The Outline of Pathology for International Students (Minimal Requirements)

The Outline of Pathology for International Students (Minimal Requirements) February 2016 1

四川大学全英语授课专业课程大纲 Syllabus of English-Teaching Program at SCU Course Code: 502375060 Total Class Hours: 112 Credit: 6 Course Name: Pathology IV Textbook/Teaching Material: Robbins Basic Pathology. 9 th edition, Kumar V, Abbas AK, Fausto N, Mitchel R, eds, 2007, Elsevier Sauders Course Objective: Pathology is a scientific study of disease. It is a bridging discipline involving both basic science and clinical practice and is devoted to the study of the structural and functional changes in cells, tissues, and organs that underlie diseases. By the use of molecular, microbiologic, immunologic, and morphologic techniques, pathology attempts to explain the pathogenesis, etiology, signs and symptoms manifested by patients while providing a sound foundation for rational clinical care and therapy. Pathology is also one of the most important methods to diagnose disease in clinical practice. By studying pathology, the medical students should not only understand the basic pathologic knowledge and master the skills, but also prepare themselves for bigger clinical courses ahead. Traditionally, the study of pathology is divided into general pathology and systemic pathology. The former is concerned with the basic reactions of cells and tissues to abnormal stimuli that underlie all diseases. The latter examines the specific responses of specialized organs and tissues to more or less well-defined stimuli. The teaching contents include lectures, laboratory practice, autopsy demonstration and clinicopathologic conference (CPC). For medical students, the goal of learning pathology is able to analyze the relationship between pathologic changes and clinical manifestations and to understand a pathologic diagnosis correctly. Prerequisite: Basic medical sciences, including, anatomy, histology, embryology, physiology, biochemistry, immunology, microbiology, parasitology Reference books: 1. Robbins Basic Pathology: with Student Consult Online Access. 9 th edition, Kumar V, Abbas AK, Aster JC, et al, eds, 2012, Elsevier Sauders 2. Rubin s Pathology: Clinicopathologic Foundations of Medicine. 4 th edition, Rubin E, Corstein F, Rubin R, et al, eds, 2005, Lippicott Williams & Wilkins 2

Grading: Total scores: 100% Final examination: 60% Visual recognition skills: 20% Semi-semester examination: 10% Attendance and home works: 10% Office Hour: Telephone and E-mail address: Education Director: 028-85423848 zhangwyliu@163.com Education Secretary: 028-85423847 gongjingpath@163.com 3

The Outline of Pathology for International Students (Minimal Requirements) February 2016 Part I General Pathology Introduction to pathology Understand the concept and contents of pathology. Be familiar with its role in medical education, medical practice and clinical research, the morphological study methods of pathology and the history of pathology. Cell injury, adaptation and death: Adaptation: Understand the concepts and recognize the lesions of adaptation: atrophy, hypertrophy, hyperplasia and metaplasia. Reversible Cell Injury: Understand the causes and the mechanisms of cellular injury (for example, hypoxic cell injury, free radicals). Recognize intracellular and extracellular accumulations in gross and light microscopic levels, especially hyaline change (vascular wall, connective tissue and intracellular). Be familiar with amyloid change, mucoid change, pathological pigmentation and pathological calcification. Irreversible Cell Injury (Cell Death): Recognize the morphological changes of reversible injury in gross and light microscopic levels: cellular swelling, hydropic change and fatty change. Define and correctly use "necrosis" and distinguish the various categories of necrosis (coagulation, liquefaction, fibrinoid necrosis, enzymatic fatty necrosis, caseous necrosis). Tell how you know a cell is dead. Briefly describe the various forms of gangrene. Apoptosis: Understand the definition of apoptosis. Be familiar with the significance of apoptosis in physiologic and pathologic conditions. Cellular Aging: Be familiar with the main mechanism of cellular aging and aging related disorders. Tissue repair: cell regeneration and fibrosis By the end of this chapter, you will be able to Understand the following definitions: regeneration, fibrosis, repair and granulation tissue. Recognize the lesions of granulation tissue, fibrosis, wound healing (by first intention and by 4

second intention). Be familiar with the molecular mechanism of regulation of cell proliferation (growth factors and their receptors, signal transduction pathway) and the significance of repair in the body survival. Be familiar with the capabilities of regeneration in various tissues. Hemodynamic disorders Hyperemia Understand the concepts of hyperemia, congestion and the difference between them. Recognize the morphologic changes of hyperemia and congestion, for example, heart failure cells. Be familiar with the classification, mechanism of hyperemia and its influences to the body. Hemorrhage Understand the concepts of hemorrhage and related terms (hematoma, petechiae, ecchymoses, hemothorax, hemopericardium, hemoperitoneum and hemarthrosis etc). Thrombosis Understand the concepts of thrombosis and thrombi, the relationship between hemostasis and thrombosis, three primary influences predispose the thrombus formation, the so-called Virchow s triad: endothelial injury, stasis or turbulence of blood flow and blood hypercoagulability. Recognize the morphology of thrombi (red, white and mixed thrombi) and the fate of the thrombus. Understand and correctly use of the concept of disseminated intravascular system (DIC). Embolism: Master the concepts: embolism, emboli and thromboembolism, especially the difference between thrombosis and embolism. Understand the classification of embolism, its influences to human body and the fate of emboli. Infarction: Understand the concept of infarction, the types of infarcts (hemorrhagic infarct, anemic infarct and septic infarct). Be familiar with the factors that influence development of an infarct. Edema: Understand the concept of edema. Be familiar with the related terms: hydrothorax, hydropericardium, hydroperitoneum (ascites) and anasarca. Be familiar with its morphologic changes and clinical pathologic correlation. Acute and chronic inflammation Understand general role of inflammation in the host response to injury and its relationship to tissue injury and repair process. Understand its significance in the host survival. Organize and discuss the acute inflammatory process in terms of vascular changes, leukocytic events, chemotaxic events, activation of leukocytes, phagocytosis and tissue injury from acute inflammation. 5

Understand and give examples and be able to recognize different morphologic patterns of acute inflammation (serous inflammation, fibrinous inflammation and suppurative inflammation), ulceration and erosion. Be familiar with the general features of chronic inflammation in terms of etiologies, cellular constituents, general histologic features and nomenclatures used to describe chronic inflammation of different organs. Understand and be able to discuss different morphologic patterns of chronic inflammation, including chronic granulomatous inflammation, chronic non-specific inflammation, inflammatory polyps and inflammatory pseudotumor. Be familiar with the relationship between chronic inflammation and abnormalities of immune system. General Pathology of Infectious Diseases and Parasitic Disorders General Pathology of Infectious Diseases Be familiar with the main types of infectious agents, including new discovered agents. Understand the general disseminated pathways, host resistance, general morphologic features and spreading of common microbes (bacteria, viruses, mycoplasmas, fungi and parasites). Sexually Transmitted Diseases Understand AIDS in term of etiology, epidemiology, pathogenesis, pathologic appearance and clinicopathologic relationship. Be familiar with the clinical and morphologic appearances of condyloma acuminatum, syphilis and gonorrhea in the male and female genital tract. Neoplasia Master (fully understand and be able to use correctly) the followings: the concepts of neoplasm (tumor) and neoplasia, the difference between benign tumor and malignant tumor (cancer), the differences between neoplastic and non-neoplastic proliferations, the general morphologic characteristics of tumors in macroscopic and microscopic levels, including structural and cytological atypia/dysplasia. Master the growth patterns of neoplasms, including exophytic, expansive, infiltrating (invasive), invasion (infiltration) and metastasis (lymphatic, hematogenous, seeding). Understand the concepts of tumor progression and heterogeneity. Understand and correctly use of grading and staging of malignant tumors (TNM system). Be familiar with the principles of nomenclature and classification of neoplasms (WHO classification). Be familiar with common clinical manifestations of neoplasms, clinicopathological features of common neoplasms (papilloma, adenoma, squamous cell carcinoma, adenocarcinoma). Be familiar with the molecular basis of neoplasia, including oncogenes, tumor suppressor genes and multi-step tumorigenesis. Be familiar with the mechanisms of tumor invasion and metastasis. Understand the general aspects of the common tumorigenic agents (including carcinogen) and their tumorigenic mechanisms. 6

Be familiar with the principles of diagnosis and treatment of neoplasms. Part II Systemic Pathology The Diseases of Cardiovascular System Atherosclerosis Master the concept of atherosclerosis. Describe the gross and microscopic morphology of the fatty streak, fibrous plaque and atheromatous plaque. Recognize the complications and clinical significance of atherosclerosis. Be familiar with the epidemiology, risk factors and pathogenesis of atherosclerosis. Hypertension Master the different types of hypertension. Categorize the different types of secondary hypertension and give examples of each. Describe, compare and be able to discuss vascular morphologic changes of essential hypertension and malignant hypertension. Understand the clinical features, the gross and microscopic morphology, and the complications of hypertension in heart, central nervous system, kidneys and blood vessels. Be familiar with the mechanisms of blood pressure regulation including cardiac influences, neural factors, hormonal factors and the rennin-angiotensin system. Organize and be able to discuss the pathogenesis of essential hypertension including genetic influences and environmental influences. Ischemic heart disease Master the definition and four syndromes of ischemic heart disease. Be able to describe the sequences of gross and microscopic morphologic changes which occur in a myocardial infarction from the acute phase to healed scarring. Learn the distribution of myocardial infarction related to site of coronary artery obstruction. Recognize the different complications of myocardial infarction. Be familiar with the epidemiology, risk factors, pathogenesis, and different etiologies of ischemic heart disease. Rheumatic heart disease and Infective Endocarditis Master the gross and microscopic changes, clinical presentation and course of rheumatic heart disease and infectious endocarditis. Compare the bacterial endocarditis with rheumatic endocarditis. Compare the acute bacterial endocarditis with subacute bacterial endocarditis. Be familiar with the epidemiology, pathogenesis of the rheumatic heart disease and infectious endocarditis. Viral myocarditis, Cardiomyopathy and Pericarditis Be familiar with the gross and microscopic changes, clinical presentation and course of the virus myocarditis, primary cardiomyopathy (dilated, hypertrophic and restrictive cardiomyopathy) and pericarditis. The Diseases of Respiratory System Obstructive Pulmonary Disease Master the incidence, etiology, pathogenesis, morphological change and clinical presentation of 7

chronic bronchitis. Be familiar with the definition of chronic bronchitis and emphysema. Recognize the gross and microscopic morphological changes of emphysema. Understand the differences of panacinar (panlobular) emphysema, centriacinar (centrolobular) emphysema and periacinar (paraseptal) emphysema in the context of definition and clinical presentation. Understand chronic bronchitis and emphysema usually coexist. Bronchiectasis Master the definition and clinical course of bronchiectasis. Recognize the gross and microscopic morphological changes of bronchiectasis. Asthma Master the definition, pathogenesis, classification and clinical course of asthma. Cor pulmonale Master the pathogenesis and clinical presentation of cor pulmonale. Recognize the gross morphological changes of it. Pneumonia Master the etiology, pathogenesis, classification of pneumonia. Be familiar with the differences of lobar pneumonia and lobular pneumonia (bronchopneumonia) in terms of clinical presentation, radiographic presentation, and clinical course-prognosis (complications). Recognize the gross and microscopic morphological changes of lobar pneumonia in hepatization stage. Recognize the gross and microscopic morphological changes of lobular pneumonia. Master the definition and clinical course of atypical pneumonia. Recognize the microscopic morphological changes of interstitial pneumonia. Pulmonary Tuberculosis Be familiar with the etiology and pathogenesis of tuberculosis in terms of predisposing factors and epidemiologic factors (poorly health conditions, developing countries, opportunistic infection to immunocompromised host, etc). Master tuberculosis in terms of difference between primary and secondary forms (age of host, infective pathway, localization of the lesion, gross and microscopic changes, radiography and outcome). Be familiar with pulmonary tuberculosis in terms of pathogenesis of Ghon complex, reactivation, cavitary, miliary and disseminated or isolated organ forms, morphology of each form, clinical presentation, and diagnosis. Be familiar with the dissemination and outcome of various subtypes of pulmonary tuberculosis. Be familiar with the clinicopatholgic features of extra-pulmonary tuberculosis, including intestine, peritoneum, meninges, urinary and reproductive system, bone and joint, lymph node et al. Tumors of the Lung Master the etiology, pathogenesis and clinical course of lung carcinoma. Be familiar with the classification of lung tumors on the basis of histologic types. Recognize the gross morphological changes of lung carcinoma. Recognize squamous cell carcinoma, adenocarcinoma and small cell carcinoma of lung. Nasopharyngeal Carcinoma 8

Be familiar with the etiology, geographical distribution, histologic types, clinical presentation and clinical course-prognosis of nasopharyngeal carcinoma. The Diseases of the Gastrointestinal Tract Diseases of esophagus Master reflux esophagitis and Barrett s esophagus in terms of morphology and clinical course. Recognize esophageal carcinoma in terms of clinical presentation, etiology (risk factors), pathological morphology and prognosis-clinical course. Diseases of stomach Master the pathogenesis (Type A and Type B), morphology, histological types (superficial and atrophic) and clinical presentation of chronic gastritis, especially the role of Helicobacter Pylorus in the pathogenesis of chronic gastritis and peptic ulcer. Understand the concept, pathological changes, clinical presentation and complications of peptic ulcer. Recognize the risk factors, classification, gross and microscopic morphology, clinical presentation and prognosis of gastric carcinoma. Recognize the difference between benign gastric ulcers and ulcerated gastric carcinomas. Be familiar with acute gastritis and chronic gastritis C (reactive gastritis, reflux gastritis). Diseases of small and large intestine Inflammatory Bowel Disease Master the clinical presentation, gross and microscopic morphology and clinical course of ulcerative colitis and Crohn s disease. Recognize the difference between Crohn s disease and intestinal tuberculosis. Be familiar with the etiology and pathogenesis of inflammatory bowel disease (IBD). Inflammation of small and large Intestine, appendix Master the morphological changes and clinical presentations of acute appendicitis. Recognize the clinical-pathological features of diarrheal diseases, including viral enteritis, bacterial enterocolitis (Shigellosis, typhoid fever), protozoal infection(amebic enterocolitis) and parasitic diseases. Tumors of small and large Intestinal Master the features of carcinoma of the colon and rectum on the basis of incidence, epidemiology, etiology and pathogenesis (the adenoma-carcinoma sequence), clinical presentation, gross and microscopic morphology, clinical course, and prognosis including prognostic indicators (staging). Recognize the different types of non-neoplastic and neoplastic polyps in terms of clinical presentation, morphology and malignant potential. Be familiar with the concept of intraepithelial neoplasia (dysplasia), intramucosal carcinoma and invasive carcinoma. The Diseases of the Liver, Biliary Tract and the Pancreas By the end of this chapter, the student should be able to: Hepatitis Be familiar with features of viral hepatitis in terms of incidence-epidemiology, clinical presentation, serologic diagnosis and clinical course. 9

Be familiar with the general types of hepatitis (A, B, C, D) in terms of etiologic agent, transmission pathways, carrier states, morphology and complications (chronic hepatitis, cirrhosis, malignancy). Master acute viral hepatitis, chronic viral hepatitis and fulminant hepatitis in terms of clinical presentation, etiology, morphology and clinical course-prognosis. Be familiar with alcoholic liver disease in terms of incidence, clinical presentation, pathogenesis, morphology, clinical course, prognosis and complications. Cirrhosis Master cirrhosis in terms of definition, classification, pathogenesis, clinical features, prognosis and complications. Master portal hypertension in terms of etiology, pathogenesis, and clinical presentation and complications. Be familiar with the difference of alcoholic cirrhosis and post-hepatitis cirrhosis based on clinicopathologic data. Hepatic Tumors Be familiar with features of hepatocellular carcinoma in terms of epidemiology, associated risks, clinical presentation, pathogenesis, morphology, laboratory diagnosis, clinical course-prognosis, and features which may affect prognosis. Be familiar with features of cholangiocarcinoma in terms of associated risks morphology, clinical presentation and prognosis. Biliary Tract Be familiar with features of cholelithiasis in terms of prevalence, risk factors, clinical presentation, pathogenesis, morphology, and clinical course-complications. Be familiar with features of acute cholecystitis in terms of etiology, clinical presentation, pathogenesis, and morphology. Discuss acute cholecystitis in terms of predisposing circumstances and clinical presentation. Be familiar with features of chronic cholecystitis in terms of etiology, clinical presentation morphology, and complications. Be familiar with epidemiology, pathogenesis, morphology and clinical presentation of hydatid cyst. Exocrine Pancreas Be familiar with acute and chronic pancreatitis in terms of incidence, risk factors, clinical presentation, pathogenesis, morphology, clinical and laboratory diagnosis, complications and prognosis. Be familiar with features of carcinoma of the pancreas in terms of incidence, risk factors, clinical presentation, genetic aspects, pathogenesis, morphology, clinical and laboratory diagnosis, complications and prognosis. Be familiar with clinical presentations and etiologies of choledocholithiasis, ascending cholangitis and choledochal cysts. The Diseases of Lymphohematopoietic System Non-Neoplastic Disorders of Hemopoietic and Lymphoid System Be familiar with the morphologic changes of reactive hyperplasia of lymph node and the possible 10

cause of distinctive infection in lymph node, including tuberculosis, toxoplasmosis and Kikuchi s lymphadenitis. Non-Hodgkin Lymphoma and Hodgkin Lymphoma Master the concept of malignant lymphoma and the general principles of WHO classification for tumors of lymphohematopoietic tissues. Be familiar with Hodgkin lymphoma in terms of characteristic morphology (Reed-Sternberg cell) and immunophenotype. Be familiar with non-hodgkin lymphomas in terms of diagnostic approach, morphologic and immunophenotype classification (T/NK vs B cells) and grading. Myeloid Neoplasm Be familiar with the concept of chronic myelogenous leukemia (BCR/ABL-1 positive) in terms of incidence, clinical presentation, genetics, pathogenesis, morphology of peripheral blood and bone marrow, laboratory diagnosis and clinical course-prognosis. Master the concept of acute myeloid leukemia in terms of incidence, clinical presentation, genetics, pathogenesis, morphology of peripheral blood and bone marrow, laboratory diagnosis and clinical course-prognosis. Be familiar with the concepts of leukemoid reactions and myeloid sarcoma (chloroma). The Diseases of Kidney and Its Collecting System Glomerulonephritis and glomerular diseases Be familiar with the etiology, basic mechanisms, and classification of glomerular diseases including circulating immune complex, immune complex in situ, cell-mediated immune and epithelial cell injury. Master the definitions of acute nephritic syndrome and nephrotic syndrome. Master the the basic morphological changes and clininicopathologic correlations of glomerular diseases. Master the morphological changes and clininicopathologic correlations of primary glomerulonephritis, especially the following types: acute proliferative glomerulonephritis, rapidly progressive (crescentic) glomerulonephritis, and chronic glomerulonephritis. Be familiar with the concept of secondary glomerulonephritis. Master the etiology, mechanisms, basic morphological changes, and clininicopathologic correlations of pyelonephritis. Be familiar with the etiology, basic morphological changes, and clinical presentations of renal stones and hydronephrosis. Be familiar with the etiology, basic morphological changes, and clinical presentations of renal cell carcinoma, Wilm s tumor, and tumors of urinary bladder. Be familiar with basic pathologic changes of urinary epithelial tumors and their clinicopatholgic relationship. The Diseases of Female and Male Genital System and Breast The Male Genital System Prostate Pathology 11

Be familiar with benign prostatic nodular hyperplasia (BPH) in terms of incidence, pathogenesis, clinical presentation, morphology, and clinical course-complications. Be familiar with adenocarcinoma of the prostate in terms of incidence, age, genetics, etiology, pathogenesis, clinical presentation, morphology, premalignant lesions, laboratory diagnosis, grading and staging, clinical course and prognosis. The Female Genital System and Breast Diseases of the Cervix Be familiar with chronic cervicitis in term of etiology (especially HPV infection), epidemiology, clinical and pathologic appearance and relationship with cervical carcinoma. Master and correctly use the term of cervical intraepithelial neoplasia (CIN). Be familiar with microinvasive squamous cell carcinoma, and invasive carcinomas of the cervix, inflammatory processes and other cervical neoplastic processes which may be in the clinical differential diagnosis of malignant neoplasms of the cervix. Be familiar with the screening and diagnostic procedures for cervical cancer in terms of methodology, indications, and utilization. Diseases of Uterine Body Be familiar with endometriosis and adenomyosis in terms definition, incidence, clinical presentation, pathogenesis, morphology and complications. Be familiar with endometrial carcinoma in terms of incidence, risk factors, clinical presentation, epidemiology, pathogenesis, morphology including common types, staging, and prognosis. Be familiar with endometrial hyperplasia and endometrial polyp in terms of etiology, morphologic types, and clinical course of the different types. Be familiar with uterine leiomyomas and leiomyosarcomas in terms of clinical presentation, pathogenesis, morphology clinical course and prognosis. Ovarian Neoplasms Be familiar with ovarian tumors in terms of incidence, risk factors, classification, cell of origin, and general clinical presentation. Be familiar with serous and mucinous surface epithelial origin tumors of the ovary in terms of definition, incidence, different types, morphology, clinical course, prognosis and complications. Be familiar with germ cell tumors of the ovary in terms of incidence classification, general morphology, and clinical course-prognosis. Be familiar with primary sites of the most common metastatic ovarian tumors. Define and be able to discuss the morphology of Krukenberg tumor. Pathology of the Placenta and Pregnancy Related Disorders Be familiar with features of the placenta in terms of development, normal gross and microscopic anatomy, the formation and quantity regulating factors of amniotic fluid and human chorionic gonadotropin (HCG). Be familiar with hydatidiform mole (complete and partial), invasive mole in terms of genetics, incidence, clinical presentation, morphology and clinical course including follow up and complications. Be familiar with choriocarcinoma in terms of incidence, risk factors, clinical presentation, morphology, clinical course and prognosis. Be able to differentiate complete hydatidiform male from partial. Breast Diseases and Mammary Carcinoma 12

Be familiar with fibroadenomas and intraductal papillomas in terms of incidence, clinical presentation, gross morphology, clinical course and complications. Be familiar with female mammary carcinoma in terms of epidemiology, risk factors, incidence, pathogenesis, clinical presentation, histological types, gross morphology, clinical-pathologic diagnosis and clinical course. Be familiar with mammary carcinoma in terms of grading, staging, prognostic indicators and survival rates. Be familiar with the diagnostic procedures of breast cancer including biopsy, intra-operation frozen section, and fine needle aspiration cytology in terms of indications, general interpretive features, sensitivity, specificity and cost-effectivity. The Endocrine System Introduction to Disease of the Endocrine System Understand the main features of the abnormal activity of endocrine system. Disorders of the Pituitary Be familiar with pituitary adenoma in terms of epidemiology, morphology classification, clinical presentation, diagnosis and complications. Be familiar with hyperpituitarism and hypopituitarism in terms of concept, causes and clinical features varying with age, respectively. Disorders of the Thyroid Glands Be familiar with goiter and Graves disease in terms of clinical presentation, pathogenesis, morphology, laboratory diagnosis, clinical course and complications. Be familiar with hyperthyroidism and hypothyroidism in terms of etiology, pathogenesis, clinical presentation and laboratory diagnosis. Be familiar with chronic lymphocytic thyroiditis and subacute granulomatous thyroiditis in terms of pathogenesis, morphology and clinical features. Be familiar with thyroid follicular adenomas, papillary carcinoma, follicular carcinoma, medullary carcinoma in terms of clinical presentation, morphology and clinicopathologic differential diagnosis. Disorders of Adrenal Gland Be familiar with pathogenesis, morphology and clinical features of Cushing syndrome and interpret laboratory procedures used in the diagnosis of Cushing syndrome and Addison disease. Be familiar with morphology, clinical features diagnosis of adrenal adenoma and pheochromocytoma. Diabetes Mellitus Be familiar with the classification system of diabetes mellitus and compare Type I with Type II diabetes mellitus in terms of incidence, clinical presentations, genetics, pathogenesis, islet cell morphology and laboratory diagnosis. Be familiar with the basic morphology of diabetes mellitus and complications due to microangiopathy of different organs, amyloid deposition of different organs, atherosclerosis and its effects on different organs, infectious processes and neuropathies. The Diseases of Nervous System 13

Be familiar with the most common pathological changes encountered in neuropathology. Master the morphological changes and clinical presentations of infectious diseases of central nervous system (viral encephalitis and bacterial meningitis). Be familiar with the morphological changes and clinical presentations of vascular abnormalities (AVM, hemorrhage and infarction). Be familiar with the morphological changes and clinical presentations of the common tumors of CNS. End of the Syllabus 14