Lecture program

Compulsory subject: 4 credits

Hours/week: lecture-2, practical works-2

General objectives: concepts necessary to understand the underlying cause of diseases, linking basic sciences and medical practice.

Specific objectives: acquiring knowledge of general pathology concerning fundamental processes at different structural levels; acquiring notions of systemic pathology concerning morphological changes in different diseases at the level of systems and apparatuses, indispensable to understanding the mechanism of their production and manifestations.

Disciplines it correlates with: correlates with a large number of preclinical disciplines (anatomy, embryology, histology, cell and molecular biology, pathophysiology) and with most clinical disciplines (surgery, internal medicine, urology, ENT, gynaecology, neurology, dermatology, oncology, etc.)

I. LECTURES

Lecture content. The lectures are systematized according to criteria already well known in general pathology and special (systemic) pathology. The general pathology lectures are held during the first semester and include basic notions on elementary lesions at cellular, tissue and organ level, on circulatory, inflammatory and neoplastic lesions. The systemic pathology lectures are held during the second semester and cover the pathology of the cardiovascular, respiratory, digestive, urinary, genital, endocrine glands, central and peripheral nervous and muscular systems.

GENERAL PATHOLOGY

1. INTRODUCTION: Framing pathological anatomy in the context of biomedical sciences; the object of study, historical development and importance of morphopathology.

2. ADAPTING, INJURY AND CELL DEATH: Etiology of cell/tissue adaption, injury and death; Cellular response to stress.

ADAPTING: Hypertrophy, Hyperplasia, Atrophy, Metaplasia
CELL INJURY AND DEATH:Reversible cell injury, Irreversible cell injury, Cell death: necrosis and apoptosis
LESIONS BY ACCUMULATION OF NORMAL AND ABNORMAL SUBSTANCES: Lesions due to carbohydrate metabolism disorder, Lesions due to lipid metabolism disorder, Lesions due to protein metabolism disorder, Lesions due to mineral metabolism disorder, Hyalinosis, Amyloidosis, Mucoid degeneration.

3. ENVIRONMENTAL AND NUTRITIONAL PATHOLOGY

ENVIRONMENTAL PATHOLOGY. Chemical Injury, Smoking, Alcohol, Drugs, Medications, Polluted Air.
NUTRITIONAL PATHOLOGY. Nutritional deficiencies: protein-calorie malnutrition, Obesity.

4. INFLAMMATION

GENERAL: General, history, definition, terminology.
ACUTE INFLAMMATION: Dynamics of acute inflammation: vascular changes, cellular phenomena, chemical mediators of inflammation; Morphological varieties of acute inflammation: catarrhal, serous, fibrinous, purulent, hemorrhagic, necrotizing; Evolution of acute inflammation.
CHRONIC INFLAMMATION: Dynamics of chronic inflammation: mononuclear infiltration, tissue recovery by fibrosis; Morphological varieties of chronic inflammation: diffuse, granulomatous; Tuberculosis: pathogenesis, dynamics of tuberculous inflammation, macroscopic aspects; Syphilis;Leprosy.
SYSTEMIC EFFECTS OF INFLAMMATION
HEALING: Regeneration, Repair/Organization, Morphological Varieties of Healing.

5. IMMUNE SYSTEM PATHOLOGY: General, Immune system disorders. Types of immune response, Hypersensitivity reactions, Autoimmune diseases, Immune deficiency diseases.

6. DISORDERS OF BLOOD, LYMPHATIC AND INTERSTITIAL FLUID CIRCULATION

DISORDERS OF BLOOD VOLUME AND DISTRIBUTION: hyperemia, hemorrhage, ischemia, shock.
CIRCULATORY DISORDERS OF OBSTRUCTIVE NATURE: thrombosis, embolism, ischemia, heart attack.
LYMPHATIC CIRCULATION DISORDERS
DISORDERS OF FLUID CIRCULATION IN INTERSTITIAL SPACES: edema.

7. NEOPLAKIA: General, limits, definition, terminology, classification

BENIGN TUMOURS: Terminology, Biomorphological characters (macroscopy, microscopy, evolution).
MALIGNANT TUMOURS: Terminology, Biomorphological features (macroscopy, microscopy, evolution), Evolution of the cancer process (initiation of the cancer process, local and regional extension phase, dissemination and metastasis phase), Regression, remission and tumor recurrence, Incidence of cancers, Etiology of cancers, Pathogenesis of cancers, Immunity in tumors.
MAIN TYPES OF TUMOURS: Epithelial tumours, Mesenchymal tumours, Nervous tumours, Melanocytic system tumours, Dysembryoplastic tumours, Tumours with unspecified histogenesis.

8. MALFORMATIONS

ETIOPATHOGENESIS OF MALFORMATIONS: Genetic factors, Environmental factors
MAIN TYPES OF MALFORMATIONS: Gametopathies, Blastopathies, Embryopathies, Fetopathies

SYSTEMIC PATHOLOGY

1. CARDIOVASCULAR PATHOLOGY

HEART PATHOLOGY: Malformations (necyanogenic, potentially cyanogenic, cyanogenic), Dystrophic lesions, Ischemic heart disease (myocardial infarction), Rheumatic disease, Endocarditis, Myocarditis, Pericarditis, Valvular heart disease, Heart tumours.
BLOOD VESSEL PATHOLOGY: Pathology of arteries (Degenerative arteriopathies, Acute and chronic arteritis, Aneurysms); Pathology of veins (Acute and chronic thrombophlebitis, Varicose veins); Tumours of blood vessels

2. RESPIRATORY TRACT PATHOLOGY

PATHOLOGY OF THE NOSE: Malformations, Acute and chronic rhinitis, Nasal tumours.
PATHOLOGY OF SINUSES: Acute and chronic sinusitis, Tumors.
PATHOLOGY OF THE LARYNX: Malformations, Acute and chronic laryngitis, Laryngeal edema, Tumour lesions.
TRACHEA PATHOLOGY: Malformations, Acute and chronic tracheitis, Tumours.
BRONCHIAL PATHOLOGY: Malformations, Bronchiectasis, Bronchial asthma, Acute and chronic bronchitis.
PATHOLOGY OF THE LUNGS: Malformations, Atelectasis, Emphysema, Inflammatory lesions (pneumonia, pulmonary suppuration, pulmonary tuberculosis), Circulatory lesions (pulmonary infarction, pulmonary thromboembolism, pulmonary oedema), Pneumoconiosis, Bronchopulmonary tumours.
PLEURAL PATHOLOGY: Acute and chronic pleurisy, Non-inflammatory pleural effusions, Tumours.

3. PATHOLOGY OF THE DIGESTIVE SYSTEM

ORAL CAVITY PATHOLOGY: Malformations, Acute and chronic stomatitis, Tumors
SALIVARY GLAND PATHOLOGY: Malformations, Salivary lithiasis, Salivary gland lesions in autoimmune diseases, Acute and chronic sialadenitis, Salivary gland tumors
OESOPHAGEAL PATHOLOGY: Malformations, Oesophageal varices, Acute and chronic oesophagitis, Oesophageal tumours
STOMACH PATHOLOGY: Malformations, Acute and chronic gastritis, Gastric ulcer, Gastric tumors
BOWEL PATHOLOGY: Malformations, Circulatory lesions (enteric mesenteric infarction), Inflammatory lesions (enteritis, colitis, appendicitis), Tumours
LIVER PATHOLOGY: Malformations, Circulatory damage (liver infarction), Acute and chronic hepatitis, Liver cirrhosis, Liver tumours
CHOLECYSTAL PATHOLOGY: Malformations, Choledochal lithiasis, Acute and chronic cholecystitis, Tumour lesions
EXOCRINE PANCREAS PATHOLOGY: Malformations, Acute and chronic pancreatitis, Tumour lesions
PERITONEAL PATHOLOGY: Acute and chronic peritonitis, Non-inflammatory peritoneal effusions, Tumours.

4. PATHOLOGY OF THE URINARY TRACT

KIDNEY PATHOLOGY: Malformations, Glomerular nephropathies (acute and chronic glomerulonephritis), Tubular nephropathies (acute and chronic tubulonephritis), Interstitial nephropathies (acute and chronic interstitial nephritis, acute and chronic pyelonephritis), Renal tuberculosis, Vascular nephropathies (nephrongiosclerosis, renal infarction, renal papillary necrosis), Hydronephrosis, Renal lithiasis, Tumors
URETERAL PATHOLOGY: Malformations, Acute and chronic ureteritis, Tumors
BLADDER PATHOLOGY: Malformations, Dystrophic lesions, Acute and chronic cystitis, Tumours
URETHRAL PATHOLOGY: Malformations, Acute and chronic urethritis, Tumours

5. PATHOLOGY OF THE FEMALE GENITAL TRACT

PATHOLOGY OF THE UTERUS: Malformations, Cervical metaplasia, Acute and chronic cervicitis, Cervical tumours, Dyshormonal endometrial lesions: endometrial hyperplasia, Acute and chronic endometritis, Endometrial and myometrial tumours: benign and malignant
SALPINGE PATHOLOGY: Acute and chronic PID, Tumours
PATHOLOGY OF THE OVARY: Acute and chronic ovaries, Ovarian tumours
MAMMARY GLAND PATHOLOGY: Malformations, Acute and chronic mastitis, Fibrocystic mastitis, Tumours

6. PATHOLOGY OF THE MALE GENITAL TRACT

PATHOLOGY OF THE TESTICLE AND EPIDIDYMIS: Malformations, Acute and Chronic Orchidididymitis, Tumors
PROSTATE PATHOLOGY: Malformations, Acute and chronic prostatitis, Tumors

7. LYMPHORETICULAR TISSUE TUMOURS

IMMUNE SYSTEM AND LYMPHOID NEOPLASIA
HODGKIN'S LYMPHOMA (HL) (HODGKIN'S DISEASE)
MALIGNANT NON-HODGKIN'S LYMPHOMA (HNML)

8. PATHOLOGY OF THE NERVOUS SYSTEM: Malformations, Circulatory lesions (meningo-cerebral haemorrhages, cerebral infarction, cerebral oedema), Inflammatory lesions (acute and chronic meningitis and encephalitis), Brain and peripheral nerve tumoursi

9. PATHOLOGY OF ENDOCRINE GLANDS

PATHOLOGY OF THE HYPOPHYSIS: Malformations, Pituitary Necrosis, Tumors
PATHOLOGY OF THE THYROID: Malformations, Glands, Acute and Chronic Thyroiditis, Tumors
PATHOLOGY OF THE ADRENALS: Malformations, Tumours
PATHOLOGY OF THE ENDOCRIN PANCREAS: Diabetes, Tumors

10. PATHOLOGY OF THE LOCOMOTOR SYSTEM

PATHOLOGY OF MUSCLES: Degenerative lesions, Myositis, Tumors
PATHOLOGY OF BONES: Dystrophic lesions, Acute and chronic osteitis and osteomyelitis, Tumours

II. PRACTICAL WORKS

Content of practical works. The first practical papers deal with the working methods and material used in pathological anatomy. Thereafter, the course topics are closely followed, comprising alternately presented microscopic and macroscopic preparations, covering general pathology and special pathology. Imaging is continuously supplemented with aspects of macroscopic preparations taken from own case reports or from existing image libraries in international databases that allow this. Practical works in general pathology include aspects of elementary lesions of cells, intercellular structures and tissues; aspects of inflammatory lesions; aspects of circulatory lesions; various aspects of benign and malignant neoplasms. Practical works on systemic pathology include aspects of diseases of the cardiovascular, respiratory, digestive, urinary, genital, endocrine glands and nervous system.

GENERAL PATHOLOGY

1. INTRODUCTION TO MORPHOPATHOLOGY / Pathological Anatomy General, Presentation of the Discipline of Morphopathology and the Laboratory of Pathological Anatomy.

2. WORKING METHODS. MICROSCOPIC METHODS in Pathological Anatomy: Cytology; Histopathology; Extemporaneous examination; Immunohistochemistry. NECROPSY: Notions of necropsy (death: definition, signs of death); necropsy technique; necropsy protocol: pathological diagnosis; Causes of death; Certificate of death - completion.

3. ADAPTATION, CELL/TISSUE INJURY AND DEATH, ACCUMULATIONS. ADAPTATION: Cardiac atrophy, Cardiac hypertrophy, Endometrial hyperplasia, Nodular benign prostatic hyperplasia, Endocervical squamous metaplasia, Endosquamous metaplasia of the gastric epithelium

REVERSIBLE AND IRREVERSIBLE INJURIES: Hepatocyte vacuolar degeneration, Renal tubular epithelial vacuolar degeneration, Hepatocyte apoptosis, Coagulation necrosis (renal infarction), Liquefaction necrosis (liver abscess), Cytosteatonecrosis, Caseation necrosis (tuberculosis).

ACCUMULATIONS. Hepatic steatosis, Cardiac lipomatosis, Atheromatosis, Gaucher disease, Hepatic glycogenosis, Gouty tophi, Gouty nephropathy, Hepatic hemochromatosis, Hyaline degeneration, Renal amyloidosis, Dystrophic calcifications. Gouty tophi, Gouty nephropathy, Hepatic hemochromatosis, Hyaline degeneration, Renal amyloidosis, Dystrophic calcifications

4. INFLAMATION.

ACUTE INFLAMMATION: Fibrinous pericarditis, Pneumonia franca lobaris, Purulent meningitis, Liver abscess.

CHRONIC INFLAMMATION: Chronic parotitis, Granulation tissue, Cholesterol granuloma, Cutgut granuloma, Tuberculous granuloma, Gouty tuft, Scar, Keloid

5.CIRCULATORY LESIONS. INTERSTITIAL FLUID CIRCULATION DISORDERS: Acute pulmonary oedema. BLOOD CIRCULATION DISORDERS:

Stasis lung, Stasis liver, Recent thrombus, Arterial thrombus on the way to organization, Myocardial infarction and complications, Splenic infarction, Renal infarction, Pulmonary infarction

6. TUMOURS (NEOPLASIA).

BENIGN TUMOURS: Cutaneous papilloma, Condyloma, Colic polyp, Ovarian chystadenoma, Breast fibroadenoma, Lipoma, Hemangioma, Cardiac rhabdomyoma, Uterine leiomyoma, Chondroma, Osteoma, Schwanoma, Dermoid cyst.
MALIGNANT TUMOURS: Cervical dysplasia (CIN), Gastric dysplasia, Carcinoma in situ, Atypical mitosis, Well-differentiated squamous cell carcinoma, Verrucous carcinoma, Adenoid squamous cell carcinoma, Basaloid squamous cell carcinoma, Basal cell carcinoma and variants (keratinized, cylindromatous, sclerosing), Well-differentiated adenocarcinoma, Gastric muciparous carcinoma, Sclerosing mammary carcinoma, Invasive ductal mammary carcinoma, Myxoid liposarcoma, Well-differentiated leiomyosarcoma, Pleiomorphic rhabdomyosarcoma, Poorly differentiated angiosarcoma, Chondrosarcoma, Osteosarcoma, Cutaneous malignant melanoma, Neoplastic embolus, Perineural invasion, Lymph node metastasis of squamous cell carcinoma

SYSTEMIC PATHOLOGY

1. CARDIOVASCULAR PATHOLOGY. MALFORMATIONS: Heart Dextroposition, Interatrial Septal Defect, Interventricular Septal Defect. CIRCULATORY INJURIES: Myocardial infarction and complications (cardiac rupture, cardiac tamponade)

Heart attack. INFLAMMATIONS: Fibrinous pericarditis, Rheumatic myocarditis, Verrucous endocarditis, Bacterial endocarditis, Myocarditis, Adult type rhabdomyoma, Mediocalcinosis.

2. PATHOLOGY OF THE RESPIRATORY TRACT. Allergic polyps, Laryngeal carcinoma, Moderately differentiated squamous cell carcinoma, Chronic pulmonary emphysema, Acute respiratory distress syndrome, Pulmonary thrombosis, Pulmonary infarction, Frank lobar pneumonia, Bronchopneumonia with disseminated foci, Interstitial pneumonia, Pulmonary tuberculosis, Squamous cell carcinoma, Adenocarcinoma in situ (lepidic), Adenocarcinoma, TTF1 immunolabelling, Acute fibrinous pleurisy, Pahypelolithiasis, Pleural mesothelioma.

3. PATHOLOGY OF THE DIGESTIVE SYSTEM.

ORAL CAVITY/SALIVARY GLANDS: Vegetative carcinoma lower lip, Moderately differentiated keratinized squamous cell carcinoma, Squamous cell carcinoma immunolabel AE1-AE3, Chronic nonspecific sialadenitis, Pleiomorph adenoma, Chistadenolymphoma, Mucoepidermoid carcinoma, Adenoid cystic carcinoma, Adenoid cystic carcinoma immunolabel AE1-AE3

ESOFAG: Infiltrative esophageal carcinoma, Well-differentiated squamous cell carcinoma, Moderately differentiated adenocarcinoma

STOMACH: Chronic atrophic gastritis, Chronic infectious gastritis with intestinal metaplasia and low-grade dysplasia, Chronic hypertrophic gastritis, Acute gastric ulcers, Chronic gastric ulcer, Infiltrating gastric carcinoma, Gastric carcinoma of well-differentiated intestinal type, Diffuse gastric carcinoma, Gastric carcinoma with "signet ring" cells, Gastric mucinous carcinoma, CK7 immunolabelled gastric carcinoma

4. PATHOLOGY OF URINARY TRACT.

KIDNEYS: Renal fusion, Acute polycystic kidney disease, Diffuse acute glomerulonephritis, Chronic glomerulonephritis, Acute tubulonephritis, Acute pyelonephritis, Chronic pyelonephritis, Malignant nephroangiosclerosis, Recent renal infarction, Bilateral renal papillary necrosis, Hydronephrosis, Clear cell carcinoma, AE1/AE3 immunolabelled clear cell carcinoma and Vimentin.
URETER: Double ureter.
URINARY BLADDER: Conventional papilloma, Low grade non-invasive papillary urothelial carcinoma, Low grade invasive urothelial carcinoma, Vegetal urothelial carcinoma, CK7 and CK20 immunolabelled invasive urothelial carcinoma

5. PATHOLOGY OF THE FEMALE GENITAL TRACT.

UTERINE COLLAR: Cervical condyloma, Low and high grade cervical intraepithelial neoplasia, Carcinoma in situ, CIN immunolabeling p16 and Ki67, Microcarcinoma , Keratinized and non-keratinized squamous cell carcinoma

UTERINE BODY: Acute purulent endometritis, Endometritis TBC, Endometrial hyperplasia with and without atypia, Uterine leiomyoma, Endometrial endometroid carcinoma, Endometrial serous carcinoma.

OVAR: Serous cystadenoma, Borderline serous tumor, Low and high grade serous carcinoma, Mucinous cystadenoma, Mucinous carcinoma, Ovarian fibroma, Granulosa cell tumor, Sertoli-Leydig cell tumor, Dysgerminoma, Mature teratoma, Ovarian metastasis from appendiceal carcinoma.

MAMMARY GLAND: Fibrocystic mastosis, Fibroadenoma, Ductal carcinoma in situ, Invasive ductal breast carcinoma

6. PATHOLOGY OF THE MALE GENITAL TRACT. PROSTATE PATHOLOGY: Benign nodular hyperplasia of the prostate, Prostate carcinoma. PATHOLOGY OF THE TESTICULOS: Chronic orchididitis, Seminoma

7. PATHOLOGY OF THE ENDOCRINE SYSTEM. Anisopholic goiter, Basedow's goiter, Hashimoto's thyroiditis, Papillary thyroid carcinoma

8. PATHOLOGY OF THE CENTRAL NERVOUS SYSTEM AND LYMPH NODES. PATHOLOGY OF THE CENTRAL NERVOUS SYSTEM: Cerebral Haemorrhage, Cerebral Ramiolysis, Meningioma. PATHOLOGY OF THE LYMPH NODES: Hodgkin's disease

BIBLIOGRAPHY

1. Simionescu C, Margaritescu C, Ciurea RN, Stepan AE, Morfopatologie generala, Ed. Medicală Universitară, 2018.

2. Simionescu C, Margaritescu C, Ciurea RN, Stepan AE, Morfopatologie sistemica, Ed. Medicală Universitară, 2018.

3. Ciurea R, Stepan A, Mărgăritescu C, Simionescu C. General Pathology- Lectures, Editura Medicala Universitara Craiova, 2020.

4. Stepan A, Ciurea R, Mărgăritescu C, Simionescu C. Systemic Pathology- Lectures, Editura Medicala Universitara Craiova, 2020.

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11. Goldblum JR, Folpe AL, Weiss SW. Enzinger & Weiss’s Soft Tissue Tumors, 7th Edition, Elsevier, 2020.

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13. Tuffaha M, Guski H, Kristiansen G. Immunohistochemistry in Tumor Diagnostics. Springer, 2017.

EXAMINATION PROCEDURE

seminars: grid tests (4 / semester)
practical works: oral/ grid
lecture: oral/ grid