RADIOGRAPHIC PATHOLOGY
Dec 18, 2015
COURSE OUTCOMESAt 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•Hypertrophy Hyperplasia•Atrophy Metaplasia
•The relationship between clinical manifestations and pathologic changes
How to study pathology?
•The core for studying pathology:
Characteristic morphologic lesions
Clinical manifestations
PathogenesisEtiology
FunctionalChanges(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
EpidemiologyIs 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
CongenitalPresent at birthGenetic or
environmental factor Example:
Down syndromeNormal – 22pairs of
autosomes + xyExtra chromosome
HereditaryDevelopmental disorderAbnormal genesExamples: Haemophilia
Sex-linked inheritanceDominance / recessive
Inflammatory DiseaseResults from the body’s reaction to a
localized injurious agent.
•Types of inflammatory disease:▫Toxic▫Infective▫Allergic▫Autoimmune
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
InfectionIs 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
HEATREDNESSTENDERNESSSWELLINGPAIN
REPAIRFibrosisCalcification
Metaplasia
MacrophagesEnzymePlasma proteinLipid mediatorsCytokinesGrowth factor
(Fikri, 2004)
Degenerative Disease
•Are caused by a deterioration of the body usually associated with aging.
•Although some degenerative diseases affect younger patients
DegenerativeCell deteriorationAging, traumaExamples
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 DiseaseDisturbance of
normal physiological function
Endocrine disorderHypersecretionOveractivity (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 forceDisruption in normal contourBruise/bleeding/contusion/
deathReparative process
▫ Cell growth/differentiation▫ (fibroblast migration)▫ (Deposition of extracellular
matrix▫ Angiogenesis▫ remodelling
Neoplastic DiseaseNew 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
MetastasisSpread 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 DifferentiationIs 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 CancerIs 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 cancer1. 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
Congestion hypertrophy morbiditynecrosis Dysplasia Edema Empyema in situEndogenous invasionExogenous ischemiaExudate FrequencyHyperplasia metaplasia
Pathology related to the head
Injuries:Concussion
ContusionFractures
Neoplastic:GliomasPutuitary adenomasMetastases
Congenital:Hydrocephalus
Cardiovascular:Cerebrovascular accident (CVA)
HaemorrhageAneurysm
Pathology related to the thorax
Related to heart congenital / hereditary:
Patent ductus arteriosusSeptal defectTetralogy of Fallot
Related to heart inflamatory / metabolic:
Rheumatic heart diseaseCongestive heart failure
Related to lungs trauma:
AtelactasisPneumothorax
Related to lungs inflamatory:Pneumonias
BronchiectasisPneumoconiosis
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 carcinomaCervical carcinoma
Related to testes:CryptorchidismTesticular carcinoma
Related to urinary bladder:Carcinoma Related to
prostate:Benign prostatic
hypertrophyProstatic carcinoma
Related to ovaries:
Ovarian cystsOvarian
carcinoma