00031 - Pathological Anatomy (G)

Learning outcomes

The course aims to provide students with the tools to understand: - the main epidemiological, etiopathogenetic, morphological, phenotypic, and clinicopathological characteristics of the most important non-neoplastic diseases (inflammatory, ischemic, and degenerative) of the following systems: cardiovascular, hemolymphopoietic, respiratory, gastrointestinal, urinary, male genital, female genital, breast, and endocrine, as well as the liver and biliary tract, pancreas, central nervous system, and skin; - the main epidemiological, etiopathogenetic, morphological, phenotypic, molecular, and clinicopathological characteristics of the most important neoplastic diseases of the following systems: cardiovascular, respiratory, gastrointestinal, male genital, female genital, breast, and hemolymphopoietic systems, as well as the liver and biliary tract, pancreas, central nervous system, skin, bone, and soft tissues; At the end of the course, the student will be able to: - correctly decode the diagnosis of these diseases, with a clear understanding of their prognostic and therapeutic significance.

Course contents

 

PATHOLOGICAL ANATOMY


12 credits (6 for each semester – 4th year)


Agreed Single Program for Channels A and B


To learn Pathological Anatomy and Histology, in-depth knowledge of Normal Human Anatomy and Normal Histology and Embryology is required. As Professor Pierre Masson (Montreal, 1968) said, to understand what is different (Pathological Anatomy), one must know the norm. Finally, one cannot understand the specific aspects of diseases without a basic understanding of General Pathology. The topics covered in class are still considered part of the exam.


The course aims to provide students with the tools to understand:


the main epidemiological, etiopathogenetic, anatomopathological, molecular, and clinicopathological characteristics of the most important neoplastic (including the concepts of grading and staging) and non-neoplastic (inflammatory, ischemic, or degenerative) diseases of the following organs and systems: cardiovascular, respiratory, gastrointestinal, liver and biliary tract, pancreas, kidney, urinary tract, male and female genitalia, breast, endocrine system, central nervous system, peripheral nervous system, skeletal muscle, osteoarticular, skin, hematopoietic, and lymphoid systems.
The methods underlying the management of biopsy material (pre-analytical phase) and pathological anatomy diagnostic procedures.
Upon completion of the course, students should be able to:


Correctly decode the diagnosis of these diseases, with a clear understanding of their prognostic and therapeutic significance.
Be able to evaluate the adequacy of the procedure that led to the diagnosis.


COURSE CONTENT


Cardiovascular Diseases


Ischemic Heart Disease.


Pathological features and pathogenesis of: angina pectoris, chronic ischemic heart disease, myocardial infarction and its complications; timing of necrosis in the progression of acute myocardial infarction - methods used for its assessment.


From necrosis to the healing process: description of the progression of infarction; pericarditis during myocardial infarction.


Sudden Death.


Heart valve diseases: pathology and pathogenesis of rheumatic heart disease, aortic stenosis, mitral valve prolapse, infective endocarditis, and nonbacterial thrombotic endocarditis.


Primary myocardial diseases: pathology and pathogenesis of myocarditis and cardiomyopathy, dilated cardiomyopathy, hypertrophic cardiomyopathy, restrictive cardiomyopathy (amyloidosis), and arrhythmogenic cardiomyopathy.


Aneurysms: congenital and acquired (atherosclerotic aneurysm, aortitis, and syphilitic aneurysm).


Aortic dissection.


Respiratory diseases


Obstructive diseases: chronic bronchitis, asthma, emphysema, bronchiectasis.


Acute restrictive diseases: diffuse alveolar damage (adult and childhood respiratory distress syndrome).


Chronic restrictive diseases: classification of the various types of pathological damage in interstitial lung diseases (usual and not otherwise specified interstitial pneumonia).


Pneumoconiosis: pathological changes and differential diagnosis, particularly silicosis and asbestosis.


Hypersensitivity pneumonitis


Granulomatous lung diseases: sarcoidosis and tuberculosis (and their differential diagnosis). Evolution of tuberculosis and systemic tuberculosis.


Smoking-related non-neoplastic lung disease: chronic obstructive pulmonary disease; small airway disease/respiratory bronchiolitis; Langerhans cell histiocytosis.


Idiopathic and non-idiopathic pulmonary fibrosis; the concept of end-stage lung disease (honeycomb lung).

Pulmonary edema.


Pulmonary vascular diseases: thromboembolism, pulmonary infarction and hemorrhage, pulmonary hypertension (primary and secondary).


Pulmonary infections: lobar pneumonia, bronchopneumonia, atypical pneumonia, lung abscess, viral and Pneumocystis carinii infections.


Lung tumors.


Pre-neoplastic lesions. Classification of lung cancers: squamous cell carcinoma, adenocarcinoma, neuroendocrine tumors (carcinoid, atypical carcinoid, large and small cell neuroendocrine carcinoma), mixed forms. Cartilaginous hamartoma.


Diseases and tumors of the nose and oropharynx.


General concepts; in particular: nasal polyps, angiofibroma, inverted papilloma.


Classification of nasopharyngeal and oropharyngeal carcinomas: keratinizing and nonkeratinizing squamous cell carcinomas, NUT carcinoma, lymphoepithelial carcinoma, intestinal and nonintestinal adenocarcinoma, undifferentiated carcinoma, and neuroendocrine neoplasms.


Laryngeal Diseases and Tumors: General Concepts; in particular: vocal cord nodules and polyps, solitary papillomas and papillomatosis. Laryngeal carcinoma and its precursors.


Thymic Diseases


Thymic hyperplasia.


Thymomas (A, AB, B1, B2, B3, C).


Serous disorders (pleura, pericardium, peritoneum)


Inflammation: pleuritis, pericarditis, peritonitis


Tumors: malignant mesothelioma, solitary fibrous tumor, tumor-like lesions, metastases


Salivary gland disorders


Pleomorphic adenoma, Warthin's tumor, acinic carcinoma, mucoepidermoid carcinoma, adenoid cystic carcinoma.


Gastrointestinal tract diseases


Esophageal diseases and tumors: esophagitis, Barrett's esophagus, squamous cell carcinoma, esophageal adenocarcinoma.


Non-neoplastic gastric diseases: gastritis (acute and chronic).


Stomach tumors and tumor-like diseases: gastric polyps, gastric carcinoma; mesenchymal tumors of the gastrointestinal tract, including GIST.


Vascular diseases: ischemic intestinal disease.


Enterocolitis: infectious enterocolitis, viral and bacterial gastroenteritis, necrotizing enterocolitis, pseudomembranous colitis (antibiotic-associated).


Malabsorption syndromes: celiac disease, Whipple's disease.


Idiopathic inflammatory bowel diseases: ulcerative colitis, Crohn's disease.


Gastrointestinal tract neoplasms.


Polyps: hamartomatous polyps, Peutz-Jeghers polyps, hyperplastic polyps, serrated polyps, tubular adenomas, tubulovillous polyps, and villous polyps. Familial polyposis and syndromes: juvenile polyposis, Peutz-Jeghers syndrome, Cronkhite-Canada syndrome, hyperplastic polyposis syndrome, Lynch syndrome, familial adenomatous polyposis (FAP), and Cowden syndrome.


Colon and rectal cancer: epidemiology, etiology, and pathogenesis. Morphological and clinicopathological aspects.


Anal canal neoplasms.


Neuroendocrine neoplasms of the gastrointestinal tract.


Appendix: acute appendicitis, appendiceal mucocele, appendiceal adenoma and adenocarcinoma, pseudomyxoma peritonei, carcinoids.


Liver and biliary tract diseases


Cirrhosis. Liver pathology and pathogenesis. Consequences and pathology affecting other organs.


Viral hepatitis. Etiological agents, pathogenesis, and pathology related to the various clinical syndromes. Fulminant hepatitis, acute hepatitis, chronic hepatitis.


Non-viral liver diseases: alcoholic liver disease, autoimmune hepatitis, drug- and toxin-induced liver disease, hemochromatosis, Wilson's disease, alpha-1 antitrypsin deficiency, neonatal hepatitis.


Intrahepatic bile duct diseases: biliary cirrhosis (primary and secondary), primary sclerosing cholangitis.


Tumors and tumor-like lesions. Hepatic angioma. Pathological features, predisposing factors, and evolution of: focal nodose hyperplasia, hepatocellular adenoma, hepatocellular carcinoma, cholangiocarcinoma.


Metastatic tumors.


Extrahepatic bile duct diseases. Pathological features and pathogenesis of extrahepatic bile duct obstruction; Classification, pathological features, predisposing factors, and evolution of carcinoma of the extrahepatic bile ducts and ampulla of Vater.


Gallbladder: cholecystitis, gallbladder carcinoma.


Pancreatic Diseases


Diseases of the Exocrine Pancreas: acute and chronic pancreatitis.


Tumors of the Exocrine Pancreas. Classification, cystic neoplasms, IPMN (Intraductal Papillary Mucinous Neoplasm), solid pseudopapillary tumor, ductal and acinic cell carcinoma, pancreatoblastoma.


Diseases of the Endocrine Pancreas: tumors of the endocrine pancreas.


Kidney Diseases


Non-neoplastic kidney disease is covered in the Nephrology program.


Renal Tumors in Adults and Pediatrics. Classification. Angiomyolipoma, cystic lesions, oncocytic lesions, clear cell carcinoma, papillary carcinoma, chromophobe carcinoma, Wilms' tumor.


Urinary Tract Diseases


Urothelial Cell Neoplasms: Papilloma, Urothelial Neoplasia of Low Malignant Potential (PUNLMP), Carcinoma in Situ (Flat), Urothelial Carcinoma (Papillary and Non-Papillary). General Characteristics of Uncommon Carcinomas and Mesenchymal Tumors of the Bladder, and Tumors of the Ureter and Urethra.


Male Reproductive System Diseases


Testicular Tumors. Classification and Germ Cell Tumors.


Prostate Diseases and Tumors. Prostatitis, Prostate Glandular and Stromal Hyperplasia, Prostate Cancer (including Grading and Gleason Score).


Breast Diseases


Male Breast: Gynecomastia, Carcinoma.


Female Breast: Mastitis. Cystic Disease and Its Components: Cysts, Apocrine Metaplasia, Fibrosis, Elastosis, Adenosis. Benign proliferative lesions.


Fibroadenoma, phyllodes tumors.


Intraductal papilloma: clinical presentation and relationship with carcinoma.


Breast cancer: epidemiology and prevention.


Non-invasive carcinoma (in situ), in its various morphological variants.


Invasive carcinoma (infiltrating) in its main forms (ductal carcinoma and lobular carcinoma).


Predictive factors (significance of estrogen, progestin, and androgen receptor determination; molecular pathology in breast cancer typing) and prognostic factors (TNM) of breast cancer.


Paget's carcinoma of the breast.


Notes on less common breast cancers.


Juvenile breast cancer: general aspects and criteria for early diagnosis.


Female Reproductive System Diseases


Pathology of the uterine cervix, vagina, and vulva: preinvasive and invasive neoplastic lesions.


Pathology of the uterine corpus.


Benign lesions: dysfunctional endometrium, endometrial polyps, endometriosis, and adenomyosis.


Preneoplastic and neoplastic lesions: endometrial hyperplasia; endometrioid intraepithelial neoplasia (EIN); classification of endometrial carcinoma.


Mesenchymal tumors, benign and malignant: leiomyoma, leiomyosarcoma, stromal sarcoma.


Ovarian tumors and cysts: benign ovarian cysts; benign, borderline, and malignant epithelial tumors; stromal and sex cord tumors (germ cell tumors are discussed in connection with the testis).


Endocrine System Diseases


General concepts, including notes on hypothalamic pathology


Pituitary gland: pituitary adenomas, craniopharyngioma


Thyroid.


Hyperthyroidism and hypothyroidism and their association with diffuse and multinodular hyperplasia: Graves' disease, multinodular goiter.


Thyroiditis: Hashimoto's disease, subacute (granulomatous or De Quervain's disease), Riedel's disease.


Thyroid neoplasms: classification and differential diagnosis between benign and malignant lesions. Papillary (papillary) carcinoma, follicular adenoma and carcinoma, poorly differentiated carcinoma, anaplastic carcinoma, medullary carcinoma (sporadic and familial). Notes on uncommon forms of thyroid neoplasms.


Parathyroid gland: hyperplasia, adenoma, and carcinoma of the parathyroid glands.


Adrenal cortex. Hyperfunction and insufficiency, their pathological basis. Adrenal cortical neoplasms.


Adrenal medulla and paraganglia. Pheochromocytoma/paraganglioma, neuroblastoma, ganglioneuroma


MEN syndromes.


Skin diseases


Epithelial tumors: benign and precancerous epithelial lesions (seborrheic keratosis, actinic keratosis, Bowen's disease). Warts. Malignant epithelial tumors: squamous cell carcinoma, basal cell carcinoma.


Melanocytic tumors and lesions: melanocytic nevus (junctional, intradermal, compound), dysplastic nevus, malignant melanoma. Histological features with prognostic significance of malignant melanoma (melanoma in situ, superficial spreading melanoma, nodular melanoma, Clark levels, Breslow thickness).


Bone Pathology


Tumors. General concepts and classification. Osteochondroma, osteosarcoma, chondrosarcoma, Ewing's sarcoma.


Soft Tissue Pathology


Tumors. General concepts and classification. Lipoma and liposarcomas, leiomyosarcoma, rhabdomyosarcoma, synovial sarcoma.


Central Nervous System Diseases


Basics of Neuropathology: Basic neuropathological changes and correlations with clinical and radiological findings.


Cerebral edema.


Hydrocephalus.


Trauma and traumatic vascular injuries (epi- and subdural hematoma).


Vascular diseases: hypoxic-ischemic encephalopathy, cerebral infarction, intracranial hemorrhage, primary intraparenchymal hemorrhages, saccular aneurysms and subarachnoid hemorrhage, vascular malformations.


Meningoencephalic infections: epidural and subdural infections, meningitis (acute, chronic, lymphocytic). Parenchymal infections (general concepts of encephalitis), abscesses.


Tumors. Classification (histopathological and molecular). Glial tumors in adults and children, medulloblastoma, ependymoma, meningioma. Metastatic tumors.


Degenerative and Demyelinating Diseases: Multiple Sclerosis, Alzheimer's Disease, Spongiform Encephalopathies, Amyotrophic Lateral Sclerosis, Leukodystrophies.


Diseases of the Hematopoietic and Lymphoid System


Classification and classification of malignant lymphomas: Hodgkin's lymphoma, major B-cell-derived non-Hodgkin's lymphomas (chronic lymphocytic leukemia, follicular lymphoma, marginal lymphoma, mantle cell lymphoma, diffuse large B-cell lymphoma, Burkitt's lymphoma), and peripheral T-cell lymphomas.


Lymphadenitis (including HIV infection and AIDS).

Readings/Bibliography

Robbins and Cotran: The Pathological Basis of Disease (or equivalent textbook).

Teaching methods

Frontal lessons.

Assessment methods

Oral exam. Each student is examined by at least two different examiners. Typically, no fewer than three questions are asked by two different examiners. To pass the exam, the student must answer all questions adequately. The final grade is based on the examiners' overall assessment of the student's demonstrated ability to know, understand, and present the specific topics covered in the exam in a concise and complete manner.


Final grades will be assigned based on the following criteria:


-Exceptional 30/30L: Complete, consolidated, and unambiguous preparation on the topics covered in the integrated course. Ability to quickly understand the topic. Ability to independently analyze and connect different topics. Concepts are presented in appropriate sequence and the student demonstrates full command of the specific language, with some original elaboration.


-Excellent 29-30/30: Complete, consolidated, and unambiguous preparation on the topics covered in the course. Ability to quickly understand the topic. Ability to independently analyze and connect different topics. Concepts presented in the correct sequence and full command of the specific language.


-Very good 27-28/30: Excellent preparation, but with significant inaccuracies that compromise the achievement of a full score. Ability to analyze and connect independently. Concepts presented in the correct sequence and with appropriate language.


-Good 23-26/30: Good preparation, but with significant inaccuracies in the presentation. Ability to analyze and connect after the instructor's input. Concepts presented in the correct sequence and with appropriate language.


-Sufficient 18-22/30: Knowledge limited to basic concepts without serious gaps, only after the instructor's input. Concepts presented and language generally acceptable.


-Insufficient <18/30: Lack of preparation. Serious and repeated conceptual errors.

Teaching tools

The teaching materials presented in class are available to students online through the websites designated by the University of Bologna. Access is reserved for students enrolled in the Medicine and Surgery program at the University of Bologna.

Office hours

See the website of Pier Paolo Piccaluga