Pathology Lecture Series

8/16/2019 Pathology Lecture Series

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PATHOLOGY LECTURE

SERIES

Butch Dumdum


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Outline

• Day 1 (Geneal Path!l!"y# – Int!ducti!n$ Cellula Ada%tati!n$Ti&&ue In'uy

– Inammati!n (Acute and Ch!nic#

– Hem!&ta&i&$Th!m)!&i&$ and In*act – +e!%la&ia

• Day , (Sy&temic Path!l!"y# –

C!mm!n &y&temic di&ea&e& (Path!l!"ical)a&i& !* di&ea&e#

– Radi!l!"ic C!elati!n (Dia"n!&tic Radi!l!"y#


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Int!ducti!n$ Cell - Ti&&ue

Dama"e


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Path!l!"y

De.niti!n

• Path!l!"y i& the &tudy (logos# !*&u/ein"0di&ea&e& ( pathos#

• In!le& )a&ic medical &cience& andclinical %actice t! ine&ti"ate& !* thecau&e& (eti!l!"y# !* the di&ea&e& andthe mechani&m (%ath!"ene&i

2


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Ba&ic temin!l!"y inPath!l!"y

• Di&ea&e

• Eti!l!"y

•

Path!"ene&i&• Dia"n!&i&

• Clinical mani*e&tati!n 3 Si"n& and

&ym%t!m&• P!"n!&i&

• E%idemi!l!"y

4


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Di&ea&e 0 di&3ea&e

• Di&ea&e i& a c!nditi!n in 5hich the %e&ence !*an a)n!mality !* the )!dy cau&e& a l!&& !*n!mal health

•

Idi!%athic 6 n! identi.a)le cau&e&• Iat!"enic 6 !ccu a& a e&ult *!m medical

teatment

• C!n"enital 6 di&ea&e e7i&tin" at )ith ! )e*!e

)ith$ in!le& in the deel!%ment !* *etu&• Ac8uied 3 deel!%& %!&t 6*etally

• +!&!c!mial 6 due t! )ein" in a h!&%italeni!nment&

9


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Eti!l!"y

• Re*e& t! the &tudy !* the cau&e !*the di&ea&e

• Geneal cate"!ie& !* eti!l!"icala"ent&: "enetic a)n!malitie&$in*ectie a"ent&$ chemical$ adiati!n$mechanical tauma$ malnutiti!n

;


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Path!"ene&i&

• I& a mechani&m !* the di&ea&e 5hicheti!l!"y !%eate& t! %!duce the%ath!l!"ical and clinical

mani*e&tati!n

•


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Dia"n!&i&

• Re*e& t! the %!ce&& !* attem%tin" t!detemine ! identi*y a %!&&i)le di&ea&e! di&!de>

?

P!"n!&i&

• Re*e& t! the e7%ected !utc!me !* adi&ea&e>


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C!m%licati!n and &e8ualae

• C!m%licati!n 6 i& the !n&et !* thedi&ea&e in a %e&!n 5h! i& aleadyc!%in" 5ith an!the e7i&tin" di&ea&e>

• Se8ualae 6 un5anted !utc!me& !*hain" di&ea&e ! ae the e&ult !*tauma

1@


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Clinical ani*e&tati!n

• Ae the &i"n& and &ym%t!m& !eidence !* di&ea&e

• Si"n& 6 !)'ectie alteati!n that can)e !)&ee ! mea&ued )y an!the%e&!n: %ul&e ate$ )l!!d %e&&ue$

Tem%eatue etc

• Sym%t!m& 6 &u)'ectie e7%eience&e%!ted )y the %e&!n$ c!m%lain&&uch a& %ain$ nau&ea$ !mitin" etc

11


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E%idemi!l!"y

• I& the &tudy !* tacin" %atte& !*di&ea&e !ccuence and tan&mi&&i!nam!n" %!%ulati!n& and )y

"e!"a%hic aea&>

• Incidence !* a di&ea&e6 i& the num)e!* ne5 ca&e& !ccuin" in &%eci.c

time !* %ei!d• Pealence !* a di&ea&e 6 i& the

num)e !* e7i&tin" ca&e& 5ithin a

%!%ulati!n& duin" the &%eci.c time 1,


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Pe.7e& and Su7e& andR!!t&

• R!!t3 the *!undati!n !* the 5!d

• Pe.7 6 %lace )e*!e the !!t t! m!di*y it&meanin"

•

Su7 6 %lace& a*te !!t t! m!di*y and "iee&&ential meanin" t! the !!t

1> Hy%eli%!%!teinemia

• Pe.7 hy%e (hi"he#

• R!!t& li%!%!tein

• Su7 3emia ()l!!d c!nditi!n#

1


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,> He%at!&%len!me"aly

• R!!t he%at! (he%a#$ &%len! (&%leen#

• Su7 3me"aly (enla"ement#

> enin"iti&

•R!!t menin" (menin"e

• Su7 3 iti& (inammati!n#

2> Tachycadia• R!!t cadia (heat#

• Pe.7 tachy 6 (*a&t0a%id#

12


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Relati!n&hi% )et5een Cell Ada%tati!n$Cell& de"eneati!n$ Cell Death

14

NORMALCELLS

CELLS ADAPTATION

CELLSDEGENERATION

CELLS DEATH(NECROSIS/APOPTOSI

S

Injuries

Injuries

Injuries


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At h


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At!%hy• Shina"e !* the &iFe !* the

cell& )y the l!&t !* the cell&&u)&tance>

• The entie ti&&ue ! !"an&dimini&he& in &iFe and*uncti!n

• ay )e due t! decea&e in5!l!ad$ l!&t !* neeinneati!n&$ Lac !* )l!!d&u%%ly$ inade8uatenutiti!n$ l!&t !* end!cine&timulati!n and a"in"

%!ce&&>

1;


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Hy%et!%hy• Incea&e the &iFe !* the

cell& and c!n&e8uentlythe &iFe !* the !"an&

• Incea&ed the &ynthe&i&!* &tuctual %!tein and!"anelle&

• Can )e %hy&i!l!"ic(e7:incea&e 5!l!adduin" e7eci&e$ uteinemy!metium duin"

%e"nancy# and%ath!l!"ic (hy%et!%hy!* my!cadium 6hy%eten&i!n0a!tic

ale di&ea&e# 1=


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Hy%e%la&ia• Incea&e the num)e !*

cell& in an !"an ! ti&&ue>(incea&e ate !* cellula

dii&i!n#

• Hy%et!%hy and

hy%e%la&ia ae cl!&elyelated (e7% "aid

uteu

• Can )e c!m%en&at!y

hy%e%la&ia (e7% lie#$h!m!nal hy%e%la&ia

(e7% uteu&$ )ea&t# and

%ath!l!"ical (e7%

end!metium# 1?


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eta%la&ia• I& a ee&i)le chan"e in 5hich !ne adult cell ty%e

i& e%laced )y an!the cell ty%e>

• Ada%tati!n !* cell& that &en&itie t! %aticula&te&& t! cell ty%e& )ette a)le t! 5ith&tand theade&e !* eni!nment

,@


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,1


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Dy&%la&ia•

+!t a tue cellulaada%tati!n

• Aty%ical hy%e%la&ia

• A)n!mal chan"e in the&iFe$ &ha%e and

!"aniFati!n !* matuecell&

• St!n"ly a&&!ciated 5ithc!mm!n ne!%la&tic

"!5th• E7% CI+ 6 ceical

intae%ithelial ne!%la&ia$hi% dy&%la&ia

,,


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,


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Cell De"eneati!n (+!nlethal In'uy#

• +!nlethal in'uy may %!duce cellde"eneati!n

• ani*e&ted a& a a)n!mality !*)i!chemical *uncti!n$ &tuctualchan"e& ! c!m)inati!n>

• It& ee&i)le )ut may )ec!me

iee&i)le (nec!&i&0a%!%t!&i

• ay %!duce clinical di&ea&e>

,4


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+ec!&i& (Lethal In'uy#

• De.niti!n 6 un%!"ammed celldeath and liin" ti&&ue&> (!%%!&ite t!a%!%t!&i

• Iee&i)le

• Acc!m%anied 5ith )y )i!chemicaland m!%h!l!"ical chan"e&

• Due t! hy%!7ia$ chemical&u)&tance&$ *ee adical$immun!l!"ic e&%!n&e$ in*ecti!n& etc

,9


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Sta"e& !* +ec!&i&

• Early changes m!%h!l!"ically n!mal

• Nuclear changes %yn!&i& 6 ch!matinclum%& int! c!a&e &tand&$ nucleu&

)ec!me &hunen• Cy!"las#ic changes denatuati!n !*

cyt!%la&mic %!tein and l!&t !*i)!&!me&$ &5ellin" !* mit!ch!ndia anddi&u%ti!n !* !"anelle mem)ane& andaut!ly&i& !ccu ia ly&!&!me&

,;


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Ty%e !* +ec!&i&

• Di/eent cell& &h!5& di/eentm!%h!l!"ic chan"e& a*te they unde"!nec!&i&> Ba&e !n that nec!&i& can )e

cla&&i.ed int!1> C!a"ulatie nec!&i&

,> Li8ue*actie nec!&i&

> Ca&e!u& 0 "ummat!u& nec!&i&2> Gan"en!u& +ec!&i&

,?


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C!a"ulatie +ec!&i&• Ty%ically !ccu in &!lid !"an: heat$ idney$ adenal

"land&• Due t! hy%!7ia (may)e *!m &eee i&chemia !

chemical#

• +!mally$ thi& nec!tic cell& etain& it& cellula !utline>

•

Denatuati!n !* %!tein al)umin cau&e& c!a"ulati!n>

@


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Li8ue*actie +ec!&i&

• +!mally !ccu& in C+S5hich a/ect& neu!nand neu!"lia cell&

• A&&!ciated 5ith *!cal

)acteial and *un"u&in*ecti!n&

• The a/ected cell&c!m%letely di"e&t )yhyd!lytic enFyme& thu&chan"e& the ti&&ue int!li8uid i&c!u& ma&&>

1


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Ca&e!u& +ec!&i&

• Ca&e!u& 6 chee&elie a%%eaance

• A&&!ciated 5ith

tu)ecul!u&%ulm!nay (TB#in*ecti!n$ e&% )y

yc!)acteium Tu)ecul!&i&

,


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Gan"en!u& +ec!&i& ("an"ene#

•

E7ten&ie ti&&ue nec!&i&• Diide int! t5!: dy and 5et

• Dy 6 !ccu& in e7temitie& a&a e&ult& !* i&chemic

c!a"ulatie nec!&i& due t!ateial !)&tucti!n

• et 6 !ccu& in e7temitie&and intenal !"an a& ae&ult& !* li8ue*actienec!&i& due t! )acteialin*ecti!n>

• Ga& 6 nec!tic ti&&ue in*ected)y cl!&tidium %e*in"e&

2


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Cau&e& !* Cell In'uy

• O7y"en de%iati!n

• Chemical a"ent&

• In*ecti!u& a"ent&

• Immun!l!"ic eacti!n&

• Genetic de*ect&

•

+utiti!nal im)alance&• Phy&ical a"ent&

• A"in"

4


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O7y"en de%iati!n

• Hy%!7ia 6 !7y"en de.ciency

• Due t! i&chemia 6 l!&t0lac !* )l!!d&u%%ly (due t! ateial )l!ca"e !

educe en!u& daina"e#

• Hy%!7ia al&! can !ccu& ia – Lac !* !7y"en in&ide )l!!d

– Reducti!n in !7y"en cayin" ca%acity inRBC (anemia#

– Ca)!n m!n!7ide %!i&!nin"

9


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Chemical a"ent&

• !&t !* the chemical &u)&tance& cancau&e cell in'uy

•

in&ecticide&$ CO$ a&)e&t!&$ ethan!l$thea%eutic& du"& etc

• Thi& a"ent& can cau&e cell death )y

– Altein" mem)ane %emea)ility – Altein" !&m!tic h!me!&ta&i&

– Altein" inte"ity !* an enFyme

;


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In*ecti!u& a"ent

• iu&e&$ )acteia$ *un"i$ %aa&ite&$helminth&

=


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Immun!l!"ic Reacti!n&

• Aut!immune di&ea&e 6 immunitya"ain&t it& !5n ti&&ue& >

etc

?


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Genetic De*ect&

• A)n!malitie& t! the "en!me& 3mutati!n

• Thi& ch!m!&!me an!maly i&a&&!ciated 5ith mi&&in"$ !ie"ulaitie& ! e7ta in %!ti!n !*ch!m!&!mal D+A

• Synd!me D!5n$ AlFheimeJ&Di&ea&e$ Huntin"t!n& Di&ea&e etc

2@


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+utiti!nal Im)alance

• Cau&e )y diectly ! indiectly lac !*e&&ential nutient& (malnutiti!n#

• O it may)e elated t! e7ce&&ie !**!!d intae (Dia)etic ellitu

•

• Calcium de.ciency 6 !&te!%!!&i&

• itamin C 3 Scuy

21


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Phy&ical A"ent&

• Tauma$ e7teme& !* tem%eatue$adiati!n$ electical &h!c all hae5ide an"in" e/ect& !n cell&>

2,


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A"in"

• A"ed cell& )ec!me la"e$ le&& a)let! diide and multi%ly

• L!&e thei a)ility t! *uncti!n&$ !

*uncti!n a)n!mally>

2


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SE$%ENCE O& E'ENTS


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SE$%ENCE O& E'ENTS• NORMAL HISTOLOG • 'ASODILATATION • INCREASED 'ASC%LAR PERMEA)ILIT • LEA*AGE O& E+%DATE • MARGINATION, ROLLING, ADHESION • TRANSMIGRATION (DIAPEDESIS- • CHEMOTA+IS • PMN ACTI'ATION • PHAGOCTOSIS. Rec!gnii!n, Aach#en,

Engul#en, *illing (0egra0ai!n !r0igesi!n-

• TERMINATION • 1223 RESOL%TION, SCAR, !r CHRONIC

IN&LAMMATION are he hree "!ssi4le


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IN&LAMMATION•'ASC%LAR E'ENTS•CELL%LAR E'ENTS (PMN!r P!lyM!r"h!nuclearNeur!"hil, Leu9!cye:,

5POL6, Neur!"hil,Granul!cye, Neur!"hilicGranul!cye

•5 6


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AC%TE

IN&LAMMATIONNeur!"hil

P!ly#!r"h!nuclearLeu9!cye, PMN, PML

5Leu9!cye6

Granul!cye,Neur!"hilicgranul!cye

5P!ly76

HISTORICAL


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Ru4!r

Cal!r

Tu#!r

D!l!r

;h (unci!

laesa

HISTORICAL

HIGHLIGHTS(Egy",


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STIM%LI!r acue in=a##ai!n

• IN&ECTIO%S

•

PHSICAL•CHEMICAL•

Tissue Necr!sis• &!reign )!0ies (&)s-

• I##une 5res"!nses6, !r

5c!#"le>es6


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'ascular Changes• Changes in 'ascular&l!? an0 Cali4er

• Increase0 'ascularPer#ea4iliy


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PERMEA)ILIT •

DILATATION•En0!helial 5ga"s6

•Direc Injury•Leu9!cye Injury

•Trans!cy!sis

(en0!/e>!-


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LEA*AGE O&PROTEINACEO%S

&L%ID (E+%DATE,NOT TRANS%DATE-

E+TRA'ASATION !


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E+TRA'ASATION !PMNs

• MARGINATION (PMN@s g!!?ar0 ?all-

• ROLLING (u#4ling an0HEAPING-

• ADHESION• TRANSMIGRATIO

N (DIAPEDESIS-

ADHESION MOLEC%LES


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ADHESION MOLEC%LES(glyc!"r!eins- aecing

ADHESION an0 TRANSMIGRATION

• SECRETINS (r!#

en0!helial cells-

• INTEGRINS (r!# #any

cells-


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CHEMOTA+IS

P+& "!in" t! the &ite !*in'uyM

A


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LE%*OCTE

5ACTI'ATION6• ti""eedM )y the !/endin" &timuli *!

P+& t! –1- Pr!0uce eic!san!i0s

(arachi0!nic aci0 0eriBaiBes-• Pr!saglan0in (an0 hr!#4!>anes-

• Leu9!rienes

• Li"!>ins

–- %n0erg! DEGRAN%LATION

–


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PHAGOCTOSIS

• RECOGNITION

• ENG%L&MENT

•

*ILLING(DEGRADATION/DIGESTION-

CHEMICAL


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CHEMICAL

MEDIATORS• &r!# "las#a !r cells• HaBe 5riggering6si#uli

• %sually haBe s"eci8carges

• Can cause a5 6


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HISTAMINE


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HISTAMINE

• Mas Cells,4as!"hils

•

POER&%L'as!0ila!r• 'as!aciBe5a#ine6

• IgE !n #as

cell

SEROTONIN


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SEROTONIN•

(;HT$ ;7Hy0r!>y7

Try"a#ine-• Plaeles an0Ener!Chr!#anCells

• Als! Bas!0ilaai!n,4u #!re in0irec

• EB!9es NFOF

synhease (a

COMPLEMENT


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COMPLEMENTSSTEM

• 2c!#"!nens, in

circulaing"las#a

• Muli"le

sies !aci!n, 4uLSIS ishe


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*ININ SSTEM• )RAD*ININ is *E c!#"!nen,

aa@s

• ALSO r!# circulaing "las#a

• ACTIONS – Increase0 "er#ea4iliy – S#!!h #uscle c!nraci!n, NON

Bascular

–PAIN

C O G


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CLOTTING

&ACTORS•

Als! r!# circulaing "las#a• C!agulai!n, iFeF, "r!0uci!n! 84rin

• &i4rin!lysis


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EICOSANOIDS


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EICOSANOIDS(ARACHIDONIC ACID DERI'ATI'ES-

•Par ! cell#e#4ranes

•1- Pr!saglan0ins (inclFThr!#4!>anes-

•- Leu9!rienesM%LTIPLE ACTIONS AT MAN


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P l 0i


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Pr!saglan0ins

(hr!#4!>anes inclu0e0-

•Pain•&eBer

•Cl!ing

L 9 i


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Leu9!rienes

•Che#!a>is

•'as!c!nsrici!n

•

Increase0Per#ea4iliy

Li i


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Li"!>ins

• INHI)IT che#!a>is

•'as!0ilaai!n

•

C!unerac aci!ns! leu9!rienes

Plaele AciBaing &ac!r


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Plaele7AciBaing &ac!r(PA&-

• Ph!s"h!li"i0

•

&r!# MAN cells,li9e eic!san!i0s

• ACTI'ATEPLATELETS,"!?erully

CTO*INES/CHEMO*IN


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CTO*INES/CHEMO*INES• CTO*INES are PROTEINS "r!0uce0

4y MAN cells, 4u usuallyLMPHOCTES an0 MACROPHAGES,

nu#er!us r!les in acue an0 chr!nicin=a##ai!n

–TN&, IL71, 4y#acr!"hages

• CHEMO*INES are s#all "r!eins?hich are aracans !r PMNs

(J2-


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L MAL


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CONSTIT%ENTS• PRIMAR • Als! calle0

AK%ROPHILIC,!r NON7

s"eci8c

• Myel!"er!>i0ase

• Lys!y#e()acF-

• Aci0

Hy0r!lases

• SECONDAR •

Als! calle0SPECI&IC

• Lac!errin

• Lys!y#e

• Al9alinePh!s"haase

• C!llagenase

&REE RADICALS


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&REE RADICALS• O 6 (S%PERO+IDE-

•HO (PERO+IDE-

•OH7 (HDRO+L RADICAL-

•'ER 'ERDESTR%CTI'E

NE%ROPEPTIDES


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NE%ROPEPTIDES

• Pr!0uce0 in CNS(neur!ns-

• S%)STANCE P

• NE%RO*ININ A

O%TCOMES O&


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O%TCOMES O&AC%TE IN&LAMMATION

• 1- 1223 c!#"leeRESOL%TION

• - SCAR

•


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M!r"h!l!gic PATTERNS! Acue IN&LAMMATION

(E+%DATE-

•Ser!us (?aery-

•&i4rin!us (he#!rrhagic, rich in

&I)RIN-•Su""uraiBe (P%S-


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)LISTER, 5aery6, iFeF,


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&I)RINO%S

P%S


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P%R%LENT

A)SCESS

POC*ET

O&

P%S


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P%R%LENT &I)RINOP%R%LENT


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%LCERATI'E

SE$%ENCE O& E'ENTS


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SE$%ENCE O& E'ENTS• NORMAL HISTOLOG

• 'ASODILATATION • INCREASED 'ASC%LAR PERMEA)ILIT • LEA*AGE O& E+%DATE • MARGINATION, ROLLING, ADHESION • TRANSMIGRATION (DIAPEDESIS- • CHEMOTA+IS • PMN ACTI'ATION • PHAGOCTOSIS. Rec!gnii!n, Aach#en,

Engul#en, *illing (0egra0ai!n !r0igesi!n-

• TERMINATION • 1223 RESOL%TION, SCAR, !r CHRONIC

in=a##ai!n

CHRONIC IN&LAMMATION


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CHRONIC IN&LAMMATION

(MONOS-

LMPHOCTMONOCTE

MACROPHAGE

HISTIOCTE

CA%SES !


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CA%SES ! CHRONIC IN&LAMMATION

•1- PERSISTENCE !Ineci!n

•- PROLONGED

E+POS%RE ! insul•


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Cellular Players

•LMPHOCTES

•

MACROPHAGES (a9a,

HISTIOCTES-• PLASMA CELLS• EOSINOPHILS

•

MAST CELLS

MORPHOLOG


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MORPHOLOG

• IN&ILTRATION

•

TISS%EDESTR%CTION

•

HEALING

GRAN%LOMAS


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GRAN%LOMASGRAN%LOMATO%S IN&LAMMATION

JCOMPONENTS

&I)RO)LASTS

LMPHS

HISTIOS

GRAN%LOMAS


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GRAN%LOMASGRAN%LOMATO%S IN&LAMMATION

CASEATING (T)-

NON7CASEATING

LMPHATIC


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LMPHATIC

DRAINAGE• SITE REGIONAL LMPH

NODES


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Hem!&ta&i&$Th!m)!&i&

and In*act


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Th!m)!&i& :Formation of solid mass in

circulation from the blood

constituents - (Thrombus)


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ich!5& tiad


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ich!5 & tiad

•Endothelial injury.

•

Alteration in the Bloodflow.

•

Hyercoa!ulability of theBlood.

Bl d l ll


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Bl!!d e&&el 5all

• Anti th!m)!tic *act!& He%ain lie &u)&tance $

Th!m)!m!dulin $ Inhi)it!& !*%latelet a""i"ati!n 6 ADPa&e$PGI, Ti&&ue %la&min!"en

actiat!

Bl d l ll


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Bl!!d e&&el 5all• P!th!m)!tic *act!& Th!m)!%la&tin $ !n ille)id

*act! $ Platelet actiatin"*act! $ Inhi)it! !* %la&min!"enactiat!

R!le !* Platelet&


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R!le !* Platelet&

• Adhe&i!n

• Platelet elea&e eacti!n

• Platelet a""i"ati!n

C!a"ulati!n &y&tem


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C!a"ulati!n &y&tem

• Pla&ma


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Hy%ec!a"ula)ility !* the Bl!!d


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Hy%ec!a"ula)ility !* the Bl!!d

• Incea&ed c!a"ulati!n *act!&

• Incea&ed Platelet C!unt and

thei adhe&iene&&>• Decea&ed c!a"ulati!n

inhi)it!t& 6 Antith!m)in III

Alteati!n in the Bl!!d !5


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Alteati!n in the Bl!!d !5

• Tu)ulance and Sta&i&

• Platelet& nea end!thelial

linin">

!%h!l!"y


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!%h!l!"y• Site& 6 Heat $ Ateie&$ein&$ Ca%illaie&>

• Ateial Th!m)i 6 E/ect i&I&chemia

•

en!u& Th!m)i 6 E/ect i&Em)!li&m


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• G!&& 6 ai!u& &ha%e& ni


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&iFe&>

• Ateial th!m)i 6 hiteand mual

•

en!u& th!m)i 6 Red and!cclu&ie

•

0E Line& !* NahnM• Ateial & en!u& th!m)i


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% "*act!&

•

Genetic 6 De.ciency !*Antith!m)in$ P!tein C and S $

• Ac8uied 6 Old a"e $ P!l!n"edBed e&t $Imm!)ili&ati!n $ !al

c!ntace%tie& $ &m!in" $ Tauma*actue )un& $ Athe!&cle!&i& $aic!&e ein&$ Cance&


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+EOPLASIA

+e!%la&ia


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+e!%la&ia• +e! Pla&ia +e5 G!5th>

• Tum!u S5ellin" any &5ellin"• Clinically tum!u Q ne!%la&m (technically

inc!ect>>#

• illi& de.niti!n“A neoplasm is an abnormal mass of tissue, the growth

of which exceeds and is uncoordinated with that of the

normal tissue and persists in the same manner after

cessation of the stimuli which evoked the change”• “Cell division without control”

• Iee&i)le D+A dama"e$ e&ultin" in

aut!n!m!u& "!5th !* a)n!mal cell&

Cell %!%ulati!n 0 G!5th C!nt!l


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Cell %!%ulati!n 0 G!5th C!nt!l• P!li*eati!n Di/eentiati!n A%!%t!&i&

+!mal

Stem cell

A%!%t!&i&

O"an 0 Ti&&ue

Ne!"lasia Beni"n 3 ali"nant

C

Cacin!"enInitiat! P!m!t!

Inam

1>P!t!3Onc!"ene& ("!5th*act!

,>G!5th0Tum! &u%%e&&!"ene&>

>Gene& c!nt!llin" A%!%t!&i&>2>Gene& c!nt!llin" D+A Re%ai>

RASR)YC%4

G!5th Di&!de&


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+!n ne!%la&tic +e!%la&tic (P!lycl!nal# (!n!cl!nal#

G!5th Di&!de&

+!mal Ada%tati!n Beni"n ali"nant

Hy%e%la&iaHy%et!%hyA%la&iaAt!%hyeta%la&iaDy&%la&ia

Cell dii&i!n C!nt!l 3 Cacin!"ene&i&


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Beni"n 3li

)ENIGN• ell di/eentiated• Sl!5 "!5th

MALIGNANT• P!!ly di/eentiated• Ra%id "!5th


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ali"nant

11;

+ec!&i&

• Sl!5 "!5th• C!he&ie$• e7%an&ile• Ca%&ule• +! ina&i!n0in.ltati!n

• Ra%id "!5th• +!n C!he&ie$• +! ca%&ule• ina&i!n0in.ltati!n• eta&ta&e&>

+e!%la&m& +!menclatue

Oma 3 Tum!uCacin3!ma 6 Had Tum!uS S * T


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)enign Malignan

• Aden!ma 3 Adencacin!ma

• Pa%ill!ma 3 S8uam!u& cell ca>

•


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• Teat!ma 6 Tum!u !* Gem cell 6 multi%le ti&&ue&>Beni"n (matue# ! mali"nant (immatue#

• elan!ma (elan!3cacin!ma# 6 ali"nancy !*melan!cyte&>

• Semin!ma (Seminal cacin!ma# 6cacin!ma !* Te&te&>

• Leuemia 6 5hite )l!!d 6 Ca> !* Haem!%!ietic &temcell&>

• Lym%h!ma (Lym%h!&ac!ma#6 ali"nancy !*lym%h!cyte&>

• i7ed Tum!u& B!th e%ithelial - c!nnectie ti&&uec!m%!nent&> Ple!m!%hic aden!ma (Saliay "land#- Cacin!&ac!ma ()ea&t0uteu


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Cance Clinical


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Cance Bi!l!"y

• Srucure. – Paenchyma 6 +e!%la&tic cell&>

– Sr!#a. +!n ne!%la&tic 3 n!mal D+A

• &eaures. – Di/eentiati!n 6 atuati!n !* cell&>

– Rate !* G!5th 6 it!tic ate 0 Ki 9;

– L!cal ina&i!n 6 Hem!ha"e$ nec!&i&$

de&tucti!n – eta&ta&i& 6 Di&tant S%ead>

1,1

• Tum!& ae cl!nal (!ne %aent#

• But hae di/eent mutati!n& +!mal

cell


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di/eent &ha%e& - *eatue&>

•

Each ne5 mutati!n add& a ne5*eatue>

ali"nant cell&

cell

mutati!n

Thidmutati!n

Sec!ndmutati!n

9


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9


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%Em)y! Cance

Sel* "!5thaut! e"ulati!n

Limitle&& %!tentialAn"i!"ene&i&

Eade a%!%t!&i&Ina&i!n - in.ltati!n

Path!"ene&i& !* Lun" Cance>


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1,4

" "

K-RasC-myc

p53

Irritation Carcinogens Initiation Promotion Ca.

S#!9e

Anaplasia

C!l!n +!mal Aden!ma Cacin!ma


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C!l!n Cance C!mm!n ty%e 3 =@

Cacin!"ene&i

Sta"e - Gade !* Cance


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"Saging. P!"e&&i!n ! &%ead in the )!dy>

Gra0ing. Cell di/eentiati!n - Rate !* "!5th 6 ic!&c!%y>

ell di/eentiated (l!5 "ade# Aden!cacin!ma Gade Undi/> (hi"h"ade#

P!&tate Ca Glea&!n Gadin"


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"

1,=

L!5

G

ade

H

i"hG

ade

TNM Sta"in" !* tum!Lun" Ca


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Lun" CaSta"e 3 Anat> &ite

T< Tetiay &ite

TJ Ad'acent

e"i!n

N2 +! L+ met&>

N1 Pimay L+

N Se!nday L+

N< Tetiay L+M2

+! meta&ta&e&

M1

eta&ta&e&

Ba&ed !n 3 A+ATOY - LYPHATICS

T1

TJ


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Cance


131/168

11

P!&tate Cance Sta"in"

eta&ta&i& Lym%hatic$ Hemat!"en!u&$ Diect>


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eta&ta&i&

P th i


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Path!"ene&i&

1> Cell l!!&enin"

,> B de"adati!n> Ina&i!n

2> L!c!m!ti!n

4> B adhe&i!n

9> Inta3a&ati!n;> Tum!uem)!lu&

=> Adhe&i!n

?> E7ta3a&ati!n

1@> An"i!"ene&i&11> G!5th>

1

hat chemical mediat!& ae in!led

• E3Cadhein$ 3catenin• ati7 etall!%!teina&e& (P#• C!lla"ena&e (n!t in )eni"n#• Actin Cyt!&elet!n$ chem!ine

Cance Dia"n!&i& e>"> Lun"Cance


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Cance>• Cell ! !rigin

• Rae ! gr!?h

• Diereniai!n

• L!cal InBasi!n• Measasis

• B!nchial E%ith>

• it!tic ate 6 "ade> – L!5$ Intemediate$ hi"h

• atuati!n !* cell& – ell 6 !d 6 P!! 6 Un di/>

• Tum!u Sta"e>> 1$,$$2>

• Di&tant S%ead>>

DIAGNOSIS: (Lung cancer)B!nch!"enic S8uam!u& cell Cacin!ma$ hi"h "ade$Sta"e T,$ +1$ 1$ Lie L+ (in.. patient details..).

DIAGNOSIS: (Lung cancer)B!nch!"enic S8uam!u& cell Cacin!ma$ hi"h "ade$Sta"e T,$ +1$ 1$ Lie L+ (in.. patient details..).

G a d e

S t a " e


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SYSTEIC PATHOLOGY

Athe!&cle!&i&


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y!cadial In*acti!n


139/168

y


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141/168

LU+GS


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Tu)ecul!&i&


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ASTHA


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GIT


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RE+AL


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Sin


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Se7ually Tan&mitted


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AIDS


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Documents

Pathology Lecture Series