Human pathology (4th year)

A.Y. 2019/2020
2
Max ECTS
24
Overall hours
SSD
MED/08
Language
Italian
Learning objectives
The course aims to provide students with the knowledge:
i) of the principal diagnostic and instrumental tools of modern pathology to adequately recognize the right clinical context and the right diagnostic procedure in patient management;
ii) of the organization, structure and function of normal cells and tissues and the pathologic principles of cellular/tissue/organ injury, related to the most relevant diseases;
iii) of the specific role of the pathologist in guiding the clinical decisional process in diagnosis, prevention, prognosis and therapy of the single disease;
iv) the ability to correctly interpret a pathology report.
Expected learning outcomes
The student will be able to:
i) choose the right clinical context to ask for a correct pathologic diagnostic procedure during diagnosis, therapy and follow-up of the patient;
ii) use the correct diagnostic pathological algorithm considering their cost-effectiveness ratio;
iii) choose and send the correct surgical specimen to the Pathology Unit;
iv) correctly interpret a pathology report.
Course syllabus and organization

Single session

Course syllabus
3rd year program:

Introductive part: the role of the surgical pathologist, from autopsy to molecular pathology.
1. Professional tasks, responsibility and fields in surgical pathologist working activity.
2. Clinical post mortem examination in adults, children and fetuses: features and aims compared to medico-legal autopsy.
3. Principal articles of the Mortuary Code, particularly those concerning clinical post mortem examination request.
4. "Cot death" regulations and "Legge Gelli" articles about post mortem examination techniques.
5. Histological examination: principal features and aims; different kinds of surgical specimens (incisional or excisional biopsy); how collect, preserve and send the histological sample to the surgical pathology lab; how to understand the pathological report.
6. Cytology (screening, second level, follow-up): principal features and aims; how to choose and send the best sample; how to understand the pathological report.
7. Immunohistochemistry: technical principles and indications.
8. Cytogenetic (classical and molecular) and Molecular Pathology: technical principles and indications.
9. Electron microscopy: technical principles and indications.
10. Intraoperative Histological Examination: methods, indications and limits.

Systematic part:
Respiratory Tract:
1. Bullous lung disease
2. Interstitial lung disease and pulmonary fibrosis.
3. Chronic obstructive pulmonary disease- Chronic bronchitis, asthma and emphysema
4. Nontuberculous lung infections.
5. Tuberculosis (pulmonary and systemic).
6. Pulmonary embolism and infarction.
7. Lung cancer.
8. Pleural pathology (neoplastic and not neoplastic).
9. Neoplastic and not neoplastic mediastinal pathology
10. Surgical pathology techniques in pleuro-pulmonary and mediastinal pathology diagnostic evaluation.
Cardiovascular system
1. Primary (essential) and secondary hypertension (pathology aspects).
2. Heart failure (pathology aspects).
3. Chronic and persistent pulmonary hypertension and right ventricle disease (pathology aspects).
4. Ischemic heart disease.
5. Acquired valvular heart disease.
6. Myocarditis.
7. Pericarditis.
8. Congenital heart defect
9. Congenital arrhythmogenic cardiomyopathy.
10. Cardiomiopathies.
11. Heart tumors.
12. Aneurism, angiomas and vascular malformations
13. Thromboflebitis and varix
14. Lower limb ulcers and gangrene
Nefrology
1. Primary and secondary glomerular disease.
2. Tubulointerstitial diseases

4th year program:
Gastrointestinal system:
1. Esophagitis and Barrett Esophagus.
2. Esophageal cancer.
3. Gastritis and Peptic Ulcer Disease and their complications.
4. Helicobacter pylori infection: pathological aspects and complications.
5. Gastric cancer
6. Acute and chronic hepatitis
7. Hepatic cirrhosis.
8. Hepatocellular carcinoma.
9. Gallbladder: non-neoplastic (including cholelithiasis) and neoplastic pathologies and their complications.
10. Celiac disease.
11. Inflammatory bowel disease.
12. Intestinal ischemia.
13. Mechanical ileum (including meconium ileum) and dynamic ileum.
14. Intestinal diverticular disease.
15. Colon and rectal neoplasms.
16. Acute and chronic pancreatitis.
17. Neoplasms of the exocrine and endocrine pancreas.
Endocrine system
1. Pituitary adenomas.
2. Diabetes mellitus and its acute and chronic complications.
3. Non-neoplastic and neoplastic thyroid nodularity.
4. Parathyroid glands: hyperplasia, adenoma, carcinoma.
5. Adrenal cortical hyperplasia and benign and malignant primitive neoplasms of the cortex and adrenal medulla.
6. Adrenal metastases.
7. Diseases of the diffuse endocrine system
8. Multiple endocrine neoplasms.
9. Gonadal abnormalities in alterations of sexual differentiation.
Immune system and rheumatology
1. Systemic autoimmune diseases: SLE (systemic lupus erythematosus), sclerosis, Sjögren's syndrome, dermato-polymyositis.
2. Vasculitis: temporal arteritis and rheumatic polymyalgia, mixed cryoglobulinemia, Schönlein-Henoch vasculitis.
3. Infectious and post-infectious arthritis.
4. Primary chronic rheumatism.
5. Arthrosis of the column and peripheral joints.
Blood and hematopoietic organs
1. Aplasia and bone marrow hypoplasia.
2. Chronic myeloproliferative syndromes.
3. Myelodysplastic syndromes.
4. Acute leukemias.
5. Chronic lymphatic leukemia.
6. Hodgkin lymphoma.
7. Non-Hodgkin lymphomas.
8. Congenital and acquired coagulopathies; disseminated intravascular coagulation.

5th year program:
Male urinary and genital system
1. Vascular diseases of the kidney.
2. Infections of the kidney, urinary tract, prostate.
3. Renal, excretory and bladder cancers.
4. Prostatic hypertrophy, prostate adenoma, intraepithelial neoplasia of the prostate, prostate cancer.
5. Neoplastic and non-neoplastic pathology of the testicle.
6. Malformations of the kidney and urinary tract.
7. Anatomopathological instruments for the diagnostic evaluation of the patient with hematuria (macroscopic or microscopic).
Gynecological pathology
1. Gynecological infections: types, anatomopathological features, complications, outcomes.
2. Human papilloma virus (HPV) infection and carcinogenesis in genital and rectal epithelia.
3. Primary preneoplastic and neoplastic lesions of the vulva, vagina and cervix: definitions, epidemiology, biological evolution, risk factors, histotypes, staging, prognostic factors, diagnostic algorithms.
4. The Pap test (conventional and in liquid phase): purpose, target population, method of performing the sampling, diagnostic results, limits; Bethesda's reporting system.
5. Definition of: pavement metaplasia of the uterine cervix, coilocytosis, dysplasia, VIN, VAIN, CIN, carcinoma in situ, minimally invasive carcinoma, superficial growth carcinoma, SIL (low and high grade), ASC-US, ASC-H , AGC.
6. Endometritis and dysfunctional endometriopathy.
7. Endometriosis and adenomyosis.
8. Preneoplastic pathologies of the endometrium: glandular hyperplasia and EIN (endometrial intraepithelial neoplasia).
9. Endometrial carcinoma: epidemiology, biological evolution, risk factors, histotypes, staging, prognostic factors, diagnostic algorithms.
10. Primary non-epithelial benign and malignant neoplasms of the uterine body.
11. Non-neoplastic and neoplastic pathology of the salpingi.
12. Ovarian neoplasms: histogenetic classification, epidemiology, main histotypes, biological evolution, staging, metastasis pathways.
13. "Borderline malignancy"; neoplasm: definition, biological meaning of the term, histological criteria, types of neoplasms in which it is present; neoplasm: definition, biological meaning of the term, histological criteria, types of neoplasms in which it is present.
14. Locations of metastasis of epithelial neoplasms of the vulva, vagina, cervix uteri, uterine body, salpinx, ovaries.
15. Metastasis to the female genital system.
Pathology of pregnancy and gestational trophoblastic pregnancy and post-pregnancy
1. Early and late spontaneous abortion, MEF (fetal endouterine death), perinatal death, neonatal death, I.U.G.R.
1. (symmetrical and asymmetrical), fetus S.G.A .: definition and main anatomical-pathological pictures.
2. Placental and umbilical cord malformations.
3. Characteristics of the "vascular bed of the placenta", its methods of formation and its main pathologies.
4. Placental pathology in the live born fetus and in the stillbirth: structural and maturation alterations; inflammatory / infectious lesions; vascular lesions; neoplastic pathologies; injuries from maternal and fetal pathologies.
5. Gestational and persistent trophoblastic gestational disease: extent, diagnostic criteria, complications, prognosis.
6. Main phenotypic aspects of the most frequent chromosomopathies and gene alterations of the product of conception
Neonatal and pediatric age
1. SUID (sudden and unexpected death) and SIDS (sudden infant death syndrome): characteristics, definition, approach, indications to family members.
2. Anatomopathological aspects of infantile cerebral palsy.
3. Cystic fibrosis.
4. Intestinal dysganglionosis (Hirschsprung disease; NID).
5. Jaline membrane disease and its outcomes.
6. Pediatric lung diseases of surgical interest (in particular: CCAM; pulmonary seizure; congenital emphysema; pleuro-pulmonary blastoma).
Breast pathology
1. Primary neoplastic and non-neoplastic lesions of the breast.
2. Locations for metastasis of breast cancer.
Cute and its annexes
1. Inflammatory skin lesions.
2. Bullous skin lesions.
3. Method of conservation and treatment of a skin biopsy in the clinical suspicion of lymphoproliferative disease.
4. Modality of conservation and treatment of a skin biopsy in the differential diagnosis of bullous and autoimmune pathology.
5. Benign and malignant skin epithelial tumors, with particular reference to: wart, seborrheic keratosis, keratoacanthoma, basal cell carcinoma, spinocellular carcinoma.
6. Benign and preneoplastic pigmented lesions of the skin (compound, junctional, dermal, congenital melanocytic nevi, dysplastic nevi).
7. Malignant melanoma: characteristics, prognostic relevance of the different histotypes, of the growth modalities and of the staging according to Clark and according to Breslow.
8. Methods and main sites of metastasization of pigmented and non-pigmented skin neoplasms.
9. Malignant neoplasms metastasizing the skin.
10. Cutaneous neurofibroma: characteristics and relationships with neurofibromatosis.
11. Sporadic Kaposi's sarcoma and associated with immunodeficiency syndrome.
12. Proliferative lesions and vascular malformations.
Oral pathology
1. Primary and metastatic benign and malignant neoplasms of the mucous membrane of the oral cavity.
2. Craniopharyngioma.
3. Odontoblastic tumors.
4. Non-neoplastic pathology of the parotid and major salivary glands.
5. Primary and secondary benign and malignant neoplastic pathology of the parotid.
Pathology of the nervous system
1. Intracranial hemorrhages: sites, etiological and pathogenic factors, outcomes.
2. Hypoxic-ischemic lesions of the central nervous system: sites, etiological and pathogenetic factors, outcomes.
3. Meningitis and encephalitis: characteristics, etiological agents, complications.
4. Demyelinating diseases.
5. Congenital malformations of the CNS.
6. Primitive and metastatic intracranial neoplasms: histotypes, staging, grading, complications.
7. Benign and malignant neoplasms of the peripheral nervous system.
8. Pathologies of the retina and eye.
Skeletal system
1. Primitive and secondary neoplasms of bone and cartilage.
2. Congenital pathologies of the skeleton.
Soft tissue tumors
1. Benign and malignant neoplasms of soft tissues (main histotypes, metastatic pathways, main macro and microscopic general criteria used to define the benign or malignant nature of soft tissue tumors; staging).
Prerequisites for admission
The student must have acquired knowledge of Normal Anatomy and Histology, Human Embriology, Human Physiology, General Pathology and Genetics, to deal with the topics of the course of Pathology.
Teaching methods
The course consists of lectures (2 CFU in the 3rd and 4th years, 5 CFU in 5th), and 6 CFU in the 5th year (lectures: 5 CFU, practical activities: 1 CFU).
Practical activities comprise work in small groups with a following "step by step" debate with the Pathology Professor; clinical cases with necessary histopathological exams (cytological, bioptic and surgical speciments, or autopsies) will be discussed with special focus on the correct use of the algorithm of available pathological procedures and on correct differential diagnosis of patient's disease based on the results obtained; furthermore, the correct comprehention of information in the pathological report will be discussed, too.
Teaching Resources
Strayer D.S., Rubin Emanuel. "Patologia Generale. Anatomia Patologica". Piccin Nuova Libreria, 2019
Kumar V, Abbas A.K., J.C. Aster. "Robbins & Cotran. Anatomia Patologica". EDRA, 2017
PubMed: http://www.ncbi.nlm.nih.gov/pubmed OMIM: http://www.ncbi.nlm.nih.gov/omim/
Orphanet: http://www.orphanet-italia.it/national/IT-IT/index/homepage/
Assessment methods and Criteria
Examination consists of an oral test at the end of the fifth years of the course.
No intermediate tests are planned.
Underlined topics of the Course Syllabus are essential to pass the exam.
The student will be asked to:
a) clearly and exhaustively describe the pathological characteristics of the different human diseases.
b) To choose the appropriate clinical context to ask for an histopathological examination during patient's care, therapy and follow up
c) properly use the algorythm of the different available pathological procedures, considering their cost-effectiveness ratio
d) correctly make and send a patient's sample to the pathologist
e) correctly interpret a pathology report
A final score, out of thirty, will be attributed if the exam is passed.
MED/08 - PATHOLOGY - University credits: 2
Lessons: 24 hours