore in medicine diseases are studied under the following
headings:
• Definition
• Epidemiology of disease
• Etiology (Why?): The cause of a disease
• Pathogenesis and pathophysiology(How?) : The mechanism
producing a disease
• Morphology ( Pathomorphology)(Morbid anatomy) (What?) :
Structural changes due to disease, it is divided into
Gross/ macroscopic- visible to the naked eye
Histopathologic/ microscopic- visible under a microscope
• Clinical features/presentation: signs and symptoms
• Investigations: correlated with clinical features to arrive a diagnosis
• Treatment and management
• Prognosis
 pathology
• Epidemiology
• Etiology (the cause leads to the
beginning of pathogenesis)

• Pathogenesis

• Morphological or chemical
alteration

• Clinical features (signs and

symptoms)

• Investigations and Diagnosis

 Pathology
• Pathology can be classified according to range of
study (and this mainly applies to anatomic
pathology due to historical effects) into :
- General (Basic) Pathology
- Systemic (Specific)Pathology

• This classification is usually used in academic

fields and academic textbooks.
 Pathology
Can also be classified according to uses and practice
field into :
• Experimental Pathology
• Clinical (Diagnostic) Pathology
 Pathology
Experimental Pathology
• Experimental pathology is the observation of the effects
of manipulations on experimental systems such as animal
models of disease or cell cultures or organoids.
 Pathology
Clinical Pathology
• Clinical medicine is based on a longitudinal approach to a
patient’s illness - the patient’s history, the examination and
investigation, the diagnosis and the treatment. Clinical
pathology is more concerned with a cross-sectional analysis at
the level of the disease itself, studied in depth - the cause and
mechanism of the disease, and the effects of the disease upon
the various organs and systems of the body. These two
perspectives are complementary and inseparable:
 The diagnostic process and the role of clinical
pathologist
• Any patient going to a clinic meets clinician who will take
history and do clinical examination. He may ask for
radiological and pathological investigation in order to
come to a diagnosis.
• The common pathological investigations are blood, urine
and stool tests. Sometimes the patient is also asked to
undergo a cytopathology or a histopathology test or other
special pathological tests in order to obtain an accurate
diagnosis.
• This way pathology plays an essential role in the
diagnosis of a disease and management and treatment of
patient.
 Methods used in Pathology
• Morphologic
– Gross observation and description
– Microscopic examination (histo & cyto pathology) :
light, fluorescence and electron microscopy (scanning
& transmission)
• Molecular/Biochemical/Cytogenetic
– Applied clinical and research methods
• Immunologic/ Serologic
– Serum, plasma, cell suspensions, tissues
• Microbiologic
– Cultures, biochemical assays, immunologic
 Main human materials used in Pathology
• Excretion and secretions:
- urine and faeces
- sputum
• Blood:
- blood cells
- plasma
- serum
• Effusions and exudate:
- Pleural and ascitic fluid
• Cytology samples
• Biopsies and organ resections :
- needle biopsy, endoscopic biopsy, incisional biopsy and surgically
resected organs
 Some instruments & techniques
used in diagnostic Pathology
1. Gross pathology
2. Light Microscopy routine stains, special stains
histochemistry &Immunohistochemistry
3. Dark field microscopy & immunofluorescence
4. Electron Microscopy
5. Biochemical techniques
6. Haematological Techniques
7. Cell Culture
8. Medical Microbiology & serology
9. Molecular Pathology
LIGHT MICROSCOPY
IMMUNOFLUORESCENCE
MICROSCOPY
ELECTRON MICROSCOPY
Length
• - meter(m), millimeter(mm) =10-3m, micrometer(µm) =10-6 m
• - nanometer(nm) = 10-9 m, picometer(pm) = 10-12 m.
• - Angstrom = 10-10 m

Sizes of living cells

• - atom - 0.1 nm
• - molecules - 0.5-10 nm
• - viruses - 30-80 nm
• - bacteria - 2 µm
• - animal and plant cells- 10-30 µm
 The branches/subdivisions of pathology:
1. Histopathology: study of tissue biopsied/excised from
body to diagnose diseases.
2. Cytopathology: study of cell morphology, exfoliated or
aspirated from body to diagnose diseases.
3. Immunohistochemistry: a special staining procedure is
used to detect special antigens in the tissue to arrive
diagnosis.
4. Hematology: study of blood, blood cells and bone
marrow, used in the diagnosis of hematolymphoid
disorders (e.g. anemias & leukemias).
5. Chemical pathology/ clinical biochemistry: study and
diagnosis of disease from the chemical changes in tissues
and fluids (e.g. blood, urine, etc).
 The branches/subdivisions of pathology:
6. Microbiology: study of infectious diseases and the
diagnosis of causative organisms.
7. Immunology: study and analysis of the immune system
of the body.
8. Toxicology: study of various poisonous and toxic
substances.
9. Cytogenetics (clinical genetics): is a study of
chromosomes and genes abnormalities.
10. Molecular pathology: e.g. fluorescent in situ
hybridization, Southern blot tests etc.
11. Autopsy (Forensic pathology): sub-specialty of
pathology which involves examining a dead body (e.g.
investigation of death in suspicious circumstances).
a) Histology b) Cytology

a) Histology under b) Cytology under

 Autopsy
• It is a sub-specialty of pathology which involves
examining a dead body
• An autopsy is useful in :
- To determine the cause of death (this is the main reason why autopsy
is done). It can be performed in any of the following situations:
Homicidal
Suicidal
Accidental
To identify the disease
- The evaluation of the accuracy of clinical diagnosis (and hence
management) before death; thus, postmortems act as a quality
control for the medical practice.
- Education tool for medical students (both undergraduates and
postgraduates) to learn pathology. It is an opportunity to correlate
clinical signs with their underlying pathological changes.
- As a source of research into the causes and mechanisms of different
diseases
- For accurate statistics about diseases.
 Pathology
an extremely exciting medical
specialty helping to
Understand & treat the diseases
via
diagnostic service
for
all other specialties
Introduction to Basic Pathology course
• LEARNING PATHOLOGY: There are two apparent
difficulties that face the new student of pathology:
language (terminology) and process.
• Pathology, like most branches of science and medicine,
has its own vocabulary of special terms: these need to be
learnt and understood not just because they are the
language of pathology but because they are also a major
part of the language of clinical medicine.
• The student must not confuse the learning of the language
with the learning of the mechanisms of disease and their
effects on individual organs and patients. For example, the
term “hyperplasia” means an increase in the size of an
organ due to the proliferation of its constituent cells; this
definition must be learnt before the student attempts to
learn about the process of hyperplasia.
Introduction to Basic Pathology course
• Learning Resources:
• a) Textbooks:
– Robbins. Basic Pathology.
• (Required Text Book)
– Robbins. Pathologic basis of disease.
• (Reference)
• b) laboratory
– Glass slides, images, virtual microscopy
– Museum for gross examination of organs, virtual
gross specimens
Introduction to Basic Pathology course
•The objectives of this course are to :
1.provide the basic concepts and principles of cell
injury, inflammatory and repair processes,
circulatory disorders, infections, cell growth and
differentiation, and neoplasia.
2.Provide the basic blocks of knowledge for
students to understand the pathological processes
that leads to various presentations of diseases as
well as the procedures or methodology of
confirming diagnosis.
Introduction to Basic Pathology course

General (basic) Pathology Outline

• 1: Cellular Adaptations and Injury: Pathological
adaptations, degeneration, death and Aging
• 2: Acute and Chronic Inflammation
• 3: Tissue Regeneration and Repair
• 4: Hemodynamic Disorders
• 5: Growth disorders & Neoplasia
THANKS