UNIT 1

What is pathological anatomy

gross and microscopic science of identifying and interpreting morphologic patterns and relating them to the physiologic and pathologic functions of a living organism

who is described as the father of pathology?

Rudolph Virchow

what is the first principle of pathological anatomy

all morphologic changes represent a dose-dependent effect in a ‘time space window’

what do all morphologic changes represent according to the first principle of pantological anatomy

a dose dependent effect in a time space window

what is the second principle of pathological anatomy

whatever the quality of injury the living organism reacts with a limited number of patterns

how does the living organism react whatever the quality of injury?

with a limited number of patterns

what is the first step in the path for diagnosis

general, importance of history taking and extraoral examination

what is included in the general stage of the path for diagnosis

history-taking and extraoral examination

what is the second step in the path for diagnosis

intraoral and dental examination

what is the third step in the path for diagnosis

investigation with image and histology techniques

what three stages make up the path for diagnosis

1. general - importance of history-taking and extraoral examination

2. intraoral and dental examination

3. investigation with image and histology techniques

why is rapport essential during history taking

patients may be nervous

what should you start with during history taking

• like what type of questions and why

open questions to let the patient talk

what should be avoided when communicating with patients

medical jargon and leading answers

why should leading questions be avoided

they suggest answers

what should you do when using terms with patients

check meaning of terms

what should you do with findings after history taking

summarise findings back to patient

what is an open question

an open question allows…… and….

allows free expression and builds rapport

what is a closed question

elicits specific information quickly

leading questions should be avoided why

bias answers

what type of questions should you start with during questioning

open questions

what should mixed for balance during questioning

open and closed questions

when should sensitive questions be delayed

until rapport is established

what does medial history link

oral and systemic disease

why is medical history important

may prevent medical emergencies in dental practice

what can medical history identify regarding drugs and procedures

contradictions to drugs and procedures

why is the age important when taking demographic details

it is a risk factor for specific diseases

what is stated about gender and autoimmune disorders

autoimmune disorders are more common in females

why is ethnicity relevant to demographic details

relevant to disease distribution

what can occupation suggest

risk if exposures

what should be observed during extraoral examination

overall appearance

which structures should be inspected and palpated during an extraoral examination

lymph nodes, parotid glands, thyroid

what should be checked during an extraoral examination in relation to the jaw

temporomandibular joint

what should be looked for during an extraoral examination

(….. disease)

systemic disease signs

(anaemia, thyroid disease)

what should be systematically inspected during an intraoral examination

(what areas)

all mucosal areas

what should be checked for during an intraoral examination

(lesions,……… )

lesions, nodules, scaring or fistulae

what should be evaluated during an intraoral examination

(to do with what the ducts do)

salivary flow and duct patency

what areas should be assessed during an intraoral examination

(back of the mouth)

oropharynx and tonsils

what should be charted during a dental examination

teeth, periodontal heath and restorations

what should be assessed regarding teeth during the dental examination

(to do with teeth)

tooth mobility and percussion response (tap tooth)

what types of vitality testing are listed ( during dental examination)

hot, cold, electric pulp test

what should tests be selected to do

answer specific clinical questions

why should unnecessary tests be avoided

to reduce costs/errors

what are investigations used to do

confirm or exclude diagnoses

what is screening applies to

populations

what is diagnostic testing used to to

confirm/exclude disease in an individual

what standard of predictive value is required for screening

high negative PV

what standard of predictive value is required for diagnostic testing

high positive PV

what is radiography good for

hard tissue

what is an advantage of radiography

inexpensive

what does CT/ Cone Beam CT provide

3D detail with high resolution

which imaging technique is superior for soft tissue

MRI

which imagining technique is used for cysts and salivary glands

ultrasound

what does histopathology involve

the study and diagnosis of disease through the examination of surgically removed organs, tissues (biopsy samples), cells, and in soe cases the whole body (autopsy)

what does histopathology involve examining in realtion to surgically removed material

organs tissues and cells

what are the types of specimens

• surgical/larges specimens

• biopsies

• cytology

• autopsy

what are the two types of biopsies

• excision

• core

what are the three types of cytology

• exfoliative

• transepithelial

• aspiration

exfoliative =

transepithelial =

aspiration =

(= with ….)

1. with swab

2. with brush

3. with needle

what is the gold standard for diagnosis

biopsy

site selection is what for a biopsy

critical (perilesional, red/speckled areas)

what area should be chosen as most diagnostic area ?

red/speckled or white area

red/speckled

which areas should be avoided during a biopsy

ulcers or necrotic tissue

what should be included when malignancy suspected

margin

what must a histology report be interpreted with

clinical data

what are the 4 types of biopsy

• incisional

• excisional

• punch

• core needle

biopsy

what is an incisional biopsy

part of a lesion

what is the purpose of an incisional biopsy

diagnostic purpose

what is an excisional biopsy

whole lesion

what is the purpose associated with an excisional biopsy

healing intention

what is the value of punch biopsy in oral mucosa

limited value in oral mucosa

purpose of punch biopsy

diagnostic purpose

what is a core needle biopsy used for

deeper structures

what is the purpose of core needle biopsy

diagnostic purpose

where does tissue/biopsy processing take place

in a pathology lab

what was tissue fixation used to be in

formalin

what was tissue embedding used to be in

paraffin

steps (image)

Biopsy → fixation → tissue dehydration and clearing → tissue embedding → tissue sectioning → slide staining → real H&E

done

what is the purpose of frozen sections

rapid intraoperative diagnosis ( approx. 10 mins)

what are frozen sections useful for in cancer surgery

margin assessment

how accurate are frozen sections compared with routine histology

less accurate

limitations of biopsy

what can happen to a specimen during biopsy removal?

specimen damage during removal

limitations of biopsy

what is a issue that can happen to a sample

unrepresentative sample

limitations of biopsy

what fixation can be a problem

poor fixation

limitations of biopsy

what disease can be a limitation

disease without diagnostic features (aphthae)

brush biopsy/exfoliative cytology

what does this collect

surface and subsurface cells

brush biopsy/exfoliative cytology

how reliable is this for oral diagnosis

less reliable

brush biopsy/exfoliative cytology

when is this used (what setting)

in experimental/adjunctive settings

aspiration cytology fine needle aspiration (FNA)

what type of technique is this

cytology

aspiration cytology fine needle aspiration (FNA)

what does this remove

cells with a fine needle

aspiration cytology fine needle aspiration (FNA)

what are the two advantages

less invasive and quick

aspiration cytology fine needle aspiration (FNA)

what is it useful for

salivary glands, tumours, lymph nodes

what do histopathology reports describe

microscopic and macroscopic features

what does interpretation of a histopathology report depend on

clinical information provided

what may histopathology reports include

caveats or recommendations

what are the three pathological anatomy disciplines

• histopathology

• cytopathology

• molecular pathology

what was used in the XIX century according to the Pathological anatomy timeline

optic microscope and haematoxylin-eosin

what was used in the early XX century

histochemistry

what was used in the mid XX century

immunohistochemistry (IHC)

when did molecular pathology appear in the timeline

late XX century