病理学. Pathology 白求恩医学院病理学系 李伟

Transcription

1 病理学 Pathology 白求恩医学院病理学系 李伟

2 The main duty of medicine Patients just want to know:? What disease am I suffering from?? How can you cure it?? How could you prevent me from having the illness in the future? prevention diagnosis diseases treatment

3 Introduction to pathology Definition of pathology How to study pathology Evolution of pathology Diagnosis and research methods Techniques for the study of pathology

4 What is Pathology? -Pathos means suffering, disease -logos means study, science Pathology is scientific study of structure and function of the body in disease. It deals with causes, effects, mechanisms and nature of disease. 病理学是用自然科学的方法研究疾病的形态结构 代谢和功能等方面的改变, 从而揭示疾病的病因 发病机制和转归的医学基础学科

5 The position of pathology in medicine Clinical medicine Bridging Subject Patholog y Foundational medicine Pathology forms a vital bridge between preclinical sciences and clinical medicine.

6 The position of pathology in medicine 基础医学课目中与临床最接近的当推病理学, 因为它是临床与基础之间的桥梁, 要学好临床先要学好病理学, 我毕业后才认识这个道理 原想加学一年病理学以资弥补, 可是没能做到, 至今引为遗憾 张孝骞 ( ) 著名医学教育家 中国消化病学的奠基人

7 How to study Pathology 总论 个论 General Pathology Common changes in all tissues. E.g. Inflammation, cancer, Systemic Pathology Specific changes in organs. E.g. pneumonia, breast cancer. The relationship between general pathology and Systemic Pathology 损伤循环障碍炎症肿瘤 循环呼吸消化泌尿 心肌梗死 心内膜炎 肺淤血水肿 肺炎 肺癌 肠扭转 肠炎 肠癌 肾梗死 肾炎 肾癌

8 How to study pathology 总论理论形态局部静态基础 各论实践功能整体动态临床 Why cause Where location What change

9 The history of pathology 器官病理学 Organ pathology 组织细胞病理学 cellular pathology 超微结构病理学 ultrastructural pathology 分子病理学 molecular pathology

10 Diagnosis and research methods Human pathology 尸体剖检 (autopsy) 活体组织检查 (biopsy) 细胞学检查 ( cytology ) Experimental pathology 动物实验 (animal experiment) 组织和细胞培养 (tissue and cell culture)

11 Diagnosis and research methods 尸体解剖检查 -- 简称 尸检, 即对死者的遗 体进行病理解剖和进 行系统的形态学分析, 是病理学的基本研 究方法之一 Human pathology Autopsy: An examination of a cadaver to determine the cause of death. Significance:

12

13 Diagnosis and research methods Autopsy: The purposes of autopsy: 1. Confirmation diagnosis and major cause of the death 2. Discover some new diseases. 3. Accumulation experience of clinical treatment 4. Accumulation specimens Significance: 盖棺定论

14 Diagnosis and research methods Human pathology Biopsy: a procedure where diseased tissue is removed from the alive body for laboratory examination to determine the diagnosis. 活体组织检查 -- 简称活检, 即用局部切取 钳取 细 针穿刺 搔刮和切取病变器官等手术方法, 从患者活体获取病变组织或病变器官进行病理诊断 又称为外科病理学, 诊断病理学 病理学诊断 金标准

15 biopsy The origin of routine biopsy materials Therapeutic resection Resected tissue for diagnostic purpose Endoscopic biopsies Shave biopsies Core biopsies Naturally discharged tissues

16 biopsy Frozen Section Examination An examination of pathologic samples from living body to set up diagnosis

17 Diagnosis and research methods Human pathology cytopathology: cytology is the diagnosis of disease from individual cells, such as cervical smears or fluid from cysts. 细胞学检查 -- 通过采集病变处的细胞, 涂片染色后进行诊断 脱落细胞 自然分泌物 体液 排泄物 细针穿刺吸取

18 Diagnosis and research methods

19 Diagnosis and research methods Experimental pathology 动物实验 (animal experiment) 组织和细胞培养 (tissue and cell culture)

20 Diagnosis and research methods Experimental pathology 动物实验 (animal experiment) 组织和细胞培养 (tissue and cell culture)

21 Basic techniques in the study and diagnosis of pathology Gross observation ( 大体 ) Histopathology Microscope observation ( 镜下 ) Immunohistochemistry (IHC): 免疫组织化学 electron microscope ( 用扫描 透射电镜观察病变亚微病 ) flow cytometry( 流式细胞学 ): 测定细胞 DNA 变化来研究诊断疾病 Laser Scanning Confocal microscope( 激光扫描共聚焦显微镜 ) Microdissection( 激光显微切割 ) image analysis ( 图像分析技术 ): 定量法分析 诊断疾病 Biological techniques 分子生物学技术

22 Basic techniques in the study and diagnosis of pathology Gross appearance: size weight shape color consistency surface edge section

23 Basic techniques in the study and diagnosis of pathology Histopathology Microscope observation ( 镜下 ) HE staining Specific staining HE HE Periodic acid schiff(pas PAS

24 Basic techniques in the study and diagnosis of pathology IF Immunohistochemistry (IHC) & immunofluorescence (IF) IHC

25 Basic techniques in the study and diagnosis of pathology Electron microscope

26 Basic techniques in the study and diagnosis of pathology Laser Scanning Confocal microscope

27 Basic techniques in the study and diagnosis of pathology flow cytometry

28 Basic techniques in the study and diagnosis of pathology Microdissection pick up target cells (e.g.tumor cells) from HE slides for DNA extraction By Manual By laser

29 Basic techniques in the study and diagnosis of pathology Biochip technique Gene chip: Protein chip: Tissue array:

30 autopsy 尸检 biopsy 活检 人体病理学 基础医学 Basic science cytology 细胞学 总论 病理学 大体组织和细胞学组织和细胞化学免疫组织化学超微结构流式细胞术图像分析技术分子生物学技术激光扫描共聚焦显微术 动物实验 细胞培养 个论实验病理学 临床医学 Clinical practices

31 Chapter one Tissue and Cellular adaptation and Injury 第一章

32 Cell and tissue adaptation and injury Normal cells Adaptation irreversible injury Diagram 2 reversible injury

33 Adaptation 适应 Cellular adaptation occurs when excessive physiologic stresses, or some pathologic stimuli, result in a new but altered state that preserves the viability of the cell. 指细胞 组织 器官和机体对于持续性的内外刺激作出的非损伤性的应答反应 通过适应性反应, 细胞 组织和器官改变其自身的代谢 功能和结构以达到新的平衡 耐受各种刺激而得以存活, 避免损伤

34 Adaptation Cell size Cell number Hypertrophy 肥大 Hyperplasia 增生 Adaptation 适应 Atrophy 萎缩 Metaplasia 化生 Cell size & number differentiation

35 hypertrophy- 肥大 Definition: An increase in the size of cells and consequently an increase in the size of the organ. 肥大 : 细胞体积的增大 组织和器官的肥大通常是由于实质细胞的体积增大 所致, 但也可伴有实质细胞数量的增加

36 Hypertrophy-types Physiologic Pathologic athletic musculature the uterus during pregnancy lactating breast hypertensive myocardial hypertrophy residual nephron hypertrophy hepatic cells hypertrophy (hyperplasia) Compensatory hypertrophy--caused by increased functional demand Endocrine hypertrophy caused by specific hormonal stimulation

37 Hypertrophy-types Physiologic hypertrophy of uterus

38 Hypertrophy-morphology Hypertrophy of cardiac muscle Normal heart hypertrophy Normal heart concentric hypertrophy (compensatory) eccentric hypertrophy (decompensate)

39 Hypertrophy-morphology

40 Hypertrophy-morphology Compensatory hypertrophy Atrophic glomeruli chronic glomerulonephritis

41 Hyperplasia 增生 Definition: An increase in the number of cells in an organ or tissue, which may then have increased volume. 器官或组织的实质细胞数目增多 增生可导致组织 器官的体积增大 增生是细胞有丝分裂活跃的结果, 也与细胞凋亡受到 抑制有关, 通常受到增殖基因 凋亡基因 激素和 各种肽类生长因子及其受体的精细调控

42 Hyperplasia-Types Physiologic Hormonal hyperplasia: female breast epithelium at puberty or during pregnancy Compensatory hyperplasia: a portion of the tissue is removed or diseased---a liver is partially resected Pathologic Excessive hormonal or growth factor stimulation: endometrial hyperplasia Hyperplasia of prostate gland would healing fibroblasts and blood vessels proliferate.

43 Hyperplasia-Types Physiologic breast hyperplasia

44 Hyperplasia-Types Proliferated endometrium Complex hyperplasia

45 Hyperplasia-Types Hyperplasia Diffuse tissue and organ diffusely enlarged Nodular single or multiple nodules hyperplasia of prostate gland

46 hyperplasia and hypertrophy Although hypertrophy and hyperplasia are two distinct processes, frequently both occur together, and they will be triggered by the same mechanism. The hyperplasia process remains controlled (reversible) Pathological hyperplasia constitutes a fertile soil in which cancerous proliferation may arise.

47 Atrophy- 萎缩 Definition Atrophy is Shrinkage in the size of the cell due to loss of cell substance. When a sufficient number of cells is involved, the entire tissue or organ diminishes in size, becoming atrophic. Although atrophic cells may have diminished function, they are not dead. 发育正常的实质细胞因细胞物质的丢失而体积变小称为萎缩 细胞萎缩可导致组织 器官的体积缩小 常伴有细胞数目的减少

48 Atrophy- Types Pathologic Physiologic Aging Endocrine Inadequate nutrition Decreased workload Denervation Pressure Loss of endocrine stimulation

49 Atrophy- Morphology 大体 : 萎缩的器官体积缩小, 重量减轻, 色泽变深 ( 褐色萎缩 ); 被膜皱缩, 边缘变锐 镜下 : 实质细胞体积变小, 可伴细胞数目的减少 心肌细胞和肝细胞等萎缩细胞胞质内可出现脂褐素颗粒 (lipofuscin) 电镜 : 线粒体 内质网等减少, 自噬泡 (autophagy vacuoles) 显著增多, 自噬泡内的细胞碎片不能被消化而以膜包绕的形式存在于细胞质, 即脂褐素 可伴间质的增生 假性肥大

50 Atrophy- Types Atrophy due to inadequate nutrition Chachexia 恶病质 is a sign of late-stage disease Marked weight loss Loss of muscle mass

51 Atrophy- Morphology Physiologic atrophy of brain 82 year-old male Normal brain of a 25-year-old male

52 Atrophy- Morphology Pathological atrophy of brain Brain atrophy caused by diminished blood supply Brain of Alzheimer's disease

53 Atrophy- Morphology Atrophy of heart

54 Atrophy- Morphology Atrophy of heart Brown atrophy of heart Tortuous of arteries

55 Atrophy- Morphology Atrophy of heart normal heart atrophic heart

56 Atrophy- Morphology Atrophy of heart Normal cardiac muscle Atrophic cardiac muscle

57 Atrophy- Morphology Atrophy of heart lipofuscin

58 Atrophy- Morphology normal atrophic normal atrophic

59 Atrophy- Morphology

60 Atrophy- Morphology Pressure atrophy of brain

61 Atrophy- Morphology Pressure atrophy of kidney

62 Atrophy- Morphology Pressure atrophy of liver Normal liver Pressure atrophy ( liver carcinoma)

63 Atrophy Atrophy represents a retreat by the cell to a smaller size at which survival is still possible; A new equilibrium is achieved between cell size and diminished blood supply, nutrition, or other stimulation. Mild---recover Severe and durative---to death

64 Metaplasia 化生 Definition: Metaplasia is a reversible change in which one adult cell type is replaced by another adult cell type. 一种分化成熟的细胞为另一种分化成熟的细胞 所替代的过程 是存在于正常组织中的干细胞或结缔组织中未分化间叶细胞通过增生转变, 即重新程序化的结果 化生只出现于具有增生能力的细胞 特异性低的细胞取代特异性高的细胞 化生只发生于同源细胞之间

65 Metaplasia-Types Epithelial metaplasia Squamous metaplasia 鳞状上皮化生 Intestinal metaplasia 肠上皮化生 columnar epithelium (trachea, cervix, cholecyst) transitional epithelium (pelvis) Gastric glandular epithelium Pseudo-pyloric gland Metaplasia 假幽门腺化生 corpus and sinus gastric gland Mesenchymal metaplasia Osseous, cartilage and adipose tissue metaplasia 骨 软骨 脂肪组织化生 Fibroblasts

66 Metaplasia-Types

67 Metaplasia-Types Squamous metaplasia normal

68 正常气管上皮 鳞状上皮化生

69 Metaplasia-Types Squamous metaplasia

70 Metaplasia-Types villi of normal trachea squamous metaplasia

71 Metaplasia-Types

72 Metaplasia-significance Metaplasia---a double-edged sword Advantage Disadvantage Defending loss of normal function Cancer transformation

73 Adaptation Increased demands Growth stimulation hypertrophy hyperplasia adaptation atrophy metaplasia Diminished nutrition Low stimulation Chronic stimulation Pathological