Download HISTOPATHOLOGY AS A TOOL FOR TEACHING NORMAL

Microscopically Yours:
A Glimpse at our Cells, in
Sickness and in Health
Nina C. Zanetti
Siena College
Department of Biology
•
Is it cancer ??
• If it is… how serious
is it?
• Will I need
treatment? What
kind?
http://1.bp.blogspot.com/_KkXx6fq12mU/SuvqknxSpI/AAAAAAAAG3g/SClWSE4hgs0/s400/breast-self-exam.jpg
Next step in the journey….
• “We need to look at
the tissues. We need
a biopsy.”
– Is it cancer or is it
benign ?
– Is it invasive?
– What treatments?
http://www.breastcancerlaw.com/counseling.jpg
Histology will answer our
questions !
• Histology: study of normal tissues
• Pathology: study of diseased tissues
• Tissue:
– Building blocks of organs
– group of cells working together to carry out a
specific function
• Biopsy: small bit of tissue removed from
patient for examination with microscope
Tissue:
•Building blocks of organs
•Group of cells working together to carry out a
specific function
From Biopsy to Pathology report
?
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http://img2.timeinc.net/health/images/journeys/brea
st-cancer/breast-cancer-interpreting-results-150.jpg
From Biopsy to Pathology report
?
1. Biopsy specimen  microscope slide
(histotechnique)
2. Interpretation of slide  pathology report
(pathologist)
From biopsy specimen to microscope slide:
HISTOTECHNIQUE
“why is it taking
so long?”
Why “fix” and
process ?
Why paraffin?
DIAGRAM: Kessel, Basic
Medical Histology, Oxford
University Press.
Why thin section?
From biopsy specimen to
microscope slide:
tissue fixation and processing
From biopsy specimen to
microscope slide:
infiltrations and embedding
From biopsy specimen to microscope slide:
sectioning
From biopsy specimen to microscope slide:
staining
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de_mountant_1.jpg
From biopsy specimen to microscope slide:
The finished microscope slide
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microscope_slide_mountant_1.jpg
Limitations of histotechnique
• Tissue is dead
• Only a slice: 2D
• Color artificial:
– Purple nuclei
– Pink cytoplasm
• Need to know
“what is normal”
From microscopy slide to Pathology Report:
POWER
of
Histotechnique
Specimen:
Clinical History
49 year old female who was found to have a mass (or calcifications) on physical exam (or
mammography). Stereotactic core biopsy reveale malignancy.
Clinical Diagnosis: Right breast cancer
Microscopic Description
Slides A3- A4 consist of a portion of breast tissue in which is located an infiltrating ductal
carcinoma of the breast. The malignancy is characterized by infiltrating nests of malignant
cells in which there is only, focal tubule or glandular formation. The cells demonstrate a
moderate degree of nuclear pleomorphism, with some of the cells having central nucleoli.
However, the mitotic rate is less than 1 mitosis per 10 high power fields. Overall the carcinoma
is grade II. Adjacent to the carcinoma are areas of ductal carcinona in situ. Histologically the
tumor is 2mm from the inked margin. No lymphatic invasion is appreciated.
Diagnosis Infiltrating ductal carcinoma of the breast, Grade II
Foci of ductal carcinoma in situ
Tumor is 2 mm from the inked margins
Metastatic cancer in 2/12 lymph nodes.
Markers The tumor is estrogen receptor positive
The tumor is Her 2 neu positive
From Biopsy to Pathology report
?
1. Biopsy specimen  microscope slide
(histotechnique)
2. Microscope slide  Interpretation of
slide  pathology report (pathologist)
From microscope slide to Pathology
Report
?
“Reading”
the Slide
From microscope slide to
Pathology Report:
Interpreting
NORMAL Tissue
structure (Histology)
Four basic tissue types
•
•
•
•
Epithelium
Connective tissue
Muscle tissue
Nerve tissue
Four basic tissue types
•
•
•
•
Epithelium : the “lining” tissue
Connective tissue : connects and supports
Muscle tissue: movement
Nerve tissue : communication
Epithelial tissue
Characteristics of epithelial tissue:
• Where is it found?
– Lining spaces, covering surfaces
• How are cells arranged?
– Tightly packed, in layers
• Good at repair/regeneration?
• Polarity? Cells have different surfaces
• Functions? Protect, seal, secrete, absorb,
Connective tissue:
Characteristics of connective tissue:
• Where is it found?
– Connecting tissues and organs
• Cells + fibers + jellies
• How are cells arranged?
– Dispersed; fibers and jellies in between
• Variations?
Muscle tissue:
Characteristics of muscle tissue:
• Where is it found?
– Where movement is needed.
• Cells: striped or dark pink “spindles”
• Variations?
– Yes - both structural and functional!
• Functions?
– Movement!
Nerve tissue:
neuron
Characteristics of nerve tissue:
• Where is it found?
– Brain, spinal cord, other organs
• Special cells: neurons
• What do neurons look like?
– Large cell, extensions, owl-eye
nucleus
• Functions?
– Communication!
Practice with normal histology:
• Epithelium:
– Lining
– cells in layers, tightly packed.
• Connective tissue
– Cells + fibers+ jellies
– Cells dispersed in matrix
• Muscle:
– striped or spindles
• Nerve:
– neurons with extensions and “owl eye” nuclei
Practice with normal histology:
epithelium, connective tissue, muscle , or nerve?
1
Practice with normal histology:
epithelium, connective tissue, muscle , or nerve?
2
Practice with normal histology:
epithelium, connective tissue, muscle , or nerve?
3
Practice with normal histology:
epithelium, connective tissue, muscle , or nerve?
4
From microscope slide to Pathology
Report
?
“Reading”
the Slide
From microscope slide to
Pathology Report:
Understanding Diseased Tissue
structure (Pathology)
What can go wrong?
• Right cells in the wrong place
• Tissue injury: inflammation
• Good cells gone bad: cancer
Pathology: right cells in the wrong
place (Barret’s Esophagus)
Pathology: right cells in the wrong
place (Barret’s Esophagus)
Small intestine, normal
epithelium
Esophagus, normal epithelium
Pathology: right cells in the wrong place
(Barret’s
Esophagus)
Biopsy specimen
Esophagus, normal
Small intestine, normal
Pathology: Tissue injury
(inflammation)
Inflammation:
the body’s response
to injury
lymphocyte
neutrophil
monocyte
eosinophil
basophil
Cells of peripheral blood, human blood smear
Cells of the inflammatory response
neutrophil
monocyte
lymphocyte
Neutrophils in acute inflammation, stomach
Lymphocytes in chronic inflammation, appendix
Pathology: Good Cells Gone Bad
CANCER
• Won’t stop dividing (mitosis)
• Weird nuclei
• Don’t stay at home
– Invade
– metastasize
CANCER: Good Cells Gone Bad
Won’t stop dividing (mitosis)
Onion root tip
cancer of uterus
CANCER: Good Cells Gone Bad
Weird nuclei
Normal epithelium
bladder cancer
CANCER: Good Cells Gone Bad
Don’t stay at home
Normal epithelium
Invasive breast cancer
Practice with pathology: which is normal
(bladder), which is cancer?
Practice with pathology: which is normal
(uterus), which is cancer?
http://www.uoguelph.ca/~rfoster/repropath/surgicalpath/fe
male/cat/F%20fel%20uterus%20duplication%20YB13141
4%2003wl.jpg
•
Is it cancer ??
• If it is… how serious
is it?
• Will I need
treatment? What
kind?
http://1.bp.blogspot.com/_KkXx6fq12mU/SuvqknxSpI/AAAAAAAAG3g/SClWSE4hgs0/s400/breast-self-exam.jpg
The journey…. Waiting for the
Pathology Report
– Is it cancer or is it
benign ?
– Is it invasive?
– What treatments?
http://www.breastcancerlaw.com/counseling.jpg
From Biopsy to Pathology report
?
1. Biopsy specimen  microscope slide
(histotechnique)
2. Interpretation of slide  pathology report
(pathologist)
Is it cancer?
Is it invasive?
What kinds of treatment?
Are hormone receptors present?
The journey continues….
– Is it cancer or is it
benign ?
– Is it invasive?
– Has it metastasized?
– What treatments?
http://www.breastcancerlaw.com/counseling.jpg
Microscopically Yours:
A Glimpse at our Cells, in
Sickness and in Health