Learning outcomes of the course unit
The course aims to provide a basic knowledge of the morphological changes induced by diseases in organs, cells and molecules as a foundation for understanding etiology, pathogenesis, prognosis and therapy.
The program includes the systematic analysis of the pathological basis of diseases of the central and peripheral nervous system, skeletal muscle, head & neck region, female genital tract and pregnancy, breast, skin, bone and soft tissues, male uro-genital system, kidney, heart, lung, pleura, biliary tract and endocrine organs.
The student will learn the role of Surgical Pathology in modern clinical medicine and the diagnostic techniques and applications currently in use, including cytology, immunohistochemistry, molecular biology applied to human tissues and cells, and electron microscopy
The student will be asked to integrate the notions provided by the course with previous knowledge in anatomy, physiology and general pathology to the understanding of:
• nomenclature and classification criteria of diseases;
• causes, molecular and physio-pathological bases, and pathological features of relevant disorders;
• basic notions concerning clinical presentation, natural history, complications and therapy of relevant anatomo-clinical entities;.
• differential diagnosis of main organ and tissue pathologies and choice of appropriate diagnostic strategies.
At the end of the course, the student will be able to integrate the knowledge provided by disciplines to:
• give appropriate indications to perform a pathological analysis;
• fill out correctly a pathology request form and interpret a pathology report;
• communicate appropriately with professionals of other disciplines;
• approach correctly the diagnostic strategy of the main tissue and organ pathologies;
• identify and interpret clinical courses and complications of the different disorders;
• understand the clinical implications of a pathological diagnosis.
Basic notions of anatomy, physiology and general pathology.
Course contents summary
The program of the course includes the systematic analysis of the pathological basis of diseases of central and peripheral nervous system, skeletal muscle, head & neck region, female genital tract and pregnancy, breast, skin, bone and soft tissues, male uro-genital system, kidney, heart, lung, pleura, biliary tract and endocrine organs.
Basic information concerning the etiology, the molecular and physio-pathological bases of diseases, the clinical presentation, natural history and complications of the individual anatomo-clinical entities and organ pathology will be provided. The different methods available for macroscopic diagnosis and cytological and histological sampling will be discussed. The role of ancillary techniques such as immunostains, FISH, molecular biology and electron microscopy will also be examined. The significance of the study of pathological cells, tissues and molecules in current strategies of prevention, diagnosis , prognosis, prediction and cure will be specifically emphasized.
CENTRAL NERVOUS SYSTEM
Edema, herniation, hydrocephalus, cerebral-vascular disease, regional and global hypoxic-ischemic encephalopathy, cerebral infarct, cerebral hemorrhage, epidural, subdural and subarachnoid hematoma.
Vascular malformations. Aneurysms. Congenital malformation and perinatal brain injury. Closure defects of the neural tube. Congenital hydrocephalus.
Infections: meningitis, viral and bacterial meningo-encephalitis, abscess, viral encephalitis, prion diseases.
Primary tumors: astrocytomas, glioblastoma, oligodendroglioma, ependymoma, PNET, medulloblastoma, retinoblastoma, pineal tumors, CNS lymphomas, gangliocytoma, neurocytoma, meningiomas, metastases.
Degenerative diseases: Alzheimer’s disease, fronto-temporal dementia, Parkinson disease, Huntington disease, lateral amyotrophic sclerosis.
Demyelinating diseases. Multiple sclerosis.
HEAD & NECK
ORAL CAVITY. Leukoplakia and erythroplakia, squamous cell carcinoma.
NASOPHARYNX & NASAL/PARANASAL CAVITIES. Nasopharyngeal carcinoma, tumors of nasal/paranasal cavities.
SALIVARY GLANDS. Inflammatory disorders, litiasis, Sjogren’s syndrome. Salivary gland tumors: pleomorphic adenoma, Warthin tumor, muco-epidermoid carcinoma, adenoid-cystic carcinoma, acinic cell carcinoma, low-grade pleomorphic carcinoma, carcinoma ex-pleomorphic adenoma, adenocarcinoma NOS.
LARYNX. Polyps, papilloma, papillomatois, carcinoma.
MYOCARDIUM. Ischemic heart disease, acute infarct and coronary syndromes, sudden cardiac death, acute and chronic cor pulmonare, hypertrophy, hypertensive cardiopathy, heart failure, cardiomyopathies and myocarditis.
HEART VALVES. Stenosis and insufficiency of mitral valve, stenosis and insufficiency of aortic valve, rheumatic fever, endocarditis.
GREAT VESSELS. Atherosclerosis, aneurysms, aortic dissection, arteritis.
LUNG. Acute alveolar damage, edema, embolism, infarct and hemorrhage, BPCO, pneumonitis, TBS, sarcoidosis, interstitial pneumonitis, pneumoconioses. Tumors: nomenclature and classificaton; squamous cell carcinoma, adenocarcinoma, undifferentiated small cell carcinoma, large cell carcinoma, neuroendocrine tumors, paraneoplastic syndromes, metastases.
PLEURA: pleuritis, pneumothorax, mesotelioma.
ENDOCRINE ORGANS. Thyroiditis, goiter, adenoma and carcinoma of the thyroid, MEN syndromes, hyper-surrenalism, adrenal insufficiency, adrenocortical tumors, pheocromocytoma, paragangliomas.
AMYLOIDOSIS. Definition, classification and tissue lesions.
VULVA. Vulvar dystrophy, lichen sclerosus, squamous hyperplasia. Vulvar intraepithelial neoplasia (VIN), carcinoma and variants; vulvar Paget’s disease,
CERVIX. Cervical intraepithelail neopalsa (CIN and SIL), squamous cell carcinoam and adenocaricnoma, variants, classification and staging.
ENDOMETRIUM. Adenomyosis, endometriosis, endometrial hyperplasai, polyps, adenocaricinoma, variants, grading and staging.
MYOMETRIUM. Leiomoyoma and variants, leiomyosarcoma, endometrial stromal sarcoma.
OVARY: Functional cysts, epithelial ovarian tumors, variants, grading and staging germ cell tumors, tumors of the stroma and sex cords.
PLACENTA. Gestational trophoblastic disease: hydatiform mole, complete and partial, invasive mole, choriocarcinoma, trophoblastic tumor of the implantation site. Placental diseases: infections, twin gestations, placental malformations, vascular disorders.
BREAST. Infections, ductal ectasia, fibro-cystic changes, non prliferative, proliferative and atypical. Tumors: fibroadenoma, papilloma, filloid tumor, carcinoma insitu and invasive, variants, grading and staging. Male breast: gynecomastia and carcinoma.
KIDNEY: primary epithelial tumors, variants, grading and staging, pediatric tumors including Wilms tumor, angiomyolipoma, metastases.
URINARY TRACT: litiasis, inflammations, urothelial tumors and precancers, variants, grading and staging.
PROSTATE: prostatitis, nodular hyperplasia, adenocarcinoma, variants, grading and staging.
TESTIS: Infections, cryptorchidism, dysgenetic syndromes, tumors: germ cell tumors, seminomatous and non-seminomatous variants, grading and staging, sex cord and stromal tumors, lymphomas, mesenchymal tumors.
GALLBLADDER AND EXTRA HEPATIC DUCT. Biliary stomnes, cholesterolosis, cholecistitis,adenocarcinoma and preneoplastic lesions. Choledocal cysts, biliary atresia, extra-hepatic cholangiocarcinoma.
INTRAHEPATIC DUCTS. : Biliary chirrosis, primary biliary cirrhosis, primary sclerosing cholangitis, autoimmune hepatitis and overlap syndromes. Cholangiocarcinoma, variants, grading and staging.
SKIN. Non-melanocytic lesions: actinic keratosis, squamous cell carcinoma Basal cell carcinoma. Melanocytic lesions: common naevi, special type naevi, melanoma variants, grading and staging e melanomi. Lymphomas: mycosis fungoides. Benign fibrous histocytoma, dermatofibrosarcoma protuberans, Kaposi’s sarcoma.
SOFT TISSUES: Tumors. General features, classification (WHO 2012), nomenclature, epidemiology and pathogenesis, grading and staging. Mesenchymal tumors of infancy. Generalities on main histotypes with special reference to tumors of the adipose tissue, vessels and peripheral nervous system.
BONE: Tumors. General features, classification (WHO 2012), nomenclature, epidemiology and pathogenesis, grading and staging. Tumors of cartilage: osteochondroma, chondroma (enchondroma, periostal chondroma), chondroblastoma, chondrosarcoma (central, periostal, dedifferentiated, mesenchymal, clear cells). Osteogenici tumors: osteoid osteoma, osteoblastoma, osteosarcoma (classical, parostal, periostal, surface).Giant cell tumors: giant cell tumor of bone, malignancy in giant cell tumor of bone. Ewing sarcoma. Notocordal tumors: chordoma. Non neoplastic pathology: aneurismatic cyst, simple cyst, fibrous displasia, osteo-fibrous displasia, osteomyelitis.
JOINTS. Arthritis (osteoarthritis, reumatoid arthritis, spondiloarthropaty seronegative, infectious arthritis). Gout. Synovial cysts. Ganglion.Tumors: giant cell tumor of tendon sheets, sinovitis villonodulare pigmentosa.
Robbins & Cotran, Pathologic basis of diseases, Elsevier, 8° Ed. (specific chapters).
Rubin, Pathology, Mosby 2006 (specific chapters).
Lessons and seminars will be given during the course. Texts, diagrams, clinical examples and a rich apparatus of gross and microscopic images the student will be used to guide the student into the understanding of the different clinic-pathological entities.
Assessment methods and criteria
An oral interview will be used to assess the reaching of learning targets. Questions will be aimed to assess knowledge and understanding of basic notions and the ability to translate this information into appropriate actions and behaviors in the relevant clinical situations.