1、病理學導論醫學知識講座病理學導論醫學知識講座病 理 學 導 論病理學的定義 病理學發展簡史病理學的分支學科病理學的研究方法病 理 學 導 論病理學的定義 Definition of PathologyThe word “Pathology” is derived from two Greek word -pathos meaning sufferinglogos meaning studyDefinition of PathologyThe worDefinition of PathologyPathology is scientific study of structure and func

2、tion of the body in disease.It deals with causes, effects, mechanisms and nature of disease. Definition of PathologyPatholoThe knowledge and understanding of pathology is essential for all would-be doctors as well as general practitioners and specialists since unless they know the causes and mechani

3、sms of disease and understand the language spoken by the pathologist in the form of laboratory reports, they would not be able to institute appropriate treatment or suggest preventive measures to the patient. The knowledge and understandinFor the medical student, the discipline of pathology forms a

4、vital bridge between initial learning phase of preclinical science and the final phase of clinical subjects.For the medical student, the d病理學發展簡史從宗教迷信走向理性探索(Antiquity to AD 1500)大體病理學時期 (AD 1500 to 1800)細胞病理學時期 (AD 1800 to 1950s)現代病理學時期 (1950s to dawn of 21st century)病理學發展簡史從宗教迷信走向理性探索(Antiquity t從宗

5、教迷信走向理性探索 (Antiquity to AD 1500)Hippocrates (Greece) 460-377 BCPermanently dissociated medicine from religious mysticism. Started study of patients symptoms as method of diagnosis.Stressed moralistic attitude for practice of medicine (Hippocratic oath)Cornelius Celsus (Rome) 53 BC-7 ADDescribed 4 ca

6、rdinal signs of inflammation (redness, heat, swelling, pain)從宗教迷信走向理性探索 (Antiquity to AD Hippocrates (Greece) 460-377 BCHippocrates (Greece) 460-377 大體病理學時期 (AD 1500 to 1800)Giovanni B Morgagni (Italy) 1682-1771Introduced clinicopathologic correlation (CPC) in the study of disease (cause, lesions, s

7、ymptoms, outcome) John Hunter (Scotland) 1728-1793Introduced pathology museum in the study of disease.R.T.H. Laennec (France) 1781-1826Described several lung diseases such as various tuberculous lesions of lungs, bronchiectasis. Described cirrhosis of liver (later called Laennecs cirrhosis).Invented

8、 stethoscope. 大體病理學時期 (AD 1500 to 1800)GiovaJohn Hunter (Scotland) 1728-1793John Hunter (Scotland) 1728-1R.T.H. Laennec (France) 1781-1826R.T.H. Laennec (France) 1781-1細胞病理學時期 (AD 1800 to 1950s)Rudolf Virchow (Germany) 1821-1905Father of cellular pathologyIntroduced histopathology as a diagnostic br

9、anch by his cellular theoryGeorge N. Papanicolaou (USA) 1883-1962Father of exfoliative cytology Developed Pap smear for detection of cervical cancer in 1930s 細胞病理學時期 (AD 1800 to 1950s)RudoRudolf Virchow (Germany) 1821-1905Rudolf Virchow (Germany) 1821George N. Papanicolaou (USA) 1883-1962George N. P

10、apanicolaou (USA) 1現代病理學時期 (1950s to dawn of 21st century)Watson and Crick 1953Described the structure of DNANowell and Hagerford 1960Philadelphia chromosome in CML i.e. t(9;22)Gall and Pardue 1969In Situ HybridizationKary Mullis 1983Introduced polymerase chain reaction (PCR)現代病理學時期 (1950s to dawn o

11、f 21s著名病理學家 梁伯強教授 1899-1968 著名病理學家 梁伯強教授 1899-1968 著名病理學家 秦光煜教授 1902-1969 著名病理學家 秦光煜教授 1902-1969 病理學的分支學科General Pathology - dealing with general principles of diseaseSystemic Pathology - includes study of diseases pertaining to the specific organs and body systems病理學的分支學科General Pathology - General

12、 Pathology （總論）細胞、組織的適應與損傷損傷的修復局部血液循環障礙炎癥腫瘤免疫性疾病General Pathology （總論）細胞、組織的適應Systemic Pathology （各論）心血管系統疾病呼吸系統疾病消化系統疾病淋巴造血系統疾病泌尿系統疾病生殖系統疾病內分泌系統疾病神經系統疾病Systemic Pathology （各論）心血管系統疾病病理學的分支學科Histo-PathologyExperimental PathologyMolecular Pathology Chemical PathologyGeographic Pathology ImmunologyHae

13、matologyMedical Genetics病理學的分支學科Histo-Pathology實驗病理學Experimental Pathology 19世紀法國生理學家Claude Bernard首創了實驗病理學，在動物身上研究疾病的動態變化以及病因和發病機理，揭示疾病發生發展的規律。實驗病理學Experimental Pathology 實驗病理學研究方法 1動物實驗(animal experiment) 2組織和細胞培養(tissue and cell culture) 實驗病理學研究方法 1動物實驗(animal expe3其它研究技術 (1)流式細胞術(flowcytometry，F

14、CM)(2)圖像分析技術(Image analysis，IA)(3)激光掃描共聚焦顯微術（Confocal laser scanning microscope，CLSM)(4)生物芯片技術（biochip technique） (5)激光顯微切割技術(laser capture microdesection，LCM)(6)原位分子雜交技術（in situ hybridization,ISH）(7)熒光原位分子雜交染色體分析技術(FISH)(8)比較基因組雜交技術(CGH)3其它研究技術 (1)流式細胞術(flowcytomet分子病理學Molecular Pathology 分子病理學是現代分

15、子生物學與傳統病理學相互融合而形成的一門新興學科，旨在探討疾病發生過程中可能出現的分子事件，以及這些事件與疾病發生的關系，并最終揭示疾病發生的根本機制。分子病理學Molecular Pathology 病理學導論醫學知識講座優質課件Signal-transducing proteinsThe BCR-ABL hybrid protein has potent, unregulated tyrosine kinase activity, which activates several pathways, including the Ras-Raf cascade.A cell with BCR-

16、ABL fusion gene is dysregulated in two ways: inappropriate tyrosine kinase activity leads to growth autonomy, while simultaneously apoptosis is impaired.Signal-transducing proteinsTheSignal-transducing proteinsThe crucial role of BCR-ABL in transformation has been confirmed by the dramatic clinical

17、response of patients with chronic myeloid leukemia after therapy with an inhibitor of the BCR-ABL fusion kinase called imatinib mesylate (Gleevec) .Signal-transducing proteinsThe病理學的研究方法尸體剖驗 Autopsy活體組織檢查 Biopsy細胞學檢查 Cytology病理學的研究方法尸體剖驗 Autopsy尸體剖驗 Autopsy 簡稱尸檢，即對死者的遺體進行病理解剖，是病理學的基本研究方法之一。尸體剖驗 Auto

18、psy 簡稱尸檢，即對死者的遺體尸體剖驗的意義確定病變，查明死因發現和確診傳染病、地方病、流行病和新發生的疾病積累各種疾病的人體病理材料 尸體剖驗的意義確定病變，查明死因Coronary thrombosis, gross Coronary thrombosis, gross Coronary thrombosis, gross Coronary thrombosis, gross . Acute myocardial infarction, gross. Acute myocardial infarction,. Acute myocardial infarction, gross . Ac

19、ute myocardial infarctionPulmonary thromboembolus, gross Pulmonary thromboembolus, grosPulmonary thromboembolus, gross Pulmonary thromboembolus, grosPulmonary thromboembolus, gross Pulmonary thromboembolus, gros病理學導論醫學知識講座優質課件代償性肥大Hypertrophy, heart, gross 代償性肥大Hypertrophy, heart, grosFatty metamorp

20、hosis of liver, gross Fatty metamorphosis of liver, 活體組織檢查 Biopsy 簡稱活檢，即用局部切取、鉗取、細針穿刺、搔刮和摘取等手術方法從患者活體獲取病變組織進行病理診斷。 活體組織檢查 Biopsy 簡稱活檢，即用局活體組織檢查的意義作出準確病理診斷，指導治療和估計預后冰凍切片可快速診斷，協助選擇手術治療方案定期活檢可連續了解病變的發展，判斷療效 活體組織檢查的意義作出準確病理診斷，指導治療和估計預后為臨床選擇治療方案提供依據明確病因（腫瘤或炎癥）治療方案 良性腫瘤或惡性腫瘤確定手術范圍 良性病變有否惡變確定手術范圍 原位癌或浸潤癌確定

21、手術范圍 肺小細胞癌或非小細胞癌治療方案 淋巴瘤或其它腫瘤化療或手術為臨床選擇治療方案提供依據提供疾疾病嚴重程度及預后的信息 惡性腫瘤的組織學類型不同，預后不同 腫瘤有無轉移，預后不同 有無激素受體，對治療的敏感性和效果不同提供疾疾病嚴重程度及預后的信息 幫助臨床判斷療效 肝穿刺判斷肝炎的治療效果 移植后穿刺判斷移植物情況、有無排斥 骨髓穿刺白血病治療療效， 骨髓移植后情況幫助臨床判斷療效活體組織檢查的步驟取材、固定脫水、浸蠟包埋、切片染色、封片閱片診斷病理報告 活體組織檢查的步驟取材、固定取材取材固定、脫水、浸蠟固定、脫水、浸蠟包埋包埋切片切片貼片貼片HE染色HE染色封片封片閱片診斷閱片診斷細胞學檢查 Cytology 通過采集病變處的細胞涂片染色后進行診斷。細胞學檢查除用于病人外，還用于腫瘤的普查。此法設備簡單，操作簡便，病人痛苦少而易于接受。 細胞學檢查 Cytology 通過采集病變 細胞的來源： 女性生殖道、口腔、食管、鼻咽部等 自然分泌物（如痰、乳腺溢液、前列腺液等） 體液（如胸腹腔積液、心包積液和腦脊液等） 排泄物（如尿液中的細胞） 內窺鏡采集或刷取的細胞（如食管拉網、纖支鏡刷片） 細針直接穿刺病變部位(如前列腺、肝、腎、胰腺、乳腺、甲狀腺、淋巴結等）所吸取的細胞。 細胞的來源： 女性生殖道、口腔、食管、鼻咽