00031 - Pathological Anatomy (AK-D)

Course Unit Page

SDGs

This teaching activity contributes to the achievement of the Sustainable Development Goals of the UN 2030 Agenda.

Quality education

Academic Year 2020/2021

Learning outcomes

LEARNING OUTCOMES

Full knowledge of normal anatomy, histology and embriology are necessary to understand Anatomic Pathology. As Professor Pierre Masson (Montreal, 1968) used to say to understand what is different (Anatomic Pathology) you first need to know the norm. One can not understand specific organ systems disorders if the knowledge of General Pathology is missing. Knowledge of immunology and genetics are also important to understand Anatomic Pathology. Topics discussed during lectures represent an integral part of the program and are the subject of evaluation during exams, including knowledge of tissue fixation and of pathology reporting (biopsies, surgical specimens, autopsies).

Objective of the course is to supply the student with the intellectual tools to understand:

  • The principal epidemiologic, morphologic, phenotypic, clinicopathologic features, as well as the main mechanisms in the etiopathogenesis of the most important neoplasms (including the concepts of grading and staging), and of the most important non neoplastic disorders, of the following organs and systems: cardiovascular, respiratory, gastrointestinal, liver and biliary system, pancreas, kidney, urinary tract, male and female reproductive systems, breast, endocrine system, central and peripheral nervous systems, musculoskeletal and osteoarticular systems, skin, hematopoietic and lymphoid systems.
  • The methods necessary for the processing of tissue samples and for the diagnostic procedures of Anatomic Pathology.

The student at the end of the course should be able to:

  • Correctly interpret the diagnoses of the pathologic conditions mentioned above, with a clear understanding of their value for the definition of patient prognosis and treatment.
  • Be able to appreciate the adequacy of the procedures that have lead to the diagnosis.

Course contents

ANATOMIC PATHOLOGY

12 cfu (6 per Semester – IV year Medical School)

Program for Tracks A e B

COURSE CONTENTS

Cardiovascular Diseases

Congenital heart diseases: principal alterations.

Ischemic heart disease: pathogenesis and morphological features of angina pectoris, chronic ischemic heart disease, myocardial infarction (timing of the progression of ischemic necrosis in myocardial infarction: evaluation methods).

From necrosis to regeneration: evolution of morphologic changes in myocardial infarction.

Pericarditis associated with myocardial infarction.

Myocardial rupture: timing and morphology.

Cardiogenic shock (pump failure): principal alterations, including scarring of necrotic myocardium and its features, post-ischemic ventricular aneurysm, cerebral complications of myocardial infarction.

Sudden cardiac death.

Valvular heart disease: morphology and pathogenesis of rheumatic heart disease, aortic stenosis, mitral valve prolapse, infective endocarditis, non-bacterial thrombotic endocarditis.

Myocardial diseases: pathogenesis and morphological features of myocarditis and cardiomyopathies, dilated cardiomyopathy, hypertrophic cardiomyopathy, restrictive cardiomyopathy (amyloidosis) and arrhythmogenic cardiomyopathy.

Pericardial disease: pathogenesis and morphological features of pericarditis and pericardial effusions.

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

Aortic dissection.

Diseases of the respiratory sysetm
Obstructive pulmonary diseases: chronic bronchitis, emphysema, asthma, bronchiectasis.
Acute restrictive diseases: diffuse alveolar damage (respiratory distress syndrome of adult and infant).

Chronic restrictive diseases: classification of various types of histological patterns in interstitial lung disease (usual interstitial pneumonia, nonspecific interstitial pneumonia).

Pneumoconioses: pathological findings and differential diagnosis, in particular silicosis and asbestosis.
Hypersensitivity pneumonia

Granulomatous lung diseases: sarcoidosis and tuberculosis (and their differential diagnosis). Evolution of tuberculosis and systemic tuberculosis.
Non-neoplastic smoke-related lung disease: chronic obstructive pulmonary disease, small airways disease/respiratory bronchiolitis, Langerhans cell histiocytosis of the lung.

Pulmonary fibrosis idiopathic and not idiopathic; end-stage lung disease ('honeycomb lung’).
Pulmonary edema.
Vascular disorders of the lung: thromboembolism, pulmonary infarction and hemorrhage, pulmonary hypertension (primary and secondary).

Lung infections: lobar pneumonia, bronchopneumonia, atypical pneumonia, lung abscess, viral and Pneumocistis carinii infections.
Lung tumors.
Pre-invasive lesions. Classification of lung carcinomas: squamous carcinoma, adenocarcinoma, neuroendocrine tumors (carcinoid, atypical carcinoid, large cell neuroendocrine carcinoma, small cell neuroendocrine carcinoma), mixed forms. Pulmonary chondroid hamartoma.
Pleural lesions: pleuritis, pleural plaque, pleural tumors (solitary fibrous tumors, malignant mesothelioma, metastatic tumors).

Diseases and tumors of the naso-pharyngeal region.

General features; specifically: nasal polyps, nasopharyngeal angiofibroma, sinonasal inverted papilloma. Classification of naso- and oropharyngeal carcinoma: keratinizing and non-keratinizing squamous carcinomas, NUT carcinoma, lymphoepithelial carcinoma, adenocarcinoma intestinal type and non-intestinal type, undifferentiated carcinoma, neoplasms with neuroendocrine differentiation.

Diseases and tumors of the larynx: general features; specifically: nodules and polyps of the vocal cords; solitary papilloma and papillomatosis. Laryngeal carcinoma and precursor lesions.

Diseases of the Thymus

Thymic hyperplasia.

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

Salivary gland pathology

Pleomorphic adenoma, Warthin tumor; acinic cell carcinoma; mucoepidermoid carcinoma; adenoid-cystic carcinoma.

Diseases of the Gastro-Intestinal system

Diseases and tumors of the esophagus: esophagitis, Barrett's esophagus, squamous carcinoma and adenocarcinoma of the esophagus.

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

Tumor and tumorlike conditions of the stomach: gastric polyps, gastric carcinoma; mesenchymal tumors of the gastro-intestinal tract including GIST.

Vascular disorders: ischemic colitis and enteritis.

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

Malabsorption syndromes: celiac disease and Whipple's disease.

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

Neoplasms of the gastro-intestinal tract.

Polyps: hamartomatous polyps, polyps in Peutz–Jeghers syndrome, hyperplastic and serrated polyps, tubular adenomas, tubulo-villous and villous adenomas.

Poliposis in familial syndromes: juvenile polyposis, Peutz-Jeghers syndrome, Cronkhite-Canada syndrome, hyperplastic polyposis syndrome, Lynch syndrome, familial adenomatous polyposis (FAP), Cowden syndrome.

Colorectal carcinoma: epidemiology, etiology and pathogenesis. Pathology and clinicopathologic features.

Neoplasms of the anal canal.

Neuroedocrine gastro-intestinal tumors.

Vermiform appendix: acute appendicitis, mucocele, adenoma and adenocarcinoma of the appendix, pseudomyxoma peritonei, appendiceal carcinoid tumor.

Diseases of the Liver and Biliary system

Cirrhosis. Liver pathology and pathogenesis. Pathology of systemic complications.

Viral hepatitis. Etiology, pathogenesis and pathology in the different clinical syndromes. Fulminant hepatitis, acute hepatitis, chronic hepatitis.

Liver diseases not related to viral infection: alcoholic liver disease, autoimmune hepatitis, drug and toxin related hepatitis, hemochromatosis, Wilson's disease, alpha-1 antitrypsin liver disease, neonatal hepatitis.

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

Tumors and tumorlike conditions. Hepatic angioma. Pathology, predisposinig conditions and evolution of: focal nodular hyperplasia, hepatocellular adenoma, hepatocellular carcinoma, cholagiocarcinoma.

Metastatic tumors.

Extrahepatic biliary diseases. Pathology and pathogenesis of extrahepatic biliary tract obstruction; classification, pathology, predisposinig conditions and evolution of extrahepatic cholangiocarcinoma and of carcinoma of the ampulla of Vater.

Gallbladder: cholecystitis, carcinoma of the gallbladder.

Diseases of the Pancreas

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 acinar carcinomas, pancreatoblastoma.

Diseases of the endocrine pancreas: pancreatic neuroendocrine tumors.

Diseases of the Kidney

Renal pathophysiology: the podocyte, the epithelial and non-epithelial cells of the renal parenchyma and their role in the development of renal failure.

Renal biopsy. Indications, preservation of the specimen, criteria to evaluate its adequacy; mandatory techniques for a consistent diagnosis.

Histopathological diagnosis in glomerular pathology: IgA nepropathy, focal segmental glomerulosclerosis, diabetic glomerulopathy, nephrotic syndromes, C3 glomerulopathies, systemic lupus erythematosus.

Thrombotic microangiopathy - hemolytic uremic syndrome (HUS) in the infancy.

Shock kidney pathology.

Macroscopic changes in chronic pyelonephritis and in the Renal vascular disease.

Tubulointerstitial pathology: principal alterations.

Renal failure. Renal and systemic alterations, morphological indicators to predict evolution to end-stage renal disease.

Polycystic kidney disease.

Alport's syndrome.

Tumors of the Kidney. Classification. Cystic lesions, oncocytic lesions, clear cell renal cell carcinoma, papillary carcinoma, chromophobe carcinoma.

Diseases of the urinary tract

Urothelial neoplasms: papilloma, papillary urothelial neoplasm of low malignant potential (PUNLMP), urothelial carcinoma in situ (flat), urothelial carcinoma (papillary and non papillary). General features of uncommon carcinomas of the urinary bladder, of mesenchymal tumors, of ureteral and urethral tumor.

Diseases of the male reproductive system

Testicular tumors. Classification and germ cell tumors.

Diseases and tumors of the prostate gland. Prostatitis, stromal and glandular hyperplasia of the prostate, prostatic carcinoma (including Gleason’s grade and score).

Breast pathology

Male breast: gynecomastia and male breast 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), morphological variants.

Invasive carcinoma, principal variants (ductal and lobular).

Prognostic factors of breast cancer: TNM.

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

Paget's disease of the breast.

Uncommon breast neoplasms: main features.

Breast cancer in young and adolescents: general features and criteria for early diagnosis.

Diseases of the female reproductive system

Pathology of uterine cervix, vulva and vagina: neoplastic pre-invasive and invasive lesions.

Pathology of the uterine corpus.

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

Neoplastic and preneoplastic lesions: endometrial hyperplasia; endometrial intraepithelial neoplasia (EIN); classification of endometrial carcinoma.

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

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

Diseases of the endocrine system

General features, including the main features of the pathology of the hypothalamus.

Pituitary gland: pituitary adenoma, craniopharyngioma.

Thyroid gland.

Hyper- e hypothyroidism and their association with diffuse and multinodular hyperplasia: Graves-Basedow disease, multinodular goiter.

Thyroiditis: Hashimoto thyroiditis, subacute thyroiditis (granulomatous, De Quervain thyroiditis), Riedel thyroiditis.

Thyroid neoplasms: classification and differential diagnosis between benign and malignant lesions.

Papillary carcinoma, follicular adenoma and carcinoma, poorly differentiated carcinoma, anaplastic carcinoma, medullary carcinoma (sporadic and familial).

Parathyroid: parathyroid hyperplasia, adenoma and carcinoma.

Adrenal cortex. Hyper- and hypofunction and their pathologic basis. Adrenocortical neoplasms.

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

MEN Syndromes.

Skin diseases

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

Melanocytic lesions and tumors: melanocytic nevus (junctional, dermal, and compound), dysplastic nevus, malignant melanoma. Prognostic significance of histologic features in malignant melanoma (in situ melanoma, superficial melanoma, nodular melanoma, Clark's levels and Breslow's depth measurement).

Pathology of bone

Tumors. General features and classification. Osteochondroma, osteosarcoma, chondrosarcoma, Ewing sarcoma.

Pathology of soft tissues

Tumors. General features and classification. Lipoma and liposarcoma, leiomyosaarcoma, rhabdomyosarcoma, synovial sarcoma.

Non neoplastic skeletal muscle and peripheral nervous system diseases

Main forms of neuropathy.

Classification of myopathies.

Diseases of the central nervous system

Foundations of neuropathology: elementary neuropathologic changes and their correlation with imaging and clinical data.

Cerebral edema.

Hydrocephalus.

Trauma and traumatic vascular lesions (epi and sub-dural hematoma).

Vascular diseases: hypoxic-ischemic encephalopathy, cerebral infarct, intracranial hemorrhage, primitive intraparenchymal hemorrhage, saccular aneurysms and sub-arachnoid hemorrhage, vascular malformations.

Meningo-encephalic infections: epidural and subdural infections, meningitis (acute, chronic, lymphocytic). Intraparenchymal infections (general features of encephalitis), brain abscess.

Tumors. Classification (histopathologic and molecular). Gliomas of adult and children, medulloblastoma, ependymoma, meningioma. Brain metastases.

Degenerative and demyelinating disorders: multiple sclerosis, Alzheimer disease, spongiform encephalopathies, amyotrophic lateral sclerosis, leukodystrophies.

Diseases of the hematopoietic and lymphoid systems
Classification and overview of malignant lymphomas: Hodgkin lymphoma, main types of non-Hodgkin B-cell lymphomas (chronic lymphocytic leukemia, follicular lymphoma, marginal zone lymphoma, mantle zone lymphoma, large B-cell lymphoma, Burkitt lymphoma).
Lymphadenitis (including HIV and AIDS infection).

Readings/Bibliography

Robbins & Cotran Pathologic Basis of Disease (Robbins Pathology) or equivalent Pathology textbook.

Teaching methods

Lessons.

Assessment methods

Oral examination. Each student is examined by at least two different teachers. As a rule, no fewer than three questions are asked by two different teachers. To pass the exam, the student must provide adequate answers to all the questions. The final grade is based on the overall assessment by the teachers of the student's ability to know, understand, and expose the specific subjects under examination in a concise and complete manner.

Teaching tools

Slide presentations are available online at the designated University of Bologna websites. Access is reserved to University of Bologna students registered to the Medicine & Surgery degree program.

Links to further information

http://virtualmicroscopy.patologia-sperimentale.unibo.it/

Office hours

See the website of Maria Pia Foschini