Pathology

Source: Wikipedia, the free encyclopedia.
"Pathobiology" redirects here. For the journal, see Karger Publishers. For other uses, see Pathology (disambiguation).
"Pathological case" redirects here. For the corresponding case in engineering, see
Pathological case (engineering)
.
Pathology
blood analysis, dissection, and other applications of medical microscopy
SpecialistPathologist
GlossaryGlossary of medicine
Pathologist
Occupation
Names
  • Physician
  • Surgeon
Occupation type
Specialty
Activity sectors
Medicine, Surgery
Description
Education required
Fields of
employment
Hospitals, Clinics

Pathology is the study of

psychological conditions (such as psychopathy).[2] A physician
practicing pathology is called a pathologist.

As a field of general inquiry and research, pathology addresses components of disease: cause, mechanisms of development (

oral pathology), as well as on the basis of the focus of the examination (as with forensic pathology
).

Pathology is a significant field in modern medical diagnosis and medical research.

History

Main article: History of medicine
Legionnaire's disease
.

The study of pathology, including the detailed examination of the body, including dissection and inquiry into specific maladies, dates back to antiquity. Rudimentary understanding of many conditions was present in most early societies and is attested to in the records of the earliest

germ theory.[citation needed
]

Modern pathology began to develop as a distinct field of inquiry during the 19th Century through

humors or even spiritual agents, that had dominated for much of the previous 1,500 years in European medicine. With the new understanding of causative agents, physicians began to compare the characteristics of one germ's symptoms as they developed within an affected individual to another germ's characteristics and symptoms. This approach led to the foundational understanding that diseases are able to replicate themselves, and that they can have many profound and varied effects on the human host. To determine causes of diseases, medical experts used the most common and widely accepted assumptions or symptoms of their times, a general principle of approach that persists into modern medicine.[7][8]

Modern medicine was particularly advanced by further developments of the microscope to analyze tissues, to which Rudolf Virchow gave a significant contribution, leading to a slew of research developments. By the late 1920s to early 1930s pathology was deemed a medical specialty.

diagnostic medicine.[citation needed
]

Etymology

The term pathology comes from the Ancient Greek roots of pathos (πάθος), meaning "experience" or "suffering" and -logia (-λογία), "study of". The Latin term is of early sixteenth-century origin and became increasingly popularized after the 1530s.[10]

General pathology

A modern pathology lab at the Services Institute of Medical Sciences

The modern practice of pathology is divided into a number of subdisciplines within the distinct but deeply interconnected aims of biological research and

organs
, and tissue types.

Anatomical pathology

Main article: Anatomical pathology

Anatomical pathology (Commonwealth) or anatomic pathology (United States) is a medical specialty that is concerned with the diagnosis of disease based on the

gross, microscopic, chemical, immunologic and molecular examination of organs, tissues, and whole bodies (as in a general examination or an autopsy). Anatomical pathology is itself divided into subfields, the main divisions being surgical pathology, cytopathology, and forensic pathology. Anatomical pathology is one of two main divisions of the medical practice of pathology, the other being clinical pathology, the diagnosis of disease through the laboratory analysis of bodily fluids and tissues. Sometimes, pathologists practice both anatomical and clinical pathology, a combination known as general pathology.[4]

Cytopathology

Main article: Cytopathology
nuclear chromatin
. This is diagnostic of erythroleukemia.

Cytopathology (sometimes referred to as "cytology") is a branch of pathology that studies and diagnoses diseases on the cellular level. It is usually used to aid in the diagnosis of cancer, but also helps in the diagnosis of certain infectious diseases and other inflammatory conditions as well as thyroid lesions, diseases involving sterile body cavities (peritoneal, pleural, and cerebrospinal), and a wide range of other body sites. Cytopathology is generally used on samples of free cells or tissue fragments (in contrast to histopathology, which studies whole tissues) and cytopathologic tests are sometimes called smear tests because the samples may be smeared across a glass microscope slide for subsequent staining and microscopic examination. However, cytology samples may be prepared in other ways, including

cytocentrifugation.[11]

Dermatopathology

Main article: Dermatopathology
malignant melanoma
can often be suspected from sight, but confirmation of the diagnosis or outright removal requires a biopsy.

Dermatopathology is a subspecialty of anatomic pathology that focuses on the skin and the rest of the

neoplasms. Therefore, dermatopathologists must maintain a broad base of knowledge in clinical dermatology, and be familiar with several other specialty areas in Medicine.[14]

Forensic pathology

Main article: Forensic pathology
Pathologist performing a human dissection of the abdominal and thoracic organs in an autopsy room

Forensic pathology focuses on determining the cause of death by

physical trauma. Forensic pathology is a major component in the trans-disciplinary field of forensic science.[citation needed
]

Histopathology

Main article: Histopathology
section of cardiac tissue reveals advanced cardiac amyloidosis. This sample was attained through an autopsy
.

Histopathology refers to the microscopic examination of various forms of

frozen section fixing is also common.[17]
To see the tissue under a microscope, the sections are stained with one or more pigments. The aim of staining is to reveal cellular components; counterstains are used to provide contrast. Histochemistry refers to the science of using chemical reactions between laboratory chemicals and components within tissue. The histological slides are then interpreted diagnostically and the resulting pathology report describes the histological findings and the opinion of the pathologist. In the case of cancer, this represents the tissue diagnosis required for most treatment protocols.

Neuropathology

Main article: Neuropathology
This coronal cross-section of a brain reveals a significant arteriovenous malformation that occupies much of the parietal lobe.

Neuropathology is the study of disease of nervous system tissue, usually in the form of either surgical biopsies or sometimes whole brains in the case of autopsy. Neuropathology is a subspecialty of anatomic pathology,

invasive.[citation needed
]

Pulmonary pathology

Main article: Pulmonary pathology
Gross pathology of miliary tuberculosis of the lung.

Pulmonary pathology is a subspecialty of anatomic (and especially surgical) pathology that deals with diagnosis and characterization of

video-assisted thoracic surgery. These tests can be necessary to diagnose between infection, inflammation, or fibrotic conditions.[citation needed
]

Renal pathology

Main article: Renal pathology
polycystic kidneys
.

Renal pathology is a subspecialty of anatomic pathology that deals with the diagnosis and characterization of disease of the

tubules and interstitium
, the vessels, or a combination of these compartments.

Surgical pathology

Main article: Surgical pathology
Brain biopsy under stereotaxy. A small part of the tumor is taken via a needle with a vacuum system.

Surgical pathology is one of the primary areas of practice for most anatomical pathologists. Surgical pathology involves the

tissue sample is the best and most definitive evidence of disease (or lack thereof) in cases where tissue is surgically removed from a patient. These determinations are usually accomplished by a combination of gross (i.e., macroscopic) and histologic (i.e., microscopic) examination of the tissue, and may involve evaluations of molecular properties of the tissue by immunohistochemistry or other laboratory tests.[citation needed
]

There are two major types of specimens submitted for surgical pathology analysis: biopsies and surgical resections. A biopsy is a small piece of tissue removed primarily for surgical pathology analysis, most often in order to render a definitive diagnosis. Types of biopsies include core biopsies, which are obtained through the use of large-bore needles, sometimes under the guidance of radiological techniques such as

polyps are very common. The pathologist's interpretation of a biopsy is critical to establishing the diagnosis of a benign or malignant tumor, and can differentiate between different types and grades of cancer, as well as determining the activity of specific molecular pathways in the tumor. Surgical resection specimens are obtained by the therapeutic surgical removal of an entire diseased area or organ (and occasionally multiple organs). These procedures are often intended as definitive surgical treatment of a disease in which the diagnosis is already known or strongly suspected, but pathological analysis of these specimens remains important in confirming the previous diagnosis.[citation needed
]

Clinical pathology

Main article: Clinical pathology

Clinical pathology is a medical specialty that is concerned with the diagnosis of disease based on the

biophysical properties of tissue samples involving automated analysers and cultures. Sometimes the general term "laboratory medicine specialist" is used to refer to those working in clinical pathology, including medical doctors, Ph.D.s and doctors of pharmacology.[18] Immunopathology, the study of an organism's immune response to infection, is sometimes considered to fall within the domain of clinical pathology.[19]

Hematopathology

Main article: Hematopathology
automated blood chemistry analyzer

Hematopathology is the study of diseases of blood cells (including constituents such as

platelets
) and the tissues, and organs comprising the hematopoietic system. The term hematopoietic system refers to tissues and organs that produce and/or primarily host hematopoietic cells and includes
lymph nodes, thymus, spleen, and other lymphoid tissues. In the United States, hematopathology is a board certified subspecialty (licensed under the American Board of Pathology) practiced by those physicians who have completed a general pathology residency (anatomic, clinical, or combined) and an additional year of fellowship training in hematology. The hematopathologist reviews biopsies of lymph nodes, bone marrows and other tissues involved by an infiltrate of cells of the hematopoietic system. In addition, the hematopathologist may be in charge of flow cytometric and/or molecular hematopathology studies.[citation needed
]

Molecular pathology

Main article: Molecular pathology

Molecular pathology is focused upon the study and diagnosis of disease through the examination of molecules within organs, tissues or

quantitative polymerase chain reaction (qPCR), multiplex PCR, DNA microarray, in situ hybridization, DNA sequencing, antibody-based immunofluorescence tissue assays, molecular profiling of pathogens, and analysis of bacterial genes for antimicrobial resistance.[23] Techniques used are based on analyzing samples of DNA and RNA. Pathology is widely used for gene therapy and disease diagnosis.[24]

Oral and maxillofacial pathology

Main article: Oral and maxillofacial pathology
Many conditions, such as this case of geographic tongue, can be diagnosed partly on gross examination, but may be confirmed with tissue pathology.

Oral and Maxillofacial Pathology is one of nine dental specialties recognized by the

oral cavity to non-invasive examination, many conditions in the study of oral disease can be diagnosed, or at least suspected, from gross examination, but biopsies, cell smears, and other tissue analysis remain important diagnostic tools in oral pathology.[citation needed
]

Medical training and accreditation

An anatomical pathology instructor uses a microscope with multiple eyepieces to instruct students in diagnostic microscopy.

Becoming a pathologist generally requires

laboratory medicine. Pathologists may pursue specialised fellowship training within one or more subspecialties of either anatomical or clinical pathology. Some of these subspecialties permit additional board certification, while others do not.[26]

In the United Kingdom, pathologists are physicians licensed by the UK General Medical Council. The training to become a pathologist is under the oversight of the Royal College of Pathologists. After four to six years of undergraduate medical study, trainees proceed to a two-year foundation program. Full-time training in histopathology currently lasts between five and five and a half years and includes specialist training in surgical pathology, cytopathology, and autopsy pathology. It is also possible to take a Royal College of Pathologists diploma in forensic pathology, dermatopathology, or cytopathology, recognising additional specialist training and expertise and to get specialist accreditation in forensic pathology, pediatric pathology, and neuropathology. All postgraduate medical training and education in the UK is overseen by the General Medical Council.

In France, pathology is separated into two distinct specialties, anatomical pathology, and clinical pathology. Residencies for both lasts four years. Residency in anatomical pathology is open to physicians only, while clinical pathology is open to both physicians and pharmacists. At the end of the second year of clinical pathology residency, residents can choose between general clinical pathology and a specialization in one of the disciplines, but they can not practice anatomical pathology, nor can anatomical pathology residents practice clinical pathology.[19][27]

Overlap with other diagnostic medicine

Main articles:
Infectious disease, and Medical imaging

Though separate fields in terms of medical practice, a number of areas of inquiry in medicine and medical science either overlap greatly with general pathology, work in tandem with it, or contribute significantly to the understanding of the pathology of a given disease or its course in an individual. As a significant portion of all general pathology practice is concerned with

etiology, immunology, and parasitology. General pathology methods are of great importance to biomedical research into disease, wherein they are sometimes referred to as "experimental" or "investigative" pathology.[citation needed
]

tactile imaging, thermography, medical photography, nuclear medicine and functional imaging techniques such as positron emission tomography. Though they do not strictly relay images, readings from diagnostics tests involving electroencephalography, magnetoencephalography, and electrocardiography
often give hints as to the state and function of certain tissues in the brain and heart respectively.

Pathology informatics

Further information: Digital pathology
Major topics and processes of pathology informatics: Data management from molecular testing, slide scanning, digital imaging and image analysis, networks, databases and telepathology.

Pathology informatics is a subfield of health informatics. It is the use of information technology in pathology. It encompasses pathology laboratory operations, data analysis, and the interpretation of pathology-related information.

Key aspects of pathology informatics include:

  • Laboratory information management systems (LIMS): Implementing and managing computer systems specifically designed for pathology departments. These systems help in tracking and managing patient specimens, results, and other pathology data.
  • Digital pathology: Involves the use of digital technology to create, manage, and analyze pathology images. This includes side scanning and automated image analysis.
  • Telepathology: Using technology to enable remote pathology consultation and collaboration.
  • Quality assurance and reporting: Implementing informatics solutions to ensure the quality and accuracy of pathology processes.

Psychopathology

Main article: Psychopathology

Psychopathology is the study of

pathological liar
).

Non-humans

haemolytic pneumonia
, possibly due to Pasteurella haemolytica.

Although the vast majority of lab work and research in pathology concerns the development of disease in humans, pathology is of significance throughout the biological sciences. Two main catch-all fields exist to represent most complex organisms capable of serving as host to a pathogen or other form of disease: veterinary pathology (concerned with all non-human species of

phytopathology
, which studies disease in plants.

Veterinary pathology

Main articles: Veterinary pathology and Animal testing

Veterinary pathology covers a vast array of species, but with a significantly smaller number of practitioners, so understanding of disease in non-human animals, especially as regards

mammals generally have the largest body of research in veterinary pathology. Animal testing remains a controversial practice, even in cases where it is used to research treatment for human disease.[33]
As in human medical pathology, the practice of veterinary pathology is customarily divided into the two main fields of anatomical and clinical pathology.

tobacco plant infected with the tobacco mosaic virus

Plant pathology

Main article: Plant pathology

Although the pathogens and their mechanics differ greatly from those of animals, plants are subject to a wide variety of diseases, including those caused by

human diet
or other human utility.

See also

References

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External links

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