GENERAL PATHOLOGY C603 INTRODUCTION Course Directors Ashley Inman, M.D. ashinman@iupui.edu Phone: 274-1690 Thomas E. Davis, M.D., Ph.D. thdavis@iupui.edu Page: 312-7297

Pathology C603 Academic Coordinator Jennifer Deppen 274-2476 Med Sci Room 128 jdeppen@iupui.edu

Course Syllabus

Course Learning Objectives At the successful completion of our course, students will: Explain the pathophysiologic basis of general cellular and tissue responses to disease processes. Describe the pathophysiologic changes which occur in different disease process associated with a given organ system. Recognize gross and histologic tissue changes associated with general types of disease processes. Correlate gross and microscopic tissue changes that accompany different disease processes. Correlate pathophysiologic changes with diagnostic and therapeutic approaches to different disease processes.

RESOURCES FOR C603 Robbins Pathologic Basis of Disease 9th edition (2014) with website (www.expertconsult.com) General Pathology C603 lab manual Robbins Review of Pathology (Practice questions) 3rd edition (2009) Gross specimens and microscopic slides in lab plus practice quizzes

Robbins Pathologic Basis of Disease 9th Edition

Robbins Pathologic Basis of Disease 9th Edition

ONCOURSE RESOURCES FOR C603 Lecture and lab schedules Digital copy of lab manual w/ links to gross images, microscopic images, and digital slides IUSM Virtual Microscopy site QBank Lab clinical case powerpoints

GRADING POLICY Honors: Top 10-20% High Pass: Top 51-79% Pass: At least 75% of the top score Fail: Less than 75% of the top point-score in the class

EXAMS IN C603 1st Lecture Exam: 200 points 2nd Lecture Exam: 200 points Final Lecture Exam: 300 points 1st Lab Exam: 100 points 2nd Lab Exam: 100 points Final Lab Exam: 100 points Total Points in Course: 1000 points

EXAM FORMAT Lecture Exams: Lab Exams: Written exam Computer exams with randomization of questions and answer choices Multiple choice Lab Exams: Written exam Includes gross specimens, images, and glass slides Some of which you may not have seen before, but you should be able to apply your knowledge and observations to arrive at the correct answer

EXAM CONTENTS ALL examinations are CUMULATIVE Lecture material is fair game on lab exams and vice versa Some questions similar to or identical to review book questions Will be expected to integrate material: Pathology Lab data (chemistry, hematology) Clinical presentation Signs (what the doc sees); symptoms (what the patient feels and expresses) Radiology

LABORATORY MS 102, 104, 106 Group assignments in lab manual and posted outside of lab Monday/Wednesday or Tuesday/Thursday rotation 1:00-3:00 PM Attendance is mandatory

In C603 and in Your Medical Practice 1. You cannot possibly know everything 2. However, you are responsible for everything

If you understand the gross and microscopic pathology, then you can…. Recognize and diagnose the disease OR order the correct tests Treat the patient; sometimes that is being able to provide a prognosis to the patient and their family Ideally, you can prevent the pathology (disease)

Learning Objectives for Lecture 1 1. List examples of gross pathology associated with changes in: size, color, shape, consistency, and location 2. Describe gross and microscopic changes associated with accumulation of amyloid and iron 3. Diagram and label the gross patterns of tissue necrosis: coagulative necrosis, liquefactive necrosis, caseous necrosis, fat necrosis, and gangrenous necrosis

GROSS OBSERVATIONS Size Shape Color Consistency/texture Location

SIZE Increased: Decreased: HYPERTROPHY: increase in cell size (no new cells; just bigger cells) HYPERPLASIA: increase in cell number Decreased: ATROPHY: once normal, now smaller HYPOPLASIA: never normal in size (developmental disorder) Accumulations of material may also increase the overall size of the organ AMYLOIDOSIS Fat

Hypertension Infarction

Hypertrophic Left Ventricle

Normal and Hyperplastic Adrenal Glands

Hypertrophy of Uterus During Pregnancy

Hypertrophy of Uterus During Pregnancy

Atrophy of Kidney

AMYLOIDOSIS causes heart and renal failure Gross – organ enlarged; waxy appearance; firm Micro - pink, fluffy extracellular (protein) material in tissue stained with H&E Congo Red Stain- orange on light microscopy and Apple-green birefringence when polarized Beta-Pleated Sheet by x-ray diffraction

Examples of Amyloid Disease Multiple myeloma Dialysis patients Inflammation Medullary CA Type of Amyloid Lambda or kappa B-2 microglobulin SAA Procalcitonin

LIVER WITH AMYLOIDOSIS

Congo Red (Lt. Microscope) Congo Red polarized H&E Stain (Lt. Microscope)

SHAPE Shape of lesions may indicate the pathologic process Infarcts are wedge-shaped (arterial blood vessels distribute in an inverted “tree-like” fashion)

Spleen Infarction

COLOR Organs may acquire color or lose their natural color FAT = yellow BILE = green MELANIN = black-brown SCAR = white-tan IRON = rust CARBON = black

When liver accumulates FAT (as in alcoholism) it becomes enlarged and pale to yellow-orange in color Normal liver color (unfixed specimen) Fatty liver (unfixed specimen)

When a SCAR forms in the myocardium of the heart (post MI), the color changes from red/tan to gray/white Old infarct (scar)

Melanoma

Lung with Anthracosis

CONSISTENCY Organs become stiff, hard, soft, waxy or greasy in disease Alcoholism and hepatitis cause extensive fibrosis (cirrhosis/scar tissue) in the liver and the liver is pale, shrunken and firm with round NODULES (firm, circumscribed areas) Tumors are often firmer than the surrounding tissue Calcification within tissues often has a “gritty” texture when cut

LOCATION Some pathologic processes occur in specific locations (organ specific, tissue specific) FAT NECROSIS occurs in the pancreas (enzymatic fat necrosis) and breast (traumatic fat necrosis) Splenic infarctions tend to be subcapsular Also, tumors in the cortex of the kidney are usually glandular in origin (adenocarcinoma)

Fat necrosis in the pancreas

Renal Cell Carcinoma in Kidney Cortex

LOCATION (2) CYST- fluid-filled sac; kidney, ovary BULLA- fluid-filled sac in the lung or skin Uterus- LEIOMYOMAS in the myometrium METASTASES- multiple nodules of tumor

Cysts

Bullae in Skin

Bullae in Lung

Bullae in Lung

Leiomyoma in Uterus

Liver Metastases

Gross Observation in Liver Disease Size: Larger = fatty change; amyloidosis Shape: Cirrhosis = nodular Color: Bile = green Rust = hemochromatosis Yellow = fat; jaundice Consistency/Texture: Firm = fibrosis/cirrhosis; tumors Soft = abscess

Icteric Sclera

Cirrhosis or Fibrosis of the Liver

Liver shows cirrhosis and bile stasis (green color)

Liver Hemochromatosis

HEMOCHROMATOSIS Genetic Secondary A. Iron overload due to transfusions for anemias B. Increased oral intake (rare)

TYPES OF NECROSIS COAGULATIVE LIQUEFACTIVE CASEATION FAT (ENZYMATIC or TRAUMATIC) GANGRENOUS FIBRINOID Infarcts Abscess TB Granuloma Pancreas and Breast Lower extremities or bowel Immune-mediated vascular damage

Coagulative Necrosis After Myocardial Infarction

Living heart muscle MI and acute Inflammation

Liquefactive Necrosis in Brain Brain Abscess

Abscess or “pus pocket”

Caseous Necrosis (tuberculosis)

Granuloma with Central Necrosis

Enzymatic Fat Necrosis in Pancreas

Viable pancreas below and Fat Necrosis above

Gangrenous Necrosis

MICROSCOPIC OBSERVATIONS Can often use same principles as gross observations Size Shape Color Location Will discuss more during lab 2 (Wednesday and Thursday)