Human pathology (3rd year)

A.Y. 2020/2021
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

In the first semester the lectures will take place as concurrent classroms:
·in the classroom with a limited number of students, who have previously booked using the "lezioniUnimi" app with the unimi e-mail account username and password; (https://www.unimi.it/it/studiare/frequentare-un-corso-di-laurea/seguire…) and at the same time through the "Teams platform" for online students ;
· The student must wear a surgical mask for the entire duration of his/her stay in the classroom and to sit using every other free seat
· the lectures will be recorded and made available on the teacher's Ariel website for students with proven difficulties to connect during classes
· the lectures will take place at the San Paolo Hospital on the 3rd floor of Blocco C. Students must access classrooms via Blocco C and exit via the side blocks (students leaving Pauling and Fleming rooms towards Blocco B and students leaving Curie, Golgi and Pasteur rooms towards Blocco A).
Students must enter from the main hall (R floor) of the San Paolo hospital and undergo body temperature measurement by the infrared cameras. It is strongly recommended to use the stairs for classrooms entering and/or leaving.
NB for any further information check the unimi.it website: (Home Studiare Frequentare un corso di laurea Seguire il percorso di studi Orari delle lezioni)
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. (Essential topic)
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. (Essential topic)
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. (Essential topic)
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. (Essential topic)


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

Nefrology
1. Primary and secondary glomerular disease. (Essential topic)
2. Tubulointerstitial diseases. (Essential topic)

4th year program:
Gastrointestinal system:
1. Esophagitis and Barrett Esophagus. (Essential topic)
2. Esophageal cancer. (Essential topic)
3. Gastritis and Peptic Ulcer Disease and their complications. (Essential topic)
4. Helicobacter pylori infection: pathological aspects and complications. (Essential topic)
5. Gastric cancer. (Essential topic)
6. Acute and chronic hepatitis. (Essential topic)
7. Hepatic cirrhosis. (Essential topic)
8. Hepatocellular carcinoma. (Essential topic)
9. Gallbladder: non-neoplastic (including cholelithiasis) and neoplastic pathologies and their complications.
10. Celiac disease.
11. Inflammatory bowel disease. (Essential topic)
12. Intestinal ischemia. (Essential topic)
13. Mechanical ileum (including meconium ileum) and dynamic ileum.
14. Intestinal diverticular disease.
15. Colon and rectal neoplasms. (Essential topic)
16. Acute and chronic pancreatitis. (Essential topic)
17. Neoplasms of the exocrine and endocrine pancreas. (Essential topic)

Endocrine system
1. Pituitary adenomas. (Essential topic)
2. Diabetes mellitus and its acute and chronic complications. (Essential topic)
3. Non-neoplastic and neoplastic thyroid nodularity. (Essential topic)
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. (Essential topic)
7. Diseases of the diffuse endocrine system
8. Multiple endocrine neoplasms. (Essential topic)
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. (Essential topic)
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. (Essential topic)

Blood and hematopoietic organs
1. Aplasia and bone marrow hypoplasia.
2. Chronic myeloproliferative syndromes.
3. Myelodysplastic syndromes.
4. Acute leukemias. (Essential topic)
5. Chronic lymphatic leukemia. (Essential topic)
6. Hodgkin lymphoma. (Essential topic)
7. Non-Hodgkin lymphomas. (Essential topic)
8. Congenital and acquired coagulopathies; disseminated intravascular coagulation. (Essential topic)

5th year program:
Male urinary and genital system
1. Vascular diseases of the kidney. (Essential topic)
2. Infections of the kidney, urinary tract, prostate. (Essential topic)
3. Renal, excretory and bladder cancers. (Essential topic)
4. Prostatic hypertrophy, prostate adenoma, intraepithelial neoplasia of the prostate, prostate cancer. (Essential topic)
5. Neoplastic and non-neoplastic pathology of the testicle. (Essential topic)
6. Malformations of the kidney and urinary tract.
7. Anatomopathological instruments for the diagnostic evaluation of the patient with hematuria (macroscopic or microscopic). (Essential topic)

Gynecological pathology
1. Gynecological infections: types, anatomopathological features, complications, outcomes.
2. Human papilloma virus (HPV) infection and carcinogenesis in genital and rectal epithelia. (Essential topic)
3. Primary preneoplastic and neoplastic lesions of the vulva, vagina and cervix: definitions, epidemiology, biological evolution, risk factors, histotypes, staging, prognostic factors, diagnostic algorithms. (Essential topic)
4. The Pap test (conventional and in liquid phase): purpose, target population, method of performing the sampling, diagnostic results, limits; Bethesda's reporting system. (Essential topic)
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. (Essential topic)
6. Endometritis and dysfunctional endometriopathy.
7. Endometriosis and adenomyosis.
8. Preneoplastic pathologies of the endometrium: glandular hyperplasia and EIN (endometrial intraepithelial neoplasia). (Essential topic)
9. Endometrial carcinoma: epidemiology, biological evolution, risk factors, histotypes, staging, prognostic factors, diagnostic algorithms. (Essential topic)
10. Primary non-epithelial benign and malignant neoplasms of the uterine body. (Essential topic)
11. Non-neoplastic and neoplastic pathology of the salpingi.
12. Ovarian neoplasms: histogenetic classification, epidemiology, main histotypes, biological evolution, staging, metastasis pathways. (Essential topic)
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. (Essential topic)
14. Locations of metastasis of epithelial neoplasms of the vulva, vagina, cervix uteri, uterine body, salpinx, ovaries. (Essential topic)
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. (Essential topic)
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. (Essential topic)
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. (Essential topic)
2. Anatomopathological aspects of infantile cerebral palsy.
3. Cystic fibrosis. (Essential topic)
4. Intestinal dysganglionosis (Hirschsprung disease; NID). (Essential topic)
5. Jaline membrane disease and its outcomes. (Essential topic)
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. (Essential topic)
2. Locations for metastasis of breast cancer. (Essential topic)

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. (Essential topic)
4. Modality of conservation and treatment of a skin biopsy in the differential diagnosis of bullous and autoimmune pathology. (Essential topic)
5. Benign and malignant skin epithelial tumors, with particular reference to: wart, seborrheic keratosis, keratoacanthoma, basal cell carcinoma, spinocellular carcinoma. (Essential topic)
6. Benign and preneoplastic pigmented lesions of the skin (compound, junctional, dermal, congenital melanocytic nevi, dysplastic nevi). (Essential topic)
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. (Essential topic)
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. (Essential topic)
12. Proliferative lesions and vascular malformations.

Oral pathology
1. Primary and metastatic benign and malignant neoplasms of the mucous membrane of the oral cavity. (Essential topic)
2. Craniopharyngioma.
3. Odontoblastic tumors.
4. Non-neoplastic pathology of the parotid and major salivary glands. (Essential topic)
5. Primary and secondary benign and malignant neoplastic pathology of the parotid.(Essential topic)

Pathology of the nervous system
1. Intracranial hemorrhages: sites, etiological and pathogenic factors, outcomes. (Essential topic)
2. Hypoxic-ischemic lesions of the central nervous system: sites, etiological and pathogenetic factors, outcomes. (Essential topic)
3. Meningitis and encephalitis: characteristics, etiological agents, complications. (Essential topic)
4. Demyelinating diseases.
5. Congenital malformations of the CNS.
6. Primitive and metastatic intracranial neoplasms: histotypes, staging, grading, complications. (Essential topic)
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. (Essential topic)
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). (Essential topic)
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.
The topics defined as essential in the course program are considered essential for passing 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