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Pathology As a Medical Specialty: Historical Overview

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Title: Pathology As a Medical Specialty: Historical Overview


1
Pathology As a Medical Specialty Historical
Overview Programmatic Summary
2
WHY DID PATHOLOGY BECOME A SPECIALTY?
  • Pathology evolved as a distinct specialty for the
    same reasons that Radiology, Anesthesiology, and
    other hospital-based disciplines did namely, the
    body of knowledge and technology involved in
    those areas grew beyond the ability of other
    practitioners to utilize it properly and optimally

3
AIMS OF PATHOLOGY AS A DISCIPLINE
  • To further our understanding of the mechanisms of
    disease, and, in so doing, allow for a more
    effective disruption of them
  • To utilize existing knowledge integrating
    information from other clinical specialties,
    several biological and physical sciences as a
    means of accurately categorizing disease
    processes in the clinical sphere
  • To consult with clinical colleagues in the care
    of patients so that laboratory information is
    effectively and properly integrated into
    diagnosis treatment planning in this context,
    pathologists must be knowledgeable about clinical
    findings and data from virtually all other
    specialty areas

4
WHY CONSIDER THE HISTORY OF PATHOLOGY?
  • Nothing gives a better perspective on a subject
    than an appreciation of the steps by which it
    reached its present state.
    --E.H. Lang

5
The 19th Century Appearance of Pathology as a
Distinct Discipline in Medicine
6
Infectious Disease in the 1800s the First
Successful Target of Pathology
  • Revolutionary ideas on infection were presented
    in the mid- to late 1800s by Pasteur (a
    biochemist), Lister (a surgeon and surgical
    pathologist of sorts), Koch (a
    bacteriologist), which, in aggregate, were used
    to identify, prevent, and treat specific
    communicable diseases

7
Virchows Cellular Theory of Disease the 1860s
  • Rudolph Virchow (1821-1902) was a German
    physician who pioneered the cellular theory of
    pathology that is, disease was considered to
    represent the aggregate dysfunction of specific
    cells in any given abnormal organ.
  • This concept paved the way for subcellular and
    molecular pathology of the 20th Century and beyond

8
Rudolph Virchow, M.D. Originator of modern
Pathologic theory
9
Virchow R Cellular Pathology--As Based Upon
Physiological and Pathological Histology.
London, Churchill, 1860
10
Paul Ehrlich (1854-1915) The First Clinical
Pathologist
  • Ehrlich was another 19th century German physician
    who recognized that reproducible changes in the
    blood and urine could be correlated with
    morphologic organ changes in specific disease
    states
  • That realization led to the development of
    diagnostic hematology and clinical chemistry

11
Paul Ehrlich, M.D.
12
The 20th Century Pathology Arrives as a Medical
Specialty
  • Specialty certification is organized and granted
    by the American Board of Pathology, as of 1936

13
Selected Non-neoplastic Diseases Described by
Pathologists in the 20th Century
  • Graft versus host disease
  • Lymphangioleiomyomatosis
  • Multiloculated thymic cyst
  • Inflammatory polyps of the GI tract
  • Necrotizing sialometaplasia
  • The currently-recognized glomerulonephritides
  • Radial scar of the breast
  • Microglandular mammary adenosis
  • Pseudoneoplastic myositides and fasciitides
  • Progressive multifocal leukoencephalopathy
  • Kikuchis disease

14
Graft-vs-host disease Lymphangioleio-
Dense deposit disease Esophagus
myomatosis C3
immunofluorescence
Progressive multifocal leuko-
Mammary radial scar encephalopathy ISH
for JC virus
15
Advances Deriving from Observational Research in
Pathology in the 20th CenturyClassification of
Other Disease Entities
  • -Essentially all specialized carcinoma, sarcoma,
    blastoma, germ cell tumor, and lymphoma
    morphotypes
  • -Pseudoneoplastic quasi-neoplastic disorders
    (e.g., nodular fasciitis, myositis ossificans,
    Rosai-Dorfman disease, virus-associated
    hemophagocytosis)
  • -Langerhans non-Langerhans histiocytoses
  • -Separation of special melanocytic nevus variants
    from malignant melanoma
  • -Recognition of the AIDS complex
  • -Identification of several specific infectious
    diseases

16
Pneumocystis-AIDS Cytomegalovirus-lung
Rosai-Dorfman Disease-S100
Pleuropulmonary Anaplastic large-
Spitz nevus Sarcomatoid Blastoma
cell lymphoma-
carcinoma ALK-1
17
MODERN SUBSPECIALTIES IN PATHOLOGY
  • Surgical pathology
  • Autopsy forensic pathology
  • Cytopathology
  • Neuropathology
  • Pediatric pathology
  • Dermatopathology
  • Hematopathology
  • Clinical chemistry
  • Microbiology infectious disease
  • Transfusion medicine
  • Diagnostic immunopathology
  • Cytogenetics
  • Molecular diagnostics

18
Teaching in the Surgical Pathology Laboratory
19
Techniques in Pathology
  • Patient-Related
  • Fine needle aspiration biopsy
  • Apheresis
  • Bone marrow aspiration biopsy
  • Procedural
  • Frozen section
  • Autopsy
  • Prosection of gross specimens
  • Light, polarization, phase-contrast microscopy
  • Electron microscopy
  • Immunohistology
  • In-situ hybridization comparative
    genomic hybridization
  • Flow cytometry
  • Cytogenetics
  • Chromatography
  • Polymerase chain reaction nucleic acid blotting
    technologies
  • Mass spectroscopy
  • Spectrophotometry
  • Bacterial, mycological, viral cultures

20
Fine Needle Aspiration Biopsy
21
Fine Needle Aspiration Biopsy-- Invasive Breast
Carcinoma
22
Therapeutic Apheresis
23
Diagnostic Transmission Electron Microscope
24
Flow Cytometry-- Peripheral T-cell Lymphoma
25
Mass Spectrogram for Trace Metal Analysis of
Liver Tissue
26
Biochemical Slant Tube Set for Microbial
Identification
27
Southern Blot-- Rearrangement of IgH gene loci in
B-cell lymphoma
28
Cytogenetics Spectral Fluorescent Karyotype
Showing Normal Chromosomal Pattern
29
Objectification of Diagnoses in Anatomic
Pathology A Continuing Goal Major Focus of
Translational Research
  • Morphology
  • Flow Cytometry
  • Electron microscopy
  • Immunohistochemistry
  • In-situ hybridization
  • Nucleic acid blotting technologies

30
Right Renal/Perirenal Mass in Adult Male-- Renal
Cell Carcinoma?
31
Right Renal/Perirenal Mass in Adult Male-- Renal
Cell Carcinoma?
32
Right Renal/Perirenal Mass in Adult
Male--Electron micrograph showing abundant smooth
endoplasmic reticulum (a feature of steroidogenic
cells)
33
Right Renal/Perirenal Mass in Adult
Male--Positive Immunohistochemical Stain for
Inhibin Diagnosis Adrenocortical Carcinoma
34
Enlarged left cervical lymph node in 49 year old
woman-- Reactive lymphadenitis or follicular
lymphoma?
35
Enlarged left cervical lymph node in 49 year old
woman-- Positive CD10 immunostain in follicular
structures Diagnosis Follicular lymphoma
36
Enlarged left cervical lymph node in 49 year old
woman-- Positive bcl-2 immunostain in follicular
structures Diagnosis Follicular lymphoma
37
Tumefactive and ulcerative lesion of the lips in
a 29 year old man with HIV infection---
infectious or neoplastic?
38
Tumefactive and ulcerative lesion of the lips in
a 29 year old man with HIV infection---
Microscopic image suggesting HSV infection
39
Tumefactive and ulcerative lesion of the lips in
a 29 year old man with HIV infection-- Positive
HSV-1 immunostain
40
Tumefactive and ulcerative lesion of the lips in
a 29 year old man with HIV infection--- Electron
micrograph showing HSV-1 virions
41
Anatomic Pathology Activities in Which Medical
Students Can Participate
  • Gross examination prosection of surgical
    pathology specimens
  • Frozen section
  • Autopsy
  • Microscopy case signout

42
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46
Quote from Sir William Osler (Arguably the
Greatest Clinical Physician in History)
  • To know Pathology is to know Medicine

47
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