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Summary of lecture notes pathology exam 1
- Instelling
- Vrije Universiteit Amsterdam (VU)
summary of all lecture notes needed for the first partial exam of pathology
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Pathology lecture notesLecture 1: introduction
Pathology is the study of diseases
What is a disease?
- An abnormality that interferes with normal health
o Causes loss of health
- Disease: set of features (signs, symptoms, morphological and functional manifestations)
What is normal?
- The most frequent state in a population defined by age, gender etc
Systematic description
- Epidemiology
- Cause (or etiology)
- Pathogenesis (disease mechanisms)
- Symptoms, manifestations
- Complications & sequelae
- Prognosis
- Mortality
Terminology
- Prefixes (hyper-, meta-, hypo-, etc)
- Suffixes (-itis, -oma, -oid, etc)
- Eponyms: Crohn’s disease
o Disease is named after the person who first described it
Autopsies: study of pathology based on the whole body
- Body, brain, spinal cord, eyes
- Get information from a patient that has died
- Performed for research purposes
For autopsies often histologic slides are made
Tissue processing:
Fixation (formalin)→dehydration→embedding→Paraffin blocks→ cutting→slides→H&E stain
What information is relevant?
- Diagnosis
o Benign or malignant?
o Type of tumor?
- Prognosis
o What are the consequences of this disease on this patient?
o TNM classification?
▪ T describes the size of the tumor and any spread of cancer into nearby tissue;
N describes spread of cancer to nearby lymph nodes; and M describes
metastasis
, • What kind of tumor, how big, where is it, are there metastasis and if
so where?
o Radicality
- Prediction
o Response to treatment
Lecture 2: cell- and tissue adaptation and damage
What is disease?
Since 1830 we realized that every disease known to man finds its origin in cells. A disease is an
occurrence of a disfunction of cells. Depending on what type of cells are dysfunctional, there will be
certain complaints
- Book about the HeLa cell line: Henrietta Lacks
Disease:
- Disfunction of an organ or tissue due to damage of cells
o This damage can be of many causes
▪ Chemical, thermal, radiation, DNA
damage, micro bacterial etc.
- Damaging agent: etiology (the cause)
- the influence on and the changes in cellular
processes reflect the pathogenesis
lots of diseases are caused by DNA damage
Virchow: the man who formulated that damage of cells
causes disease
- founder of pathology
o wrote the book cellular pathology and laid the groundworks for pathology
cells are often not alone but are found in communities
multicellularity can be a coping strategy for individuals, but it comes with problems
- internal milieu is optimized and attractive for intruders
o effective defense is required (immunological defense)
▪ infectious diseases
- organization and clear division of tasks is mandatory
o discipline of cells with a.o. regards to proliferation
▪ you want the right cells to proliferate
• otherwise chance of cancer
cell damage, stress and stressors
- disease is caused by damage to (part of) a cell or groups of cell by an etiological agent
- initial damage can cause further damage (pathogenesis)
- the cell/organ reacts to minimize impact of damage: adaptation
o coping with the damage caused
- damage can be reversible, lead to adaptation or ultimately cell death
o death of one cell is not a catastrophe, but damage to multiple cells can have bad
consequences
,adaptation vs cell death
In the case of cell death the cell is unable to cope with all
damage
- yellow area= infarcted tissue
o cells are death due to lack of oxygen
hypertrophy is a form of cell adaptation
- = increase in the size of cells (not an increase in the
number of cells)
o Also increase in size of organ due to enlarged cells
- Muscle cells
- Pregnancy is one cause of uterine hypertrophy (adaptation)
Myocardial hypertrophy
- Can be caused by increased workload of
cardiac smooth muscle cells (mechanical
stretch)
- can be caused by drugs
- can be caused by growth factors
- ultimately leads to production of more
proteins needed for contraction
o in order for the contractile workload
to increase
o this leads to hypertrophy:
▪ bigger cells because they
have more proteins in them
Hyperplasia is also a cell- and tissue adaptation
- increase in NUMBER of cells (not in size!)
- this can for instance be seen in the breasts during pregnancy
o for lactation, you need more tissue in the breasts and this happens due to hyperplasia
of the cells in this tissue
Normal duct increased duct
Cell and tissue adaptation: atrophy
- = decrease of tissue by decrease of cell size and/or number
- Example in the brain:
o Wider gyri and smaller sulci indicate shrinkage of the organ
, o This can be seen in Alzheimer’s where patients lose brain cells
- Atrophy can occur through several ways
o Cell loss
▪ Usually due to apoptosis
• Programmed cell death
o Autophagy
▪ Taking out part of the cell
▪ Cell destroys parts of itself without
completely killing itself
▪ Cell shrinks because of it (which can
cause shrinkage of the tissue)
o Proteasomal degradation
Metaplasia
- Replacement of one tissue by a (normal) other tissue
- Why?
o This happens for instance in airways of smokers where tissue remodels into a
stratified epithelium instead of the normal one cell layer
▪ This new layer is much better in dealing with the smoke damage because
there are more cells
Cell death
One of the major reasons for cells to die or be damaged is because of a lack of oxygen (O2 shortage)
- Too little oxygen causes the cells to be unable to replenish their oxygen stores
o This causes swelling of the cells because oxygen is needed to generate energy for
pumping out water and potassium
o Failure of Na+-K+-ATPase
o
- In the beginning of this, the swelling is reversible if the
oxygen stores are replenished
o Cell returns to its original size
- There is a big difference in how long different cells can live with an oxygen shortage
o Nerve an heart cells die very quickly
2 ways of cell death in cellular pathology: necrosis and apoptosis
- Necrosis is always triggered by
something from outside the cell
o Usually oxygen depletion
- Apoptosis is (usually) triggered by
something from within the cell
There is a great difference in reaction of the
body to the 2 deaths
- Necrosis causes inflammation
o Pro-inflammatory
o Inflammatory reaction causes
repair
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