1、Introduction of Pathology （病理學緒論)1,What is Pathology2, The history of pathology and the position in medicine3, How to study pathology 一、What is pathologypathology,study of sufferring (Logos) (pathos) 1，The branch of pathology 總論（general pathology)（1）基礎病理學 (Basic pathology)各論(systemic pathology)（2）臨床

2、病理學(clinical pathology)Basic pathology1，A bridge which can help medical students to across the river between basic medical science and clinical subjectsThe task of basic pathology2，基礎病理學的內容：（1）etiology(病因學)（2）pathogenesis(發病機制)（3）Morphology(病理變化) （4）consequence(結局)考試成績組成(五年制)1， 平時成績（回答問題）10%2， 實驗繪圖

3、10%3， 期中考試 10%4， 實驗考試 20%5， 期末考試 50%考試成績組成(八年制上)1， 平時成績（回答問題）10%2， 實驗繪圖 10%3， 實驗考試（PPT） 10%4， 期末考試 70%考試成績組成(八年制下)1， 平時成績（回答問題）10%2， 實驗繪圖 10%3， 實驗考試（口試） 30%4， 期末考試 50%The history of pathology 3 stepsThe first steporgan pathology Visalius human anatomy started in 1600s. It is the beginning of modern

4、medicine. Morgagni He is the founder of organpathology, who reported more than700 cases about locations and reasons of the diseases in 1761. Rokitansky - reported more than 30,000 pathology anatomy.細胞病理學（cellular pathology） Schleiden & Schwan The founder of cell biology. Their conclusion is “all the

5、 living body was organized with cells.” Virchow-The founder of cellular pathology. The famous book “ cellular pathology” was published in 1858De humani corporis fabrica On the Fabric of the Human BodyAndreas Vesalius (15141564)founder of modern human anatomy1543 1761 “the seats and causes of disease

6、s investigated by anatomy” 論疾病的位置和原因 Giovanni Battista Morgagni 1682-1771人物介紹Full-time professor of pathologyHandbook of pathological Anatomy“First sorting out the facts scientifically on a pure anatomic basis, and thereby creating the subject of general pathological anatomy” Karl Rokitansky （1804-1

7、878）人物介紹Rudolf Virchow（1821-1902）人物介紹Founder of modern pathology“Cellular pathology as based upon physiological and pathological histology”(1858)EM and molecular pathology EM in 1930s Molecular pathology in 1970s Osteoclastoma (Giant cell tumor of bone) Bonequestion1, Is this a real tumor?2, Is this

8、 tumor a polyclonal one?3, Which cell are the real tumor cell?Answer1, Yes, this is a real tumor.2, This tumor is a monoclonal proliferation.3, The real tumor cell is the CD68- mononuclear spindle cell. 4, The CD68+ cells, both polynuclear and mononuclear are reactive proliferation.The position in m

9、edicine1，the bridge subject in medical education2，the final diagnosis in the clinic3，the gold standard in the medical legal cases4，the gold standard of standard medical quality control5，the gold standard in the medical research3, How to Study PathologyPracticeThe Relationship of Clinical and Patholo

10、gyThe Keys in the Pathologic Study1 the basic essential words in the general pathology(總論中的基本概念)2 the basic pathologic changes in the organ pathology(各論中的基本病理變化)3 To use the knowledge in the geneal pathology to the organ pathology(總論各論的融會貫通)The first chapteradaptation and injury (組織、細胞的適應和損傷)Injury

11、factors1 Oxygen deprivation2 Chemical agents3 Infectious agents4 Immunologic reactions5 Genetic defects6 Nutritional imbalances7 Physical agents8 AgingCell injury, adaptation and deathOxygen deprivation normal cells (adaptation) (reversible injury) (irreversible injury) The most important reasons fo

12、r the injury：The power of the injury factors(損傷因子的作用強度) The characters and functional status of the cell and tissue. 組織、細胞的特性及功能狀態1 cellular adaptation, （細胞適應）Adaptation of cellular and tissuethe morphologic and functional changes of the cell and tissue to the environmental changes. (機體組織、細胞對內、外環境的變

13、化所發生的形態結構和功能代謝的改變)Classification： atrophy （萎縮）hypertrophy （肥大）hyperplasia （增生）metaplasia （化生)（一） atrophy(萎縮) Shrinkage in the size of the cell by the loss of cell substance in the normal developed organs (發育正常的器官、組織和細胞體積的縮小)morphologyGross: Smaller in sizeBrown in colorBrown atrophy(褐色萎縮)microscope:

14、 Cell becacome smaller, lipofuscin increased. EM: increased autophage Results: reversible, decreased function1, Atrophy of the brain aging idiot 2, Atrophy of the adrenalAddisons disease 3, Atrophy of the isletDiabetesThe classification of the atrophy1, physiologic atrophy:a, adolescent stage: thymu

15、sb, aging: uterus, beast, brain2, pathologic atrophy:a, inadequate nutritionb, decreased workloadc, loss of innervationd, pressure (hydronephrosis)e, loss of endocrine stimulationHypertrophy （肥大) Hypertrophy is an increase in the size of cell resulting in increase in the size of the organ.Morphology

16、Gross：(heart) increased size in heart wall.LM： Increased size in the cardiomyocyte, and the nuclear strongly Stained.classificationPhysiologic hypertrophy:the uterus and the breast in pregnancyPathologic hepertrophy:adaptation (heart in hypertension) compensation (kidney after removed one ) results

17、of the hepertrophyReversibleIncreased function, but may cause the compensation ability lossed.hyperplasia （增生） Hyperplasia is an increase in the number of cell s in an organ or tissue. It often occurs with the hypertrophy at the same time. ClassificationPhysiologic hypertrophy:the uterus and the bre

18、ast in pregnancyPathologic hypertrophyadenosis of the breast healing : granulation tissue Morphyology The number of cells increasedResults:1, make the organ adapt to the demands of function2, hyperplasia can cause dysplasia and even cancermetaplasia （化生）One adult cell type is replaced by another adu

19、lt cell type.Epithelial become another type epithelialMesenchymal become another type mesenchymalReversible changeclassificationMetaplasia of normal ciliated columnar to squamous epithlium Fibro-tissue to chondro-tissue squamous to epithelium columnar The significance of metaplasiaSuit to the enviro

20、nmental changeLoss the original function cellular degeneration （細胞變性）The normal or abnormal substances accumulated in the cells caused by the injury factor. reversible injury cellular swelling （細胞腫脹）The degeneration is a slight lesion, and often occurs in the highly metabolic organs. Gross: pallor,

21、increased in weight of the organ.Microscope: the cytoplasm become clear, and a lot of particles in it. So, it is also called as hydropic change or vacuolar degeneration. Mechanism Na+ -K+ ATPas disfunctionfatty degeneration (脂肪變性)Fatty change refers as to any abnormal accumulation of triglycerides w

22、ith parenchymal cells except fat cells. Hepatic steatosis Gross: increased in size. The cutting surface became yullow. LM: clear vacuoles without any substance. the well-preverved nuleus is aqueezed into the displaced rim of cytoplasm about the fat vacuole. fatty change in cardiomyocyte Fatty change

23、 in kidneyMechanism Starving, over-nutrition, toxic, hypoxia, cell death （細胞死亡), irreversible injury）necrosis（pathologic Two types apoptosis（physiologic or pathologic） necrosis （壞死）Local cells or tissue died in the living body. Morphology 1.Nuclear changes The most important marker of cell death. a.

24、pyknosis （核固縮）the nucleus shrinkage and increased basophilia. b. karyorrhexis （核碎裂）the nucleus broken and basophilia of the chromatin fade. c. karyolysis （核溶解）the nucleus compeletely disappearedMorphology 2.Cytoplasmic changes Increased iosinophilic and homogeneous of cytoplasm Degradation of protei

25、n and RNAMorphology 3. interstitial tissue changesDegradation of matrix structureless eosinophilic material Inflammation cells infiltration Mechanism of the nocrostic morphologyDegradation by the enzymes from broken lysosomesAutolysis: degradation from the died cells lysosomes.Heterolysis: degradati

26、on from the infiltrated inflammation cells. Types of necrosis1. coagulation necrosis （ 凝固性壞死） character：the basic structure outline of the cell or tissue was kept for a span of days. location：heart, kidney, liver, spleen, arms, center of the cancer2. liquefaction necrosis （液化性壞死）Characters: The stru

27、cture outline was not kept, but left the liquefaction space. Location：Brain, 、spine3. Special type of necrosisA, caseous necrosis （干酪樣壞死） The special marker for tuberculosis and some fungi infection.Gross：yellow, and looks like cheese.LM：complete necrosis without structure outline, and amorphous gra

28、nular appearance.b, fat necrosis （脂肪壞死）The character of acute bleeding necrotic pancreatitis.Gross：the areas of white chalky deposits represent foci of calcium soap formation. LM：necrosis contain shadowy outlines of necrotci fat cells with basophilic calcium deposit. C, fibrinoid necrosis （纖維蛋白樣壞死）T

29、he character of immune reactions involving blood vessles.Morphology：The immune complexes together with fibrinoid material result in a bright pink and amorphous appearance. d. gangrene （壞疽）Classification:1, dry gangrene2, wet gangrene3, gas gangreneDry gangreneUsually occurs in a limb that lost its b

30、lood supply and has undergone coagulative necrosis involving multiple tissue layers. It appears black, dry, and shriveledWet gangreneSwollen and reddish-black.Occurs in the case of both artery and vein blocked. Gas gangreneThe gross appearance is similar to that of wet gangrene, with the additional

31、presence of gas in the tissues. The results of necrosis1, resolved and absorbed. No scar formed.2, separated and excluded. Ulcer, cavity and capsulated. 3. organization （機化） scar formed 4. calcification （鈣化） calcium accumulatedApoptosis （細胞凋亡）Apoptosis is induced by a suicide program in the cells. I

32、t appears in the many physilogic programm. MorphologyLM： single cell may appear as round or oval masses with intensely eosinophilic cytoplasm. The nuclei show pyknosis, karyorrhexis, karyolysis. One of the apoptotic characters is no inflammative reaction. Autophage(自噬)Autophage refers to lysosomal digestion of the cells own components. Physiological function: clearance of damaged or aging organelles.Pathological function: protection of toxic, resistance to microbiologies. hyaline degeneration （玻璃樣變性）A amorphous and pink material accumulated in the cells, vessel wall