Pathology

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Man is the Architect of his life
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Pathology

• An Introduction.

Dr. Venkatesh M. Shashidhar. Associate Professor
of Pathology Fiji School of Medicine
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Study of Disease

• Epidemiology
• Etiology - Causes
• Pathogenesis - Evolution
• Morphology - Structural Changes
• Clinical Significance Functional Changes
• Management
• Complications
• Prevention

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Pathology

• Study of what is abnormal or wrong or disease!
• Scientific Study of Disease
• Normal ? Abnormal ? Treat

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Pathology

• Is the foundation of medical science and
  practice. Without pathology, the practice of
  medicine would be reduced to myths and folklore

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Diagnosis

• What is Diagnosis?
• The formal name(s) used to describe a patients
  disease
• The process of identifying a disease based on the
  patients symptoms, the doctors findings, and
  the results of investigations and laboratory
  tests
• What do you need to make a diagnosis?
• A system of classification that supplies the
  necessary names, definitions, and criteria
• The means to ascertain the defining
  characteristics of a disease in the individual
  patient

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History of Pathology

• animism Philosophies of Plato God/devil
• Magic Primitive thoughts
• Humors Phlegm excess/deficiency c300
• Abiogenesis Spontaneous upto c1800
• Environmental Modern 1850 to present
• Genetic Molecular pathology 20th century

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Past and Present.!

• In the past, .. people mistook magic for
  medicine!
• Now people mistake medicine for magic.!

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Scope of Pathology

• Experimental Pathology
• Clinical Pathology

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Subdivisions of clinical Pathology

• Histopathology
• Cytopathology
• Haematology
• Microbiology
• Immunology
• Chemical Pathology
• Genetics
• Toxicology
• Forensic Pathology

• Histopathologist
• Cytologist
• Haematologist
• Microbiologist
• Biochemist
• Geneticist
• Toxicologist
• Forensic Pathologist
• Molecular Biologist

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Learning Pathology

• General Pathology
• Common changes in all tissues.
• E.g.. Inflammation, cancer, ageing.
• Systemic Pathology
• Specific changes in organs.
• E.g.. Goiter, pneumonia, breast cancer.

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Study of Disease (Pathology)

• Epidemiology
• Etiology - Causes
• Pathogenesis - Evolution
• Morphology - Structural Changes
• Clinical Significance Functional Changes
• Management
• Complications
• Prevention

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Etiology

• Environmental agents
• Physical
• Chemical
• Nutritional
• Infections
• Immunological
• Psychological
• Genetic Factors
• Age
• Genes

Multifactorial
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Multifactorial Etiology

• Diseases are caused due to internal or external
  factors.
• Multifactorial
• No more one cause to one disease
• Genetic factors affect acquired diseases and
  environment has profound effect on genetic
  diseases.

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Classification of Diseases

• Developmental genetic, congenital.
• Inflammatory Trauma, infections, immune, etc.
• Neoplastic tumors cancers
• Degenerative ageing.

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Pathogenesis

• Sequence of events in the response of cells
  tissues to a stimulus/pathogen starting from the
  initial stimulus to the ultimate expression of
  disease.
• Gross and microscopic Structure, Function,
  Chemistry molecular mechanisms.

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Morphology

• Structural and associated functional changes in
  cells, tissues and organs that are characteristic
  of the disease or condition.

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Clinical Significance

• Functional derangements and its clinical
  manifestations resulting from the morphologic
  changes.
• Signs and symptoms, course and prognosis of
  disease depend on the morphology.

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Techniques in Pathology

• Gross Pathology
• Light Microscopy
• Histochemistry, Biochemical
• Immunohistochemistry
• Electron Microscopy
• Cell Cultures, Medical Microbiology
• Molecular Pathology

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Sample Case
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Clinical Details

• 34 year Fijian male
• Neck swelling, 2-3 months,
• Fever, weight loss,
• no other lymphadenopathy
• Lymphnode biopsy done

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Right neck mass
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Lymphnode Biopsy

• Diffuse tumour
• Capsule

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Lymphnode Biopsy

• Large cells
• Mitotic figures

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Histiocytic/Tcell NHL

• Diffuse pattern no follicles.
• Large cells with moderate cytoplasm
• Plenty of mitotic figures, Nuclei are vesicular
  prominent nucleoli
• Features suggest T-cell NHL malignant lymphoma.
• Needs further marker studies for typing
  management.
• cancer Chemotherapy.

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Pathology Summary

• Etiology
• Carcinogenesis. DNA Damage, Mutation.
• Pathogenesis
• Uncontrolled cell division, tumor.
• Morphology
• Enlarged lymphnodes, liver, spleen,
  microscopically lymphoma cells.
• Clinical Features
• Fever, Wt loss, tumor-Ln, Liver, Spleen.

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"Never does a man portray his character more
vividly than when he is proclaiming the character
of another."Winston Churchill1874-1965, Former
British Prime Minister