Introduction to Radiographic Pathology

1. Introduction to Radiographic Pathology Spring 2012

2. Pathology • Pathogenesis • Disease • Signs vs. Symptoms • Diagnosis • Prognosis • Syndrome • Acute vs. Chronic disease • Sequelae • Etiology • Epidemiology

3. Causes of Disease • Normal agents • Bacteria, viruses, trauma, and heat • Poor infection control • Nosocomial • Adverse reactions to medical treatment • Iatrogenic • No known cause • Idiopathic

4. Technique Adjustments • Subtractive • Lytic • Destructive • Additive • Sclerotic

5. Disease Tracking • CDPH • NCHS • CDC • Monitoring • Trends • Epidemics • Intervention

6. Life Expectancy

7. Health Care Costs and Changes • Delivery Methods • Ambulatory care • Inpatient services • Health care costs • Increasing costs • Sources of funding • Medicare • Medicaid • Private insurance • Cash

8. Disease Classifications • Hereditary • Congenital • Inflammatory • Metabolic • Degenerative • Traumatic • Neoplastic

9. What is the difference between Congenital and Hereditary?

10. Congenital • In utero • Maternal infections, radiation, trauma or drugs • Usually cannot be recognized before birth

11. Hereditary • Genetically transmitted from either parent to child • Genetic testing can detect these before birth • Intervention • Terminate pregnancy • Make decisions • 46 chromosomes • 44 automsomal • 2 are X and Y • XY • XX

12. Hereditary Terms • Homozygous • Heterozygous • Dominant Genes • Recessive Genes • Codominant Genes • Mutations • Autosomal Dominant • Autosomal Recessive • Sex linked disorders

13. Homozygous- genes are same for a trait • Blue and blue • Heterozygous- genes differ from each parent • Blue (recessive) and Brown (dominant) • Dominant Genes-always produce effect • Recessive Genes- traits manifest only if person is homozygous • Codominant Genes- both traits are expressed • AB blood types

14. Autosomal Dominant - Autosomal Recessive • Transmitted from one generation to next. • Affects males and females • Either can transmit • Affected father + Unaffected Mother • = ½ children will have disease • Not all will demonstrate the trait • Some may demonstrate differently • EX: • Polydactyly • Marfan’s syndrome • Disorders when a person in homozygous • Parents may not show disease but siblings may • EX: • cystic fibrosis • Tay-sachs • Sickle cell anemia

15. Sex Linked Disorders • Mutations- alterations in DNA that become permanent hereditary change if they affect gonadal cells • Generally as a result of a defective X chromosome • Y chromosomes are small and carry few genes • Virtually all are recessive • Most transmitted through heterozygous female • To sons • 1-2 chance of receiving mutant gene • Affected fathers transmit to ALL daughters • EX: • Color blindness • Hemophilia • Muscular Dystrophy

16. Inflammatory Diseases • What is inflammatory disease? • Body’s reaction to a injurious agent • Primary causes • Invasion by microorganisms • Infective diseases • Poisoning by biologic substances • Toxic diseases • Overreaction of body’s own defenses • Toxic diseases

17. 4 Stages of Inflammation • 1) Alterations of blood flow and vascular permeaability • Dilation of arterioles, capillaries and venules • Produces increased blood flow around injury site • Causes heat, redness and pain 2) Migration of WBC to injured tissue • Leukocytosis occurs • Mainly leuckocytes such as neutrophils and macrophages

18. 4 Stages of Inflammation 3) Phagocytosis • WBC engulf and digest infecting organisms 4) Repair of injury • Regeneration of normal cells • Granuation tissue

19. Inflammation • Chronic inflammation: • Damage caused by an injurious agent may not result in necrosis • Longer duration of inflammation periods • Acute inflammation: • Heat • Redness of skin • Swelling • Pain • Loss of function • Elevated body temperature

20. Redness

21. Heat And Fever

22. Swelling

23. Pain

24. Loss of Function

25. Localized Edema Inflammatory Process Lymph obstruction

26. GeneralizedEdema Usually occurs form CHF, cirrhosis and many renal diseases Gravity causes it to be more prominent in lower body Sedentary persons Lower back Lungs Sacral area

27. Traumatic • Disease that may result from mechanical forces such as crushing or twisting of a body part or from the effects of ionizing radiation on the body • Fracture • Wound • Bruise/contusion

28. Neoplastic • Defined as: new abnormal tissue growth • Come from latin word “neoplasia” meaning new growth • Abnormal proliferation that are not governed by laws of normal cells • Cell act as parasites competing with normal cells for their metabolic needs • Onocology- study of neoplasms • Derived from greek word “oncos” which means tumor

29. All tumors have 2 basic components • The organ tissue is made up of proliferating neoplastic cells • The supporting tissue is made up of connective tissue, blood vessels and possibly lymphatic cells.

30. Grading (Differentiation) • Used to assess biologic behavior and choice of treatment • Differentiated tumors • Tend to grow slow • Resemble cells of origin • Poorly differentiated or undifferentiated • Rapid growth • Exhibits atypical characteristics and does not resemble cells of origin

31. TNM System • Staging of cancer • TNM system emerged in 1950s and endorsed by AJCC • T—Tumor • N—Node (lymph node involvement) • M—Metastases • Addition of numbers indicates the extent of malignancy and progressive increase in size or involvement of tumor

32. Tumor Word Roots

33. Benign Neoplasms • Closely resemble their cells of origin in structure and function • Remain localized • Can be surgically removed • Can still have severe consequences • EX: • Pituitay tumore can cause pressure and destruction of gland • Pancreas- excessive insulin can be fatal • Brain and spinal cord- impair or alter CNS function • Trachea / esophagus- occlude air supply or swallowing

34. BenignTumors • Consist of differentiated cells • Add suffix OMA to root word • Examples: • Fibromas • Chondromas • Adenoma • Lipomas • Myomas • Angiomas

35. Malignant Neoplasms • Invade and destroy adjacent structures • Metastasize • Poorly or undifferentiated so it may be impossible to determine origin • Cancer comes from the latin word crab, because it has fingerlike projections that resemble crablike claws

36. Malignant Neoplasms • Carcinomas- epithelial origin • Affects epithelial cells, skin and mucus membranes • Comes from greek word “karkinos” which means crab • Adenocarcinoma- malignancies from glandular tissue • breast, liver, pancreas, and cells lining the GI tract

37. Malignant Neoplasms Cont. • Squamous cell carcinoma- tumors of connective tissue • Resemble stratified squamous epithelia • Lungs, head and neck regions • Sarcomas- connective tissue • Highly malignant and spread rapidly • Bone, muscle, and cartilage • Less common than carcinomas

38. Metastatic Methods 4 1) Seeding- travels to distant sites and organs 2) Lymphatic-Spreads through lymphatic system • Especially lung and breast • major metastatic route of carcinomas 3) Invasion • Spreads to other areas in close proximity

39. Metastatic Methods cont. 4) Hematogenous- spreads through circulatory system • Tumor cells invade and penetrate blood vessels • Travel as emboli until they get stuck • Invade wall in the vessel they are stuck • Infiltrate to surrounding tissue • Examples • Abdominal carcinomas metastasize to liver • Because of flow of the portal vein blood to that organ • Midline organs spread to vertebrae • Neoplasms in organs that drain into inferior & superior vena cava, such as kidneys spread to lung

40. Carcinogens • Chemicals that alter DNA • Air and water pollution • Cigarette smoke • Asbestos • Sun, bombs, and radiation • Viruses that alter genetic material

41. Treatment Options • Surgical removal • Well localized tumors with no metastases • Radiation Therapy • Fast growing • Poorly or undifferentiated tumors • Chemotherapy • Cytotoxic substances used to kill neoplastic cells • Kills good cells to causing significant complications

42. Degenerative • Degenerative—Disease caused by a deterioration of the body • May occur following traumatic injury, regardless of age • May occur as a hereditary illness • Process of aging • Factors affecting the rate of aging • Hereditary • Diet • Enviromental factors • Sedentary lifestyle

43. Degenerative Diseases • Atherosclerosis • Osteoporosis • Osteoarthritis

44. Metabolic Disease • Disease caused by the disturbance of the normal physiologic function of the body • Metabolism is the sum of all physical & chemical processes in the body • To function • Maintain homeostasis

45. Metabolic Disease • Endocrine disorders • Hypersecretion • Insufficient secretion • Fluid and Electrolyte imbalances • Dehydration • Insufficient water • Loss of too much water • Can occur from: • Vomiting • Diarrhea • Diuretics • Athletic (very hard training)