RADIOGRAPHIC PATHOLOGY

COURSE OUTCOMES At the end of the course, you should be able to: Define the basic terms related to pathology. (PLO1, C1) Describe processes and causes of tissue disruption, including the repair and healing process. (PLO1, C2) Describe various systemic classifications of disease in terms of etiology, pathophysiology, types, common sites, pathogenesis, manifestations, complications, prognosis and their relevance to radiologic procedures of common pathological conditions of the musculoskeletal system, the respiratory, digestive, urinary, reproductive, circulatory, central nervous and endocrine systems. (PLO1, C2) Describe the radiographic appearances of frequently occurring pathologies affecting the body systems. (PLO1, C2)

How to study pathology? The difficulties Medical terms and nomenclatures For example HypertrophyHyperplasia Atrophy Metaplasia The relationship between clinical manifestations and pathologic changes

How to study pathology? The core for studying pathology: Characteristic morphologic lesions Clinical manifestations Pathogenesis Etiology Functional Changes (Pathophysiology)

How to study pathology? Background: Basic medical sciences (anatomy, histology, physiology, biochemistry, immunology, microbiology, parasitology,etc) Medical terms (e.g. hyperplasia, etc) Clinical knowledge (physical examination, laboratory tests, X-ray, CT, etc)

Introduction: To patient: ▫disease = discomfort, dis- ease, dis- harmony with his environment To the physician or surgeon: ▫disease = variety of symptoms and signs To the radiologist: ▫disease = one or more anatomical, physiological and/or structural changes(lesions).

Pathologic terms: Pathology - define as study of disease Disease - body’s response to some type of injury

Pathologic terms: Disease process - any abnormal change that may take place in the body Etiology - the study of disease causes

Pathologic terms: Pathogenesis - the sequence of events that leads to the development of disease or made the disease apparent Manifestations - observed changes

Pathologic terms: Symptoms - abnormality perceived by patient, changes that are perceived by the patient in the form of complaints by patient eg, nausea, headache, ache, pain Signs - observable manifestation, visual abnormal changes in the patient that may be interpreted by doctors eg, swelling, discoloration, changes in tissue texture, distortion

Pathologic terms: Lesion - structural change that is abnormal that is the result of trauma or disease ▫ Presence of lesions can distinguish:  organic or structural disease  functional or physiological disease

Pathologic terms: Structural or organic disease - involves physical and biochemical changes within the cells eg. hereditary disorders, inflammatory disorders, physical injury or trauma, neoplasms or tumors

Pathologic terms: Functional or physiological disease - any disease that presents no lesion eg. mental illness, spastic colon, headaches due to tension or psychosomatic causes

Pathologic terms: Distribution of disease within a body Local = confined to one region of the body. Systemic = More widespread. Distribution of disease within an organ Focal = damage is limited to one or a few sites. Diffuse = damage is uniformly distributed.

Pathologic terms: Length of time over which the disease is occur: Acute = quick onset, last a short period of time Chronic = slow onset & last a very long time Terms refer to the identification & outcome of the disease: Diagnosis = name of a disease an individual is believed to have Prognosis = outcome of the disease

Types of Manifestations Symptoms: ▫Complaints offered by the patients.  Headaches, nausea, aches and pains Signs: ▫ Abnormal changes as observed by a physician  Can be acquired by touch, smell, tests or visual inspection  Includes fever, swelling, discoloration and rash.

Etiology Is the study of the cause of a disease. Common agents: ▫Viruses ▫ Bacteria ▫Trauma ▫ Heat, ▫Poor infection control

Iatrogenic Disease Adverse responses induced in a patient by a physicians manner, activity or therapy. Ex: A collapsed lobe of the lung that occurred due to a complication during an arterial line placement. *Idiopathic disease?

Acute vs. Chronic Acute disease ▫Quick onset ▫Lasts a short period of time  Ex. Pneumonia Chronic ▫Presents more slowly ▫Lasts a long time  Ex. Multiple Sclerosis

Identification and Outcome Diagnosis ▫Is the name of the disease an individual is believed to have Prognosis ▫The prediction of the course and outcome of the disease

Technique Considerations Decrease technique ▫In diseases that are destructive ▫Decreasing tissue density ▫Subtractive or lytic changes Increase technique ▫In diseases that increase tissue density ▫Additive or sclerotic changes

Epidemiology Is the investigation of diseases in large groups. Prevalence is the number of cases in a given population Incidence is the number of new cases in a given time period Endemic are diseases in high prevalence in a certain area Epidemic - ?? Pandemic - ??

Disease Classifications Congenital and Hereditary Inflammatory Degenerative Metabolic Traumatic Neoplastic

Congenital and Hereditary Congenital are present at birth and result from genetic or environmental factors ▫2-3% of all live births have one or more congenital disease Hereditary are developmental disorders genetically transmitted from either parent

Congenital  Present at birth  Genetic or environmental factor  Example:  Down syndrome  Normal – 22pairs of autosomes + xy  Extra chromosome

Hereditary  Developmental disorder  Abnormal genes  Examples: Haemophilia  Sex-linked inheritance  Dominance / recessive

Inflammatory Disease Results from the body’s reaction to a localized injurious agent. Types of inflammatory disease: ▫Toxic ▫Infective ▫Allergic ▫Autoimmune

Inflammatory  Reaction to injury  Infection  Allergy  Poisoning  Autoimmune disorder  Acute/chronic

Acute Local Inflammatory Disease Characteristics: ▫Heat ▫Redness ▫Swelling ▫Pain ▫Loss of function Capillary dilatation Cellular necrosis

Chronic Inflammatory Disease More commonly it does not result in cell death Lasts for extensive periods of time

Repair from Inflammatory Disease (Healing process) The repair of tissues is the body’s attempt to return the body to normal. Tissue regeneration – new tissue (identical to those replaced tissue) Fibrous connective tissue repair – alternative to regeneration; leave scars / fibrosis Debridement – remove dead cells (can be remove by surgery) Remodeling – last phase; response to normal use of tissue

Infection Is an inflammatory process caused by a disease causing organism. It invades, multiplies and causes injury. Generally localized infections causes inflammation Virulence – ability of pathogen to cause a disease ▫High virulence ▫Low virulence

CELL DEATH INJURY Acute Chronic INFLAMMATION INFLAMMATORY MEDIATORS HEAT REDNESS TENDERNESS SWELLING PAIN REPAIR Fibrosis Calcification Metaplasia Macrophages Enzyme Plasma protein Lipid mediators Cytokines Growth factor (Fikri, 2004)

Degenerative Disease Are caused by a deterioration of the body usually associated with aging. Although some degenerative diseases affect younger patients

Degenerative  Cell deterioration  Aging, trauma  Examples  Osteoporosis  Artherosclerosis  Osteoarthritis  Cell number reduced (hypoplasia)  Hypofunction

Metabolic Disease Diseases caused by a disturbance of the normal physiologic function of the body. Metabolism is the sum of all physical and chemical processes of the body. Includes endocrine disorders and imbalance of fluid and electrolytes.

Metabolic Disease  Disturbance of normal physiological function  Endocrine disorder  Hypersecretion  Overactivity (tumor)  Hyposecretion

Endocrine System The major glands are: pituitary, thyroid, parathyroids, adrenal glands, pancreatic islets, ovaries and testes. A disorder can be caused from ▫Hypersecretion ▫Insufficient secretion

Fluid and Electrolyte Imbalance Dehydration is the most common fluid imbalance ▫Caused by lack of water ▫Excessive loss of water Electrolytes are mineral salts ▫Potassium and sodium Depletion of electrolytes is caused by: ▫Vomiting, diarrhea, and diuretics

Traumatic Disease Diseases as a result of a mechanical force ▫Crushing ▫Twisting ▫Radiation ▫Extreme temperatures (hot or cold) Can involve ▫Bone ▫Soft tissue ▫Skin ▫Capillaries

Traumatic  Mechanical forces  Effect of radiation  Environmental factors  Burn/frosbite Mechanical force Disruption in normal contour Bruise/bleeding/contusion/death Reparative process ▫Cell growth/differentiation ▫(fibroblast migration) ▫(Deposition of extracellular matrix ▫Angiogenesis ▫remodelling

Neoplastic Disease New or abnormal tissue growth. Uncontrollable growth Neoplasm ▫Benign: remain localized and non-invasive ▫Malignant: continue to grow, spread and invade other tissues

Neoplastic  Abnormal tissue growth  Benign/malignant  Effect of injury & repair  Congenital: Mitosis – cell separate the chromosomes in its cell nucleus into 2 identical sets nuclei Growth rate Neoplasm

Metastasis Spread of malignant cancer. Cancer is the general term to denote malignant neoplasms. Ways of metastasis ▫Hematogenous ▫Lymphatic ▫Invasion ▫Seeding

Staging of Cancer TNM system adopted in 1950’s is the standard ▫American Joint Committee on Cancer ▫American Cancer Society ▫American College of Radiology Staging is the evaluation of the extent of cancer based on clinical findings Treatment protocol is based on these findings Provides indication of prognosis

TNM Staging T: size of the tumor ▫Untreated primary cancer or tumor N: Regional lymph node involvement M: Presence or absence of distant metastasis Numerical staging is usually designated ▫T1 - T4 ▫N1 - N4 ▫M1 – M4

Cell Differentiation Is a process in which cells mature into a functional and structurally specialized cell. Differentiated tumor cells ▫Resemble normal cells ▫Grow and spread a slow rate Undifferentiated or poorly differentiated ▫Lack structure and function of normal cells ▫Grow uncontrollably

Grading of Cancer Is an attempt to estimate the degree of malignancy of a neoplasm. Classified into 4 grades ▫Grade I ▫Grade II ▫Grade III ▫Grade IV

Type of cancer 1.Carcinoma = derived from epithelial tissues 2.Sarcoma = arises from connective tissues 3.Leukemia = arise from blood cells 4.Lymphoma = arise from lymphatic cells

Tumor word roots based on tissues type: Common word root:Cells of origin: Adeno-Gland Angio-Vascular Chondro-Cartilage Fibro-Fibrous tissue Hemangio-Blood vessels Lipo-Adipose Myo-Muscle Neuro-Nerve Osteo-Bone

RELATED TERMINOLOGY Congestionhypertrophymorbidity necrosis Dysplasia Edema Empyema in situ Endogenousinvasion Exogenousischemia ExudateFrequency Hyperplasiametaplasia

Pathology related to the head Injuries: Concussion Contusion Fractures Neoplastic: Gliomas Putuitary adenomas Metastases Congenital: Hydrocephalus Cardiovascular: Cerebrovascular accident (CVA) Haemorrhage Aneurysm

Pathology related to the thorax Related to heart congenital / hereditary: Patent ductus arteriosus Septal defect Tetralogy of Fallot Related to heart inflamatory / metabolic: Rheumatic heart disease Congestive heart failure Related to lungs trauma: Atelactasis Pneumothorax Related to lungs inflamatory: Pneumonias Bronchiectasis Pneumoconiosis COPD Related to lungs neoplasia: Bronchogenic carcinoma Metastases

Pathology related to the abdomen Related to GI tract congenital / hereditary: Hypertrophic pyloric stenosis, Intussuception Related to hepatobiliary system congenital / hereditary: Cystic fibrosis Related to GI tract inflamatory / metabolic: Peptic ulcers, Gastritis Regional entritis Ulcerative colitis Diverticulitis Related to hepatobiliary system neoplasia: Pancreatic carcinoma Metastases Related to kidneys inflamatory / metabolic: Acute pyelonephritis, Acute glomerulonephritis Renal calculi Related to kidneys neoplasia: Renal cysts, kidney adenocarcinoma Related to kidneys congenital / hereditary: Polycystic kidney disease, position anolamies Related to hepatobiliary system inflamatory / metabolic: Cholelithiasis, cholecystitis, pancreatitis, cirrhosis, hepatitis, jaundice. Related to GI tract neoplasia: Adenocarcinoma of the stomach Adenocarcinoma of the colon

Pathology related to the pelvis Related to uterus: Endometriosis, Leiomyoma Uterine carcinoma Cervical carcinoma Related to testes: Cryptorchidism Testicular carcinoma Related to urinary bladder: Carcinoma Related to prostate: Benign prostatic hypertrophy Prostatic carcinoma Related to ovaries: Ovarian cysts Ovarian carcinoma