Department of Pathological

Anatomy
Head of the Department
V.A. Basynskyi

Academic staff

Associate Associate Associate Assistant

professor professor professor lecturer
Candidate of Candidate of Candidate of Kononov E.V.
medical sciences medical sciences medical sciences
A. V. Shulha
Literature for preparation
Definition
 Pathology (Pathologic Anatomy) is fundamental
biomedical science that studies the structural basis of
pathological processes of human disease
 PATHOLOGICAL ANATOMY – is a part of pathology
(“pathos”-disease), studying the different aspects of
disease. Pathological anatomy studies structural
(material) bases of diseases. This study serves as to
theory of medicine, as to clinical practice. Due to this
pathological anatomy is a scientific-applied subject.
 Pathology studies:
 Cell pathology
 Molecular basis, etiology, pathogenesis,
morphology and morphogenesis of
pathological processes and disease
 Thanatogenesis
 Pathomorphosis of disease
 Abnormal embryogenesis
 Develops classifications of disease
Pathomorphosis
 persistent and significant changes in quantity and quality
of the disease under the influence of various factors
(treatment, environmental factors, characteristics of
infectious agent, economic level of society)
Morphological
Modern Theory of
basis of the
pathology medicine
clinical
diagnosis
Pathology is divided into…
 General
 studies alteration, inflammation, hemodynamic disorders,
tumours, adaptation etc.
 Special
 studies organ pathology (kidney, liver, GIT, lung, heart, thyroid,
CNS etc.)
Problems of general pathology
 Synthesis of evidence obtained through a variety of
medical and biological research methods
 Etiology, pathogenesis, and morphogenesis of human
diseases
 Study of typical pathological processes
 Theoretic basis of medicine
Methods of Pathological Anatomy
 Biopsy - removal of tissue from a living subject to
determine morphological changes;
 Autopsy - post-mortem examination of a corpse to
determine the cause and manner of death and to
evaluate any disease or injury that may be present
 Experiment - modelling of pathological process on
animals and subsequent post-mortem examination
Types of biopsies
 diagnostic
 during surgery

 puncture (needle biopsy)

 aspiration
 excisional
 incisional
 scrape
Needle biopsy
Needle biopsy
Objectives of autopsy
 examination of the correctness of the diagnosis and
treatment
 establish the cause of death
 research
 teaching students and physicians
Legal authority of autopsy (in Belarus)
 Autopsy is performed mandatory:
 Suspicion of violent death;
 Death less then 1 day after admission to hospital;
 Death during surgery, diagnostic manipulations and/or
anesthesia;
 Death from infection;
 Suspicion of overdose or drug intolerance;
 Pregnant women, women in/after childbirth
 Children under 1 year.

 Autopsy can be not performed on religious

grounds
Iatrogeny
 (pronounced ī-a-trə-je-nē)
 is “pathology of treatment” - any unwanted or adverse
effects of preventive, diagnostic, therapeutic or surgical
interventions
 (preventable harm resulting from medical treatment or
advice to patient)
Levels of study
 organismal
 organ
 tissue
 cellular
 ultrastructural
 molecular
Modern methods in morphology
 Immunohistochemistry (IHC)
 Electron microscopy
 In situ hybridization (ISH)
 Polymerase chain reaction (PCR)
Immunohistochemical techniques
 It is based on specific interaction of tissue and cellular
antigens with a specially derived antibodies bearing the
different labels.

 Immunohistochemistry
 Immunofluorescence
Opportunities IHC
 Determination of cells belonging to a particular tissue;
 Identification of individual products (e. g. abnormal
proteins), routes of cellular and intercellular signals,
synthesis of certain proteins, glyco-and lipoproteins
Electron microscopy
 Used to study the details of cell structure, detection of
viruses, bacteria, immune complex deposits
 Examples of use:
 Oncology - Birbeck granules in histiocytosis X
 Oncology - Z-discs in rhabdomyosarcoma cells
 Nephrology - diagnosis of glomerulonephritis
In situ hybridization (ISH)
 Method for detection of specific sequences of DNA or
RNA in situ (i. e. directly in tissue specimens)
 It is based on principle of complementary interaction of
DNA or RNA in specimen with labelled nucleotide
sequence (probe)
In situ hybridization (ISH)
 Is used for:
 Detection of viral genomes
 Detection of mutant genes
 Detection of active protein synthesis (unlike IHC which allows
to determine the presence of a protein)
 IHC data validation
Polymerase chain reaction
 Method for detection of specific sequences of DNA or
RNA in any biological sample
 PCR is in vitro amplification (i. e. increase in the number
of copies) of nucleic acids triggered by synthetic
oligonucleotide primers
Polymerase chain reaction
 Differences from the in situ hybridization:
 Because of amplification it is more sensitive (about 1 million
times)
 Usually not combined with morphology
Historical periods of pathology
1. Anatomical (before XIX century)
 J. Morgagni (1685-1777)
 K. von Rokitansky (1804-1878) performed nearly 30,000
autopsies, wrote an outstanding monograph on diseases of
arteries and congenital heart defects
2. Microscopic (XIX century - mid-XX century)
 R. Virchow (1821-1902) – “father of cellular pathology”
3. Ultramicroscopic (mid-XX century)
4. Modern - pathology of a living person
Moscow School
 A.I. Polunin (1820-1888)
 M.N. Nikiforov (1858-1915)
 A.I. Abrikosov (1875-1955) - author of fundamental
multivolume handbook in special pathology, published a
lot of works about pathological morphology of
tuberculosis and tumors
 M.A. Skvortsov (1876-1963)
Moscow School
 I.V. Davidovsky (1887-1968) - one of the founders of
pathology services in USSR, author of manual in
pathology
 V.T. Talalaev (1886-1947)
 N.A. Krajewski (1905-1985)

 A.I. Strukov (1901-1988)

 V.V. Serov
 - authors of main textbook for medical students in USSR
Belarusian school
 Titov, Ivan T. (1875-1949)
 Gulkevichi Yuri V. (1905-1974)
 Lazyuk Gennady I.
 Kravtsova Garina I.
 Nedzved Michael K.
 Cherstvoy Eugene D.
Classical Autopsy techniques

 written in German by Rossle

1. Albrecht
2. Fischer
* 3. Ghon
4. Heller
* 5. Letulle
6. Nauwerck
* 7. Rokitansky
* 8. Virchow
9. Zenker

* Principal techniques
Principal Autopsy Techniques

 Technique by R. Virchow

organs are removed one by one

most widely used method with some

modifications
Principal Autopsy Techniques
 Technique of C. Rokitansky

in situ dissection combined with en bloc

removal
Principal Autopsy Techniques

 Technique of A. Ghon

thoracic and cervical organs, abdominal

and urogenital organs are removed as
organ blocks
Principal Autopsy Techniques

 Technique of M. Letulle

thoracic, cervical, abdominal and pelvic

organs removed en masse and dissected
into organ blocks

best suited for inspection of connections

between organs and organ system
Physical Examination
 The physical examination of the body is
broken up into two parts.
 External Examination
 The external examination consists of inspecting
the physical outer layer of the body for signs of foul
play that would result in injury or death.
 Internal Examination.
 The internal examination consists of inspecting the
internal organs of the body for evidence of trauma
or other indications of the cause of death.
Livor Mortis
 Defined as ‘Color of Death’.
 Coloration of the skin.
 At death, the heart stops working. When the heart
stops working, the blood stops pumping. The
blood stops pumping, the red blood cells and
plasma gather on the bottom part of the body,
closet to the floor.
 A line forms after 8 hours if the body hasn’t been
moved. If moved, a new line starts to form. It is
impossible to tell which was first. The thinker the
line, the longer the position the body was in.
Algor Mortis
 Defined as ‘Coolness of Death’.
 Temperature of body.
 In a controlled environment, stating at 98.6 degrees, the
body will drop one degree per hour.
 This happens because at death, the respiratory system stops
working, the body stops functioning, it is no longer moving.
 When taking the temperature of a corpse, you can’t take it in
the mouth because the muscles will be relaxed and the
tongue wont stay on top of the thermometer.
 Thinner people cool faster then fat people.
Rigor Mortis
 Defined as ‘Stiffness of Death’.
 Flexibility of the body.
 Shows up 2 hours after death
 Peaks 12 hours after death.
 Takes 12-24 hours for entire rigor mortis effect to take place.
 At approximately 0 hours after death, the body is at its
stiffest.
 The eyelids are affected first, the the jaw, face, trunk, arms,
legs.
 Ends after 24-36 hours.
Pallor Mortis
 Defined as ‘Paleness of Death’.
 Tone of the body.
 Happens 15-20 minutes after death.
 Happens due to lack of capillary circulation in the
body.
 Can not be used to determine time of death except
if body is found still with color.
Autopsy room
 External Examination

 Trace Evidence
 Sign of injury or
mistreatment
 Sign of illness,
disease, or
abnormalities

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Body Block

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nk Dissection
 Y-shaped
incision
 From the
shoulders to
the pelvic bone
 This incision is
deep
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Opening the Chest
 Skin & muscle,
are pulled from
the chest wall
 Chest Plate is
extracted
 Heart is
extracted
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Removal and Dissection of the
Organs
 One organ at a time
 All body organs at once - ”Rokitansky
Method”
 Upon removal each organ is:

 Weighed & measured

 Examined

 Sliced in cross sections

 Sampled for microscopic & chemical

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Sample
s

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Organ Containers bsapp.com
“Running the Gut”

The contents of the stomach,

intestines, and bowels must be
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Removing the Brain

The Scalp is
cut ear to ear
across the
crown of the
head

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 Exposing the Skull
Next the scalp is pulled forward and back to
expose the skull

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Exposing the Brain
Two methods of cutting the skull cap

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 Removal of the Brain
 Spinal Cord is cut
 The soft brain is
removed
 Brain is so soft it
must be placed in
formaldehyde for
about a week
before an in depth
examination
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 Close Up
 Skull cap is
replace
 Skin pulled back
in place
 Body Organs
may or may not
be replaced
 Incisions are
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Trends in autopsy rates at several
academic medical centers