Introduction to Pathology

Learning Objectives
1) Introduction
2) Importance of Pathology
3) Evolution of Pathology
4) Division of Pathology
5) Discuss the four aspects of disease in pathology
6) Know the diagnostic techniques used in pathology
7) The causes of disease

Dr. Saleh Ben Sumaidea

assistance professor of Histopathology and Cytopathology

Introduction to Pathology
▪ Pathology Literally it is the study of suffering
▪ The word ‘Pathology’ is derived from two
Greek words—pathos meaning suffering,
and logos meaning study.
▪ Definition: Pathology is scientific study
of diseases.
▪ What happens to tissues/organs of the
body in the presence of disease.
Introduction to Pathology
▪ Disease: Literally a “lack of ease”; an abnormal
changes in structure (tissues & cells) or function
of any part of the body.
▪ Disease: is any variation from the normal
function and/or structure in the human body.
▪ Patient: is the person affected by disease.
▪ Pathophysiology: study of disordered function or
breakdown of homeostasis in diseases.
 Importance of Pathology

▪ The knowledge and understanding of pathology is

essential for doctors as well as general
practitioners and specialists.
▪ Pathology is essential in the diagnosis,
prevention, early detection, and treatment of
many of the causes of disease–e.g. cancer,
cardiovascular disease and diabetes.
 Evolution of Pathology
1) From religious beliefs to rational approach
(Antiquity to AD 1500)
2) Era of gross pathology (AD 1500 to 1800)
3) Era of technology development and cellular
pathology (AD 1800 to 1950s)
4) Modern pathology (1950s to dawn of 21st
century)
 1) From religious beliefs to rational
approach (Antiquity to AD 1500)
❖ Hippocrates (460-377BC)
▪ Permanently dissociated medicine from religious mysticism.
Considered the father of medicine, used direct observation
as the main method.
❖ Aristotle (384-322 BC)
▪ Formulated the first concepts of embryology and
comparative anatomy, describing the chicken embryo and
the sperm fluid which will become the book of many
European sages from the medieval period.
❖ Avicenna (980-1037)
▪ with his work "The Canon of Practical Medicine" which will
become the book of many European sages from the
medieval period.
 2) Era of gross pathology (AD 1500 to 1800)
❖ Giovanni B Morgagni (Italy) 1682-1771
▪ Introduced clinicopathologic correlation in the study
of disease
❖ John Hunter (Scotland) 1728-1793
▪ Introduced pathology museum in the study of
disease.
❖ R.T.H. Laennec (France) 1781-1826
▪ Described several lung diseases such as various
tuberculous lesions of lungs, bronchiectasis.
▪ Described cirrhosis of liver (later called Laennec’s
cirrhosis).
▪ Invented stethoscope.
 3) Era of technology development and
cellular pathology (AD 1800 to 1950s)
❖ Rudolf Virchow (Germany) 1821-1905
▪ Father of cellular pathology.
▪ That introduced histopathology as a diagnostic
branch by his cellular theory
▪ Started to cut thin sections of diseased tissues with
a razor blade and examined them using the
microscope.
❖ George N. Papanicolaou (USA) 1883-1962
▪ Father of exfoliative cytology Developed Pap smear
for detection of cervical cancer in 1930s
 4) Modern pathology (1950s to dawn of
21st century)
❖ Watson & Crick 1953
▪ Described the structure of DNA
❖ Nowell & Hagerford 1960
▪ Philadelphia chromosome in CML i.e. t(9;22)
❖ Galland Pardue 1969
▪ In Situ Hybridization
❖ Kary Mullis1983
▪ Introduced polymerase chain reaction (PCR)
 Professional divisions of pathology

▪ Pathology includes two major professional

divisions:
1. Medical pathology which deals with the study
of diseases in humans.
2. Comparative pathology which deals with the
study of diseases in all animal species as well as
human diseases.
 Academic divisions of pathology
▪ In academic studies, pathology (medical or
comparative) is divided into two major
divisions:
1. Anatomic pathology which deals with the study
of the disease effects in cells, tissues and organs.
2. Clinical pathology which deals with the study of
the disease effects in body fluids & secretions
(blood, urine, milk… etc.) using certain laboratory
methods.
 Branches of anatomic pathology

1. General pathology: deals with the study of the

common basic changes in all tissues as a result of a
disease, e.g., cell injury, necrosis, inflammation &
neoplasm.
2. Systemic pathology: deals with the study of
morphological changes in tissues & organs of a
particular system as a result of a disease e. g.,
pathology of respiratory system, digestive system,
nervous system…etc.
3. Special pathology: deals with the application of
the basic changes to the various specific diseases
e.g Diabetes.
4. Surgical Pathology: deals with the study of tissue
abnormalities using gross & microscopic
examination of biopsy samples surgically removed
from living bodies.
5. Cytopathology deals with the study of cellular
changes.
6. Forensic pathology: focuses on the medico-legal
investigation of the cause of death by examination
of a dead body.
7. Immunopathology which deals with the study of
diseases mediated by immune reactions. Such as
immunodeficiency diseases, autoimmune diseases and
hypersensitivity reactions.
8. Molecular pathology which deals with the study of
alterations that take place at the molecular level (e.g.,
DNA damage) as a result to a disease.
9. Experimental pathology:
The diseases have been created or induced
experimentally to analyze the structural & functional
abnormalities in tissue. Usually laboratory animals
used in experimental pathology (Rabbits, Rats,
Mice….ect.
 Methods of Obtaining tissue sample

❖Biopsy
❖Cytology
❖Autopsy or necropsy: It is a special surgical
operation, performed by specially-trained
physicians, on a dead body (human cadaver) to
identify the cause of death. This can be for
forensic or clinical purposes.
Autopsy
 What is biopsy?
▪ Biopsy: is a tissue sample obtained surgically from
a living body in order to be examined grossly and
microscopically (by a pathologist) to help in
establishing the diagnosis. Therefore, even only
very small samples are needed.
▪ Methods of obtaining biopsy:
✓ Open biopsy- post surgical biological material:
(removed totally or partially)
✓ Core needle biopsy
✓ Laparoscopic biopsy
✓ Endoscopic biopsy
Type of material obtained in laboratory
The human tissue comes from:
▪The surgery and
▪The autopsy room
➢From surgery:
1. A small piece of lesions or tumor which is sent for
diagnosis before final removal of the lesion or the tumor it
is called Incisional biopsy.
2. If the whole of the tumor or lesion is sent for
examination and diagnosis by the pathologist, it is called
excisional biopsy.
3. Needle biopsy:
➢The surgeon will choose the type to use based on
patient's condition and the area of body that needs closer
review.
Some examples of Incisional & Excisional biopsy:
Bone Marrow Biopsy
▪Inside some of larger bones—such as the hip or the
femur—blood cells are produced in a spongy material
called marrow.
▪This test can single out both cancerous and noncancerous
conditions, such as leukemia, anemia, infection or
lymphoma.
▪ Bone marrow is most easily accessed using a long needle
inserted into hip bone. This may be done in a hospital or
doctor’s office.
Endoscopic Biopsy
▪Endoscopic biopsies are used to reach tissue inside the
body in order to gather samples from places like the
bladder, colon, or lung.
▪During this procedure, the doctor uses a flexible thin tube
called an endoscope.
▪The endoscope has a tiny camera & a light at the end. A
video monitor allows to view the images & to collect a
sample.
▪The endoscope can be inserted through a small incision in
your body, or through any opening in the body, including
the mouth, nose, rectum, or urethra.
▪This procedure can be done in a hospital or in a doctor’s
office.
Cystoscopy to collect tissue from inside bladder
Bronchoscopy to get tissue from inside lung
Colonoscopy to collect tissue from inside colon.
Needle biopsy
▪During a needle biopsy, your doctor uses a special needle
to extract cells from a suspicious area.
▪A needle biopsy is often used on tumors that your doctor
can feel through your skin, such as suspicious breast lumps
and enlarged lymph nodes.
▪When combined with an imaging procedure, such as X-ray,
needle biopsy can be used to collect cells from a suspicious
area that can't be felt through the skin.
 Needle biopsy procedures include:
•Fine-needle aspiration. During fine-needle aspiration, a
long, thin needle is inserted into the suspicious area. A
syringe is used to draw out fluid and cells for analysis.
 Needle biopsy procedures include:
•Vacuum-assisted biopsy. During vacuum-assisted biopsy, a
suction device increases the amount of fluid and cells that is
extracted through the needle. This can reduce the number
of times the needle must be inserted to collect an adequate
sample.
 Needle biopsy procedures include:
•Core needle biopsy. A larger needle with a cutting tip is
used during core needle biopsy to draw a column of tissue
out of a suspicious area.
 Needle biopsy procedures include:
•Image-guided biopsies. Image-guided biopsy combines an imaging
procedure — such as X-ray, computerized tomography (CT), magnetic
resonance imaging (MRI) or ultrasound — with a needle biopsy.
Image-guided biopsy allows your doctor to access suspicious areas
such as the lung, liver, or other organs
Post surgical sample

Endoscopic biopsy
 What is diagnosis?

▪ (Gr. Dia “through” + gnosis “knowledge”)

▪ The formal name(s) used to describe a patient’s
disease
▪ The process of identifying a disease based on
the patient’s symptoms, the doctor’s findings,
and the results of investigations and laboratory
 What is the pathologist’s
conclusion important?
▪ Looking at the disturbances of normal tissue
▪ Analyzes each cell for size, shape, chromatin
content, cell cycle and viability
▪ The pathology report gives specific information
regarding the cells characteristics.
▪ Grading and staging (staging may be Clinical,
Pathologic or a combined) based on recognition of
tumor size, invasiveness & local or distant
metastasis
 Methods of investigations in pathology
1) Macroscopic examination (by naked eye).
2) Microscopic examination (by microscopic).
3) Cytopathological method
4) Hematopathology
5) Immuno-pathological method (determination of the
presence of antibodies in examined tissue)
6) Immuno-histochemical method: assessment of certain
cellular & tissue antigens via antibodies.
7) Microbiological examination
8) Biochemical examination
9) Molecular method (composition of nucleic acids).
10)Electron-microscopic method
11)Cyto-genetic method (chromosomes & genetic defects)
 The tree of medicine
▪ Pathology is considered a
vital link between basic
sciences (anatomy,
physiology, biochemistry,
pharmacology…….etc)
and clinical sciences
(internal medicine,
surgery, neurology,
dermatology, ……….etc).
 Pathology focuses on 4 aspects of disease:

➢ Pathology gives explanations of a disease by

studying the four aspects of the disease.
1. Etiology: Cause of disease
2. Pathogenesis: Mechanisms of development
of disease
3. Morphology: The structural alterations
induced in cell and tissues.
4. Functional derangements & clinical
significance: Functional results of the
morphologic changes, as observed clinically.
 The Etiology
▪ ‘why’ of disease
▪ Etiology: “Study of the cause of a disease"
▪ Importance of etiology: Knowing the cause remains
the backbone for
oThe diagnosis,
oUnderstanding the disease, &
oTreatment.
▪ An etiologic agent:
o Is the factor responsible for lesions or a disease.
▪ Predisposing factors of Disease:
o Factors which make an individual more susceptible
to a disease (humid weather, poor ventilation, etc.)
▪ If the etiology is known it is called primary
etiology, but if unknown it is called idiopathic.
▪ There are 2 major classes of etiologic factors:
- Genetic
- Acquired
▪ The etiology is followed by pathogenesis.
Genetic
▪ These are hereditary factors that are inherited
genetically from parents.
Aqcuired: are classified into:
1. Physical agents
2. Chemicals
3. Infections
4. Nutritional deficiencies & excesses
5. Immunological factors
6. Psychogenic factors
1. Physical agents
▪ Trauma, Radiation, Increase temperature,
Cold, Electric power.
2. Chemicals
▪ Cyanide is toxic to all cells.
▪ Strong acids act locally at the site of application.
▪ Certain organs: Paracetamol & alcohol on liver.
3. Immunological factors
The abnormalities of the immune system include:
A. Hypersensitivity reaction
B. Immunodeficiency
C. Autoimmunity
4. Nutritional deficiencies and excesses
▪ It may take the form of deficiency either of major
classes of food, usually protein, vitamins or
elements essential for specific metabolic
processes, e.g. iron for hemoglobin production.
▪ Obesity has become increasingly common, with
its attendant dangers of type 2 diabetes, high
blood pressure and heart disease.
5. Infections
Viruses, bacteria, fungi, protozoa, all cause diseases.
6. Psychogenic factors
 Pathogenesis
▪ ‘how’ of disease
▪ The sequence events in the response of the cells
or tissues to the etiologic agent, ”from the time it
is initiated to its final conclusion in recovery or
death”
▪ The pathogenesis of the disease is the core of the
pathology.
▪ The pathogenesis could take place in the latent
or incubation period.
▪ Pathogenesis leads to morphologic changes.
 Morphology (Structural/Pathological
changes)
▪ The structural alterations in cells or tissues that
occur following the pathogenesis.
▪ Pathologic changes can be:
- Recognized with the naked eye (gross or
macroscopic changes) or
- Studied by microscopic examination of tissues.
▪ The pathologist uses the morphologic changes to
diagnose the disease.
▪ The morphologic changes will lead to functional
alteration & clinical signs & symptoms of the
disease.
Morphology -Structural changes in disease
 Functional derangements
▪ The morphologic changes influence the normal
function of the organ; so, they determine the
clinical features (symptoms and signs).
o Clinical symptoms: are the patient’s complain
usually by his own words (chest pain,
headache)
o Clinical signs: the functional evidence of
disease detected by a physician during a
physical examination of a patient (ascites,
hepatomegaly, splenomegaly)
Clinical significance
▪ ‘what’ of disease
- What is wrong (diagnosis),
- What is going to happen (prognosis),
- What are the undesired development
(complications),
- what can be done about it (treatment),
- What should be done to avoid
complications & spread of disease
(prevention)
Morphology -Structural changes in disease
Course, Outcome & consequences of disease
The course of disease is shown with a simplified diagram as follows.
Biological onset:
Exposure to initiation of the disease
causative agent process, without any sign
or symptom
Clinical onset:
Latency period when the signs and
symptoms of the disease
become apparent.

❖Natural recovery, i.e. recovery Permanent

without any intervention, can damage
occur at any stage in the
progression of the disease. Death
 Types of death
Clinical death
▪ Clinical death is the reversible transmission
between life and biologic death.
▪ Clinical death is defined as the period of
respiratory, circulatory and brain arrest
during which initiation of resuscitation can
lead to recovery.
 Types of death
Biological Death
▪ Biological death (sure sign of death), it is an
irreversible state of cellular destruction.
▪ It manifests with irreversible cessation of
circulatory and respiratory functions, or
irreversible cessation of all functions of the
entire brain.
 Preparing the tissue sample
▪ Fix the tissue (immersed in a solution of formalin)
▪ Solid tissue placed in hot liquid wax
▪ Cut into thin slices by a microtome
▪ Placed on glass slides
▪ Wax is removed
▪ Many stainscan be used to examine various cellular
features
▪ Examined using a light microscope
▪ Light microscopes can magnify objects up to 1,000 times,
revealing microscopic details.
Collected material
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