RADIOGRAPHIC PATHOLOGY

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

InflammatoryReaction to injury

InfectionAllergyPoisoningAutoimmune

disorderAcute/chronic

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