Introduction
Michal Hendrych


Pathology
uGeneral pathology: Scientific study of disease
u     causes (aetiology)
u      mechanisms of development (pathogenesis)
u      structural changes in diseases (morphology)
u      clinical consequences of changes
u
uPathology in clinical practice (diagnostic pathology)
-diagnosis of the disease based on the examination of surgically removed tissue specimens
(histopathology, examination of biopsies) and cytological specimens (cytolopathology): 98 %
-autopsies (necropsies – post-mortem examinations): 2 %*
-
u     *in the Czech Republic majority of autopsies are performed in the forensic medicine/pathology
dpt,
u       only minority of autopsies are performed in the dpt of pathology/anatomical pathology
u

Who is a pathologist?
uPhysicians specialized in the diagnosis and characterization of disease based on examination of
tissues (biopsies) and cytological specimens (pleural and pericardial fluid, ascites (from
peritoneal cavity), urine, cervical smears, blood, …..)
u
uSpecial focus on histopathological diagnosis of oncological diseases
u
uClinico-pathological cooperation
u

How the tissue for histopathological examination is obtained?
uCurretage
uFluid aspiration
uFine needle aspiration
uCore needle biopsy
uDermal punch
uEndoscopy
uStereotactic biopsy
uSurgical excision and resection

EXFOLIATIVE CYTOLOGY
1.Cells are shed from body surfaces by a brush
2.The smear is spread on a pre-labelled slide
3.Then, the smear is fixed by 95% alcohol or dried out by air

Fine Needle Aspiration Cytology
https://www.sgh.com.sg/Clinical-Departments-Centers/Pathology/Pathology-Handbook/Lab-Discipline-Spe
cial-Instructions/PublishingImages/image032.jpg

Papillary carcinoma of the thyroid gland
NE tumor 357606
Neuroendocrine tumour of the pancreatu

Fluid effusion
1.Effusion is drained
http://www.homeveda.com/assets/images/v_Thumbnails/ascites_018.jpg?fbrefresh=random_parameter_12345
6
2.centrifuged
3.sediment is placed onto a slide
4.sediment inserted into a cassette→ cytobloc (emersed in paraffin - HE + IHC)







Stereotactic biopsy
C:\Users\uziv\Pictures\kraniotomy position.JPG
C:\Users\uziv\Pictures\5909aebc2df9166865e41be9_biopsy.png
https://www.mayfieldclinic.com/PE-Craniotomy.htm

Stereotactic biopsy
C:\Users\uziv\Downloads\Obrázok2.png


Glioblastoma - resection
Imagining prior the surgery
After the surgery

Resection specimen - rectum
Formalin-fixed tissue


Evaluation of surgical resection specimens: brain resection specimen
Temporal pole resection specimen
Amygdalohippocampal complex
10% neutral buffered formalin, 24 hours, formalin fixed paraffin embedded tissues, paraffin
sections
Remaining unfixed tissue slices snap frozen in liquid nitrogen – molecular biology and genetics
Gross inspection, measuring, cutting representative tissue slices,
perpendicular to the cortical surface




Techniques of pathology
uGross pathology
uLight microscopy
uEnzyme histochemistry
uImmunohistochemistry and immunofluorescence
uElectron microscopy
uMolecular pathology and genetics
u
u+ biochemical, haematological and microbiological techniques, cell cultures (in clinical
pathology)
u

Focal cortical dysplasia: maldevelopment of cortex
histopathological examination
5258-08-IIa-100x 4979-08-NF 8389-08-02 sel
NF-01
Common staining methods: haematoxylin-eosin
Immunohistochemistry (IHC):
detecting antigens (e.g. proteins) in a tissue section using antibodies with subsequent
visualisation of this binding (Ag/Ab)

Immunohistochemistry (IHC)
a immunofluorescence(IMF)
§ histological methods, which selectively identify the presence of specific tissue antigens by
employing targeted antibodies binding specifically to antigens within the tissue section. The
antibody is labelled by fluorochrome (immunofluorescence) or a secondary antibody binging to the
primary antibody (against the assessed antigen) and labelled by enzyme to visualize the reaction.
§
§ Functions:
- Diagnostics
u (pathology classification, differenciation benign and malign neoplasms, origion of a metastasis
- Prognostic
u   (prognosis predictive, mutation in IDH genes in astrocytomas leads to improved outcome
- Predictive
u   (predicts tumour responds to therapy, steroid receptor expression assessment in breast
carcinoma predicts the tumour respond to hormonal therapy)
u

IHC: Steroid receptor expression
SPT_PgR_60x SPT_ER_60x
negative
positive

Native biopsies
§ Frozen section biopsy
§ Biopsy for enzyme histochemistry
§ Biopsy for immunofluorescent examination
§ Muscle biopsies
00010+

Autopsy
(= necropsy, post-mortem examination)
uDetermining the cause of death
u
uAudit of the accuracy of clinical diagnosis
u
uEducation of undergraduates and postgraduates
u
uResearch into the causes and mechanisms of the disease
u
uGathering accurate statistics about disease incidence

Learning pathology
uGeneral pathology
-The mechanisms and characteristics of the principal types of disease process (e.g. inflammation,
tumours, degenerations,…)
-
uSystemic pathology
-The descriptions of specific diseases affecting individual organs or organ systems (e.g. GIT,
respiratory tract, brain, muscles…)
-

Recommended literature for the exam
…and especially content of lectures!
…the questions for the exam will strictly follow the lectures..
u

Characteristics of the disease
uAetiology (cause: genetic, multifactorial, environmental)
u
uPathogenesis (mechanism: inflammation, degeneration, carcinogenesis, immune reaction)
u
uPathological and clinical manifestation
u     (morphological, functional, clinical)
u
uComplications and sequelae
u
uPrognosis (or outcome)
u
uEpidemiology (or incidence, population distribution)

Thanks for your attention……..