Attendance and successful examination in:

i. General Morphology ii. Specific Morphology

FACE TO FACE LECTURES, DISTANCE LEARNING VIA SUITABLE PLATFORM

• Powerpoint
• Use of light microscope to observe laboratory digital and non-digital slides.

Examination:

• Theory: multiple choice test, true/false questions, short answer questions, oral examination of students with special educational needs

• Microscopy: examination on digital and/or non-digital laboratory slides, based on what the students have learned during the semester.

Course evaluation: online, anonymous.

The aim of this course is to introduce students to the morphological changes that develop in tissues and organs of all systems in pathological conditions, in precancerous lesions-dysplasias as well as in benign and malignant neoplasms. Furthermore, the course provides students with the fundamentals of the pathogenetic mechanisms, epidemiological data, and clinical correlations of specific diseases. Special emphasis is given on the study of the classic histopathological characters, as well as the recent molecular-cytogenetic findings of tumors with prognostic and predictive significance.

Upon successful completion of the course, the student will be able to use the acquired knowledge to: 

• Understanding of the classical morphological changes that occur in human tissues and organ systems
• Recognize, through special histological techniques, the differences between normal tissue structures and lesions related to inflammatory diseases, precancerous lesions, and neoplasms
• Correctly using terminology and combine it with basic knowledge from other subjects
• Understanding and analyzing the histopathological and molecular biomarkers of neoplasms with prognostic and/or predictive significance
• Collaborate with fellow students in searching literature and writing scientific articles – interesting clinical cases, as well as participating in conference presentations.

General Abilities

The Pathology Laboratory organizes courses, workshops, post-educational meetings and actively participates in research and conferences aimed at:

• Promotion of knowledge and medical ethics, with rules of ethics, which serve the recent needs of the student-future doctor as well as society needs.
• Promotion of knowledge and research, within a free academic environment, aiming at the highest quality educational level.
• High-level research, published in contemporary highly prestigious scientific Journals.
• Education of students, in order to understand the modern medical thought, the way research is conducted, theories and methodological approaches related to morphology of human body tissues and the multistage process of carcinogenesis.

The goal is the preparation of students, capable of further continuing their studies within our university as well as their successful careers.

Module 1

Oral cavity and gastrointestinal system diseases. Congenital and mechanical anomalies of the esophagus, Achalasia, Mallory-Weiss syndrome, Gastroesophageal reflux, Barrett’s esophagus, Adenocarcinoma, esophageal squamous cell carcinoma, CMV esophagitis, Herpes esophagitis, Candida albicans esophagitis, Pyloric stenosis, Acute hemorrhagic gastritis, gastric ulcer, Chronic gastritis, autoimmune atrophic gastritis, Intestinal gastric carcinoma, diffuse type, Hypertrophic gastritis, GIST, Hirschsprung’s disease, Whipple’s disease, Crohn’s disease, ulcerative colitis, indeterminate colitis, Toxic megacolon, Ischemic bowel disease, Pseudomembranous colitis, infectious colitis, Angiodysplasia, Appendicitis, Tubular, villous adenomas, Colon adenocarcinoma, Familial adenomatous polyposis, Lynch syndrome, Carcinoid, Diverticular bowel.

Module 2

Liver diseases. Liver cirrhosis, inflammations such as hepatitis, chronic – acute hepatitis, alcoholic hepatitis, alcoholic steatosis, hemochromatosis, Liver disease from α1-AT deficiency. Primary biliary cirrhosis, genetic alterations of hemochromatosis, Wilson’s disease, Drug-induced liver changes, cholangiopathies, Primary sclerosing cholangitis, Budd-Chiarri syndrome, Chronic passive hyperemia of the liver, hemangioma, benign and malignant neoplasms.

Module 3

Pancreas, Bile duct: inflammatory diseases, benign, malignant neoplasms. Acute – chronic pancreatitis, Types of diabetes. Adenocarcinoma of the pancreas, Pancreatic endocrine tumors – MEN 1, 2, gallstones, risk factors and mechanisms of formation, different types of gallstones, Cholesterolosis, Acute cholecystitis, Chronic cholecystitis, Gallbladder carcinoma parameters.

Module 4

Breast: Benign lesions and neoplasms. Clinical significance of specific cytogenetic alterations-therapeutic targets. Brief review of normal microscopic structure. Clinical problems in which the investigation involves biopsy. Fibrocystic lesions: the mistaken view of the disease and the therapeutic implications, in the distant past, Pathogenetic interpretations, Clinical significance of cystic lesions. Hyperplastic breast lesions with an increased risk of developing cancer. Typical and atypical intraductal hyperplasia. DIN. Intraductal carcinoma of the breast.  Microfiltration in intraductal carcinoma. Paget’s disease of the breast. Small duct papillomas.  Large pore papillomas. Lobular carcinoma in situ. LIN (lobular intraepithelial neoplasia). Nodule-like carcinoma (NOS). Ductal-type carcinoma. Indicative morphological images of NOS. Grade and generally prognostic indicators (ER, PR, Her2). Infiltrating lobular carcinoma: morphological images, diagnostic difficulties. Special evidence for the biological behavior of lobular carcinoma. Myeloid carcinoma. Mucinous carcinoma. Tubular carcinoma of the breast. Radiant scar: morphology, its imaging appearance as a “possible” neoplastic lesion. Sclerosing adenosis: morphology and how it mimics carcinoma. Adenosis from small adenomas. Porectasia. Inflammatory carcinoma: morphology, clinical and prognostic associations. Familial breast cancer: basic information. Ancillary prognostic indicators. Examples of applications of such markers in histopathology. Fibroadenoma. Leafy tumor. Gynecomastia.

Modules 5-6

Female reproductive system: Diseases of the vulva, vagina, cervix, endometrium-myometrium, ovaries-fallopian tube diseases, trophoblastic disease of pregnancy. Warts: macroscopic and microscopic morphology. Virus detection by in situ hybridization. VIN: morphology and the concept of intraepithelial neoplasia, reference to flat wart. Vulvar squamous cell carcinoma: clinical picture, morphology, prognostic indicators. Leukoplakia: use and abuse of the term, histopathologically respectively. Lichen sclerosus/atrophic: macroscopic and microscopic morphology, etiopathogenetic correlations. Relationship to vulvar carcinoma. Paget’s disease of the vulva: macroscopic and microscopic appearance, associations, and differential diagnosis. Papillary hidradenoma: differential diagnosis (clinical) and morphology, (macroscopic and microscopic image). Cystic dilatation of the Bartholinian duct: clinical and morphological picture.

VAIN: morphology, relation to HPV types, Atrial adenosis: macroscopic and microscopic picture. Aetiological associations, with an emphasis on the possible development of carcinoma.

Fibroepithelial sinus polyp: macroscopic and microscopic picture. Possible problems from insufficient histopathological diagnosis. Embryonic rhabdomyosarcoma (botryoid): Clinical – macroscopic picture and histopathological picture. Basic epidemiological and prognostic data.

Intraepithelial neoplasia. Criteria for distinguishing the various degrees of intraepithelial neoplasia (in the squamous epithelium). Basic principles in exfoliative cytology. Image and “concept” of microinvasive (or “superficially invasive”) carcinoma. Invasive squamous cell carcinoma of the cervix: macroscopic images, staging. Microscopic morphology and histological grading criteria. Risk factors for “developing” cervical squamous cell carcinoma. Cervical adenocarcinoma: microscopic morphology, emphasis on the diagnosis of adenocarcinoma in situ and the clinical significance of this diagnosis. Ancillary diagnostic markers (simple reference). Endocervical polyp: morphology (macroscopic and microscopic), clinical appearance. Cervicitis: colposcopic image. Diagnostic approach, etiology. The concept of pelvic inflammatory disease and its distribution. Clinical presentation and complications.

Endometrial hyperplasia: morphology and comparison with endometrial polyp. Macroscopic and microscopic differences. Morphological picture of simple hyperplasia, complex hyperplasia, atypical endometrial hyperplasia. Early cancerous or precancerous lesions. Relationship between polyp and endometrial carcinomas.

Endometrial carcinoma: Macroscopic view and microscopic image. Distinguish from complex / atypical hyperplasia. Various histopathological types and corresponding models of carcinogenesis. Grading criteria. Relative frequency. Depth of infiltration as a prognostic factor and its application in daily surgical practice. Staging of endometrial carcinomas.

Endometrial stromal sarcoma: Macroscopic and imaging picture. Basic / diagnostic microscopic images. Differentiation of low grade and high-grade stromal sarcoma and its biological significance.

Malignant mixed Müllerian tumor of the endometrium: Macroscopic view and microscopic findings. Biological behavior. Potential diagnostic problems due to inappropriate specimen or incomplete histopathological evaluation.

Leiomyomas: Frequency, biological behavior, clinical presentation. Macroscopic image. Miniature pictures. Degenerative atypia and the importance to avoid misdiagnosis.

Leiomyosarcomas: What are the “diagnostic criteria” and how pathologists use them for evaluation. The diagnostic value of mitoses and a certain type of necrosis.

Adenomyosis: Frequency, clinical presentation. Macroscopic image. Microscopic image. Potential problem in assessing the depth of infiltration of coexisting carcinoma.

Endometriosis: What is it, “definition”. Clinical events. Morphological findings. Chocolate cysts. Variety of locations. Relationship to cancer development. Emphasis on unusual findings and their importance in daily diagnostic practice.

Classification of primary ovarian neoplasms. Neoplasms of the “pluripotent” surface epithelium of the ovary. Borderline malignant tumors. Ovarian serous tumors. Ovarian mucinous tumors. Endometrioid neoplasms of the ovary: Morphology and biological behavior. Clear cell carcinoma of the ovary. Brenner tumors of the ovary. Thecoma: Relationship with endometrial diseases. Ovarian granulocytic tumors: Macroscopic and microscopic images. Biological behavior and the importance of early diagnosis. Sertoli – Leydig tumors: Differentiation and “functional” events. Biological behavior. Germ cell tumors of the ovary: Correspondence with corresponding testicular tumors where the study of morphology is referred. Morphology of mature cystic teratoma and morphology of aurora / malignant teratoma. Reference to the grading system based on the percentage of the aurora neuroepithelial element. Reference to other tumors which may grow in teratoma terrain. The role of the pathologist in the assessment of the biological behavior of teratomas. Krukenberg tumor: Macroscopic and microscopic picture. Biological behavior. Possible primary foci. Differentiation from ovarian tumors with a similar macroscopic picture.

Chronic salpingitis. Ectopic, tubal pregnancy.

Gestational trophoblastic disease: multiple pregnancy and choriocarcinoma.

Full molar pregnancy: Pathogenesis. Possible “complications”. Partial molar pregnancy: microscopic picture and comparison with full molar pregnancy. The difficulty in morphological diagnosis. Pathogenesis. Biological behavior.

Infiltrative molar pregnancy: Pathogenesis. Relationship between vascular infiltration and various clinical manifestations. Choriocarcinoma: Macroscopic and microscopic picture. The role of molecular methodology to identify the “substrate” on which it developed. Metastases. The role of early chemotherapy and therefore early diagnosis.

Spontaneous wave abortions: Causes and mechanisms by trimester. Causes during the first trimester. Ectopic pregnancy (morphology and locations). Basic facts about the structure of the placenta. Causes during the second trimester. Chorioamnionitis, macroscopic and microscopic images. Meconium staining, morphology, and forensic significance. Spontaneous miscarriages in the 3rd trimester, a brief overview of the causes. The two main causes of bleeding before delivery. Twin pregnancy. Inflammation of placental villi. Basic umbilical cord abnormalities.

Modules 7-8

Kidney and urinary tract: benign lesions and neoplasms. Glomerulonephritis, glomerular diseases – nephrotic syndrome. Inflammations – acute-chronic pyelonephritis, Berger’s disease, Diabetes mellitus glomerulopathy, Potter syndrome, Alport syndrome (hereditary nephritis), Nephritis from circulating/local immune complexes.

Kidney neoplasms. Differential diagnosis elements of focal papillary tubular hyperplasia. Similarities and differences of various histopathological types of renal cell carcinomas. Grading criteria. Contribution of immunophenotyping to the differential diagnosis of histological types of renal cell carcinomas. Grading criteria. Contribution of immunophenotyping to the differential diagnosis of histological types of renal carcinomas. Molecular/genetic analyses and the differentiation of renal cell carcinomas into distinct entities. Pediatric kidney tumors – nephroblastoma – mesoblastic nephroma.  Angiomyolipoma: pathogenesis, immunophenotype, PEComas. Problems in the diagnosis of cystic neoplasms of the kidney. Identification of metastatic renal cell carcinoma (classic and rare examples of differential diagnosis with an emphasis on possible errors).

• Tumors of the urinary bladder and urinary tract (kidney caps, renal pelvis, ureter, and urethra)
• Papillomas. Carcinomas from transitional epithelium (urothelial). In situ carcinoma from transitional epithelium. Biological behavior of bladder cancers (p16, p53, FGFR3 mutations). Grade of malignancy (grading), differentiation-depth of infiltration and clinical significance.

Modules 9-10

Male reproductive system: diseases of testicles, penis, and prostate gland. Orchitis tuberculous, granulomatous. Testicular torsion. Spermatocele, seminal granuloma. Testicular neoplasms: seminoma, embryonal carcinoma, choriocarcinoma, teratoma. Etiology of male infertility. Leydig, Sertoli cell tumors. Penile squamous cell carcinoma. Acrochordon carcinoma.  Papillomatosis – HPV role. Hypospadias.

Prostatic hyperplasia. Difficulties in evaluating the PIN. Adenocarcinoma of the prostate. The importance of the Gleason score in the management of patients, familiarity with staging, morphological problems in needle-biopsy diagnosis, the role of immunohistochemistry, the importance of distinguishing ductal carcinoma. Morphology of chronic prostatitis and malacoplakia. Quality problems in the management of biopsy material in the laboratory.

Module 11

Cardiovascular diseases. Congestive heart disease. Left ventricular failure (pulmonary edema, heart failure macrophages). Right ventricular failure (congestion of soft tissues and abdominal viscera, “muscocaryoid” liver). Ischemic (coronary) heart disease. Myocardial infarction. Chronic ischemic heart disease. Hypertensive heart disease. Pulmonary heart (acute and chronic pulmonary heart and morphological changes).

Valvular heart diseases: Rheumatic fever. Aortic stenosis from calcification. Mitral valves prolapse. Non-microbial thrombotic endocarditis. Infective endocarditis. Myocarditis. Cardiomyopathies. Congenital heart diseases. Atrial septal defects. Defects of the mediastinal septum. Patent ductus arteriosus. Tetralogy of Fallot . Displacement of large vessels). Stenosis of the aortic isthmus. Pericarditis. Neoplasms of the heart:  Myxoma. Rhabdomyoma. Metastatic heart neoplasms.

Diseases of the arteries: Atherosclerosis: epidemiological data, risk factors, association of hypercholesterolemia with atherosclerosis, pathogenesis, mechanism and stages of atherosclerotic plaque formation, role of macrophages and their cytokines in the progression of atherosclerotic plaque. Complications of atherosclerotic plaques (calcification, ulceration, thrombosis, bleeding, aneurysm) and their clinical significance.

Hypertension and hypertensive vascular disease: types and mechanisms of hypertension.  Histopathological alterations of blood vessels in hypertension.

Vasculitis: definition, classification. Polyarteritis nodosa (localization, pathogenesis, morphology, Wegener’s granulomatosis, Microscopic polyarteritis, Temporal (giant cell) arteritis, Arteritis Takayasu, Obstructive thromboangiitis (Berger’s disease).

Aneurysms: types of aneurysms. Atherosclerotic aneurysms of the abdominal aorta, Syphilitic aortitis and syphilitic aneurysm (location, pathogenesis, morphology, CPAS), Dissecting aortic aneurysm (location, pathogenesis, morphology, association with Marfan syndrome).

Diseases of the veins: Varicose veins, Phlebothrombosis and thrombophlebitis, Superior vena cava and inferior vena cava syndrome

Diseases of the lymphatic system: Lymphangitis. Primary and secondary lymphedema Vascular neoplasms. Cavernous and capillary hemangiomas. Glomangioma (glomus tumor). Hemangioendothelioma. Angiosarcoma. Kaposi’s sarcoma. Types, morphology (depending on stage), association with AIDS, comments on HHV-8 etiology.

Module 12

Molecular mechanisms of carcinogenesis. Genetic alterations – mutations, rearrangements, translocations, oncogene and tumor suppressor gene alterations, major signaling pathways

.

 Title: General and systematic pathology

by: UNDERWOOD JAMES C.E., CROSS SIMON S.

ISBN: 9789605835668