tonegawasusumu1987 nobel prize antibody diversity basel old university
TRANSCRIPT
TONEGAWATONEGAWA SusumuSusumu
1987 1987 Nobel prizeNobel prizeantibody diversityantibody diversity
BASELBASEL
old university
FREIBURGFREIBURG
TAWARA, SunaoTAWARA, Sunao1906 1906 cardiac conducting systemcardiac conducting system
IMAI Michiko et al. IMAI Michiko et al. 23.7.196923.7.1969Japanese direttissima routeJapanese direttissima route
EIGEREIGER north face - „top of Europe“ north face - „top of Europe“
Teaching Modules Teaching Modules in in
Pathology EducationPathology Education
Prof. Dr. Urs-N. Riede, Department of Pathology, University of FreiburgProf. Dr. Urs-N. Riede, Department of Pathology, University of Freiburg
Textbook: Textbook: Georg Thieme, Stuttgart – New York Georg Thieme, Stuttgart – New Yorkfirst edition 1986 second edition 1988first edition 1986 second edition 1988
Textbook: Textbook: Georg Thieme, Stuttgart – New York Georg Thieme, Stuttgart – New Yorkthird edition 1992 forth edition 1998third edition 1992 forth edition 1998
Textbook: Textbook: Georg Thieme, Stuttgart – New York Georg Thieme, Stuttgart – New Yorkfifth edition 2004 chinese editions 1998, 2004fifth edition 2004 chinese editions 1998, 2004
Color atlas: Color atlas: Georg Thieme, Stuttgart – New YorkGeorg Thieme, Stuttgart – New Yorkgerman edition 1998 german edition 1998
Color atlas: Color atlas: Georg Thieme, Stuttgart – New YorkGeorg Thieme, Stuttgart – New Yorkenglish edition 2008 greek edition 2009 english edition 2008 greek edition 2009
teaching in pathology:teaching in pathology:aims aims
- The pathologic diagnosis of a disease results The pathologic diagnosis of a disease results from the superposition of formal reaction from the superposition of formal reaction patterns. patterns.
- The diagnosis of formal reaction patterns The diagnosis of formal reaction patterns requires the analysis of a few structural and requires the analysis of a few structural and color changes.color changes.
- The stepwise analysis of the formal reaction The stepwise analysis of the formal reaction patterns elucidates the progress of a disease.patterns elucidates the progress of a disease.
Textbook: Textbook: Springer Heidelberg – New York – Tokyo 2009Springer Heidelberg – New York – Tokyo 2009
BASICS IN GENERAL AND SPECIAL PATHOLOGYBASICS IN GENERAL AND SPECIAL PATHOLOGY
new:new:learning moduleslearning modules
- structural patternstructural pattern- contour patterncontour pattern- consistency patternconsistency pattern- color pattern …color pattern …
teaching in pathology:teaching in pathology:modulesmodules
- Substructuring of a lesion into formal reaction Substructuring of a lesion into formal reaction patternspatterns
- Pathobiologic explanation of the reaction Pathobiologic explanation of the reaction patterns patterns
- Assembling of distinct reaction patterns to a Assembling of distinct reaction patterns to a diagnosisdiagnosis
- Reconstruction of the pathogenetic sequenceReconstruction of the pathogenetic sequence- Training by cases of a virtual autopsyTraining by cases of a virtual autopsy
quick-fix diagnosis:quick-fix diagnosis:
facial skin lesionsfacial skin lesions
The patient suffered from The patient suffered from lupus erythematodeslupus erythematodes
But why did she die?But why did she die?
diagnosis by pattern analysisdiagnosis by pattern analysis
color color redred
patternpattern - inflammation- inflammation- bleeding disorder- bleeding disorder
formal formal macrofocalmacrofocal
patternpattern - lupus erythema- lupus erythema
microfocalmicrofocal- purpura- purpura
distributiondistribution multiple multiple
patternpattern - septic purpura- septic purpura
patterns of expansionpatterns of expansionmacrofocalmacrofocal
skin erythemaskin erythema
microfocalmicrofocal
miliary TBCmiliary TBClung cancerlung cancer
macrofocalmacrofocal
secondarysecondarytumortumor
(uni-) (uni-) macrofocalmacrofocal
primary primary tumortumor
destructiondestruction
patterns of distribution patterns of distribution
microfocalmicrofocal
inflammationinflammation
multifocalmultifocal
systemicsystemic
generalisedgeneralised
bleeding bleeding disorderdisorder
discontinuousdiscontinuous
inflammationinflammation
cancercancer
cancercancer
dis-/continuousdis-/continuous
spreading patternsspreading patterns
inflammationinflammation
cancercancer
cavitarycavitary
cancercancer
lymphaticlymphatic
cancercancer
inflammationinflammation
cancercancer
haematogenoushaematogenous
coag
ulo
pat
hy
coag
ulo
pat
hy
infl
amm
atio
nin
flam
mat
ion
cancercancer
cancercancer
contour patternscontour patterns
instillation / infiltration:instillation / infiltration: - gaz- gaz > emphysema > emphysema - water- water > edema > edema - cells- cells > inflammation > inflammation
> malignoma> malignoma
fuzzycontours
melanomamelanoma
skin erythemaskin erythema
destruction:destruction: - ischemia- ischemia > infarction > infarction - inflammation- inflammation > abscess > abscess
proliferation:proliferation: > benignoma> benignomaretention:retention: > (pseudo) cyst> (pseudo) cyst
sharp sharp contourscontours
abscessabscess
lipomalipoma
cystcyst
structural patterns structural patterns
diffus
diffusediffuse
erythemaerythema
skinskin
netlikenetlikereticularreticular
lunglung
lymphangiosislymphangiosis fibromafibroma
whirledwhirledstripedstriped
musclemuscle
fat interpositionfat interposition
surface patternssurface patternspseudo-pseudo-membranemembrane
epidermisepidermismucosamucosa
subcutissubcutissubmucosasubmucosa
erosionerosion ulcerulcer polyppolyp
steric patternssteric patterns
hollow spherehollow sphere
cysticcysticpseudocysticpseudocystic
diffusediffuse
diffusediffuse
spheresphere- large: nodularlarge: nodular- small: granularsmall: granular
granular nodulargranular nodular
hard hard
fibrosisfibrosis
consistency patternsconsistency patterns
pulpy pulpy
proteolysisproteolysis
fluid fluid
firm-elastic firm-elastic
liquefactionliquefaction
liquid liquid
very hard very hard
ossificationossification
softsoft
soft tissuesoft tissue
brittle brittle
proteolysisproteolysis
siderosissiderosis
hemosiderinhemosiderin
icterusicterus
bilirubinbilirubin
cholestasischolestasis
bilebile
color patterns: e.g. color patterns: e.g. liver liver
leucemia (CLL)leucemia (CLL)
cell infiltrationcell infiltration
neutral fatneutral fat
melaninmelanin
melanomamelanoma
fatty degenerationfatty degenerationnormal (perfusion)normal (perfusion)
- hemoglobin- hemoglobin
normal normal
+ oxy-+ oxy-hemoglobinhemoglobin
cyanosiscyanosis
desoxy-desoxy-hemoglobinhemoglobin
carcinomacarcinoma
color patterns: color patterns: whitewhite
coagulationcoagulation
Tyndall-effect because ofTyndall-effect because of
- coagulation- coagulation
leukoplakialeukoplakia pleuritispleuritis
- increase of cells- increase of cells
myofibromamyofibroma
- increase of collagen- increase of collagen- increase of keratin- increase of keratin
- increase of fibrin- increase of fibrin
color patterns: color patterns: red red
pheomelaninpheomelanin
solar erythemasolar erythema
oxyhemoglobin oxyhemoglobin redred
tyrosinogenoustyrosinogenousyellow-redyellow-red
tyrosinogenoustyrosinogenousyellow-redyellow-red
porphyria / urinporphyria / urinlivoreslivores
desoxyhemoglobindesoxyhemoglobinredred
cyanosiscyanosisinflammation inflammation (chemosis)(chemosis)
patterns of hollow organspatterns of hollow organs
patterns of stenosispatterns of stenosisd
irec
tio
n o
f re
mo
val
dir
ecti
on
of
rem
ova
l
- thrombus/embolus- thrombus/embolus- neoplastic tumor- neoplastic tumor- inflammatory tumor- inflammatory tumor- foreign body - foreign body - ligatur / accretion- ligatur / accretion
post-post-
stenosisstenosis
pre-pre-
normalnormal
complicationscomplications
- retention- retention- dilatation- dilatation- inflammation- inflammation- hyperplasia- hyperplasia
- dysfunction- dysfunction- atrophy- atrophy
case historycase history
• 48 year-old patient48 year-old patient• cigarette smoker (27 pack years) cigarette smoker (27 pack years) • onset: flu-like symptoms (caugh, fatigue)onset: flu-like symptoms (caugh, fatigue)• x-ray: suspicion of pneumonia > antibioticsx-ray: suspicion of pneumonia > antibiotics• recurrent pericardial + pleural effusionsrecurrent pericardial + pleural effusions• back painback pain• accelerating respiratory insufficiencyaccelerating respiratory insufficiency• cachexia cachexia • exitusexitus
color patterncolor pattern of the lesion ?of the lesion ? - white > collagen increase- white > collagen increase- white > fibrin increase- white > fibrin increase- white > keratin increase- white > keratin increase- white > cell increase = tumor
tumor
cut face right cut face right lunglung
contour patterncontour patternof the lesion?of the lesion?
- sharp - sharp > encapsulation> encapsulation- sharp- sharp > destruction > destruction - fuzzy - fuzzy > edema> edema
- fuzzy > infiltration
fuzzy contour
infiltration: - water
- cells
cut face right lungcut face right lung
pulmonary lesionpulmonary lesion
colorcolor consistencyconsistencycontourcontour surroundingssurroundings
whitewhite
false false false
fuzzyfuzzy hardhard
false
infiltratinginfiltrating
lung cancerlung cancer
formal patternformal pattern of the lesionof the lesion - unifocal pattern- unifocal pattern- cystic pattern- cystic pattern- diffuse pattern- diffuse pattern- reticular pattern
cut face left cut face left lunglung
color patterncolor pattern of the lesion ?of the lesion ? - white > collagen increase- white > collagen increase- white > fibrin increase- white > fibrin increase- white > necrotic coagulation- white > necrotic coagulation- white > tumor
tumor
cut face left cut face left lunglung
progress of the lung cancerprogress of the lung cancer
formform distributiondistributioncolorcolor surroundingssurroundings
reticularreticular
false false false
whitewhite diffusediffuse
false
infiltratinginfiltrating
intrapulmonary tumor spreadingintrapulmonary tumor spreading (lymphangiosis) (lymphangiosis)
formal patternformal patternof the lesion ?of the lesion ? - cystic pattern- cystic pattern- reticular pattern- reticular pattern- diffuse pattern- diffuse pattern- multinodular pattern
surface of the visceral pleurasurface of the visceral pleura
color patterncolor patternof the lesionof the lesion - white > collagen increase- white > collagen increase- white > fibrin increase- white > fibrin increase- white > necrotic coagulation- white > necrotic coagulation- white > tumor
tumor
surface of the visceral pleurasurface of the visceral pleura
spreading patternspreading patternof the lesionof the lesion
- lymphogenous metastasis - lymphogenous metastasis - hematogenous metastasis- hematogenous metastasis- ductogenous metastasis- ductogenous metastasis
- cavitary metastasis
surface of the visceral pleurasurface of the visceral pleura
systemic complications of the lung cancersystemic complications of the lung cancer
formform stericstericcolorcolor spreadingspreading
reticularreticular
false false false
whitewhite multinodularmultinodular
false
cavitarycavitary
cavitary metastasiscavitary metastasis
color patterncolor pattern of the lesionof the lesion - bright red- bright red > bleeding> bleeding- wine red- wine red > porphyria> porphyria- yellow red- yellow red > pheomelanin> pheomelanin
cyanosiscyanosis
- dark-red > cyanosis
cut face right lungcut face right lung
stenotic pattern stenotic pattern complications of the lesioncomplications of the lesion
- - poststenotic atrophypoststenotic atrophy- poststenotic dysfunction - poststenotic dysfunction - prestenotic hyperplasia- prestenotic hyperplasia- prestenotic retention
post-stenotic
prestenoticprestenotic
stenosis
cut face right lungcut face right lung
local complications of the lung cancerlocal complications of the lung cancer
colorcolor stenotic patternstenotic patternformform consistencyconsistency
cyanosiscyanosis
false false false
diffusediffuse prestenoticprestenotic
false
proteolysisproteolysis
prestenotic retention pneumoniaprestenotic retention pneumonia
pathogenetic sequence pathogenetic sequence of the lesionsof the lesions
1 > 2 > 3 > 41 > 2 > 3 > 4 3 > 2 > 1 > 4 3 > 2 > 1 > 4 4 > 1 > 3 > 24 > 1 > 3 > 2
11
22
33
44
pathogenetic sequence pathogenetic sequence of the lesionsof the lesions
1 > 2 > 3 > 41 > 2 > 3 > 4 3 > 2 > 1 > 4 3 > 2 > 1 > 4 4 > 1 > 3 > 24 > 1 > 3 > 2 2 > 4 > 1 > 32 > 4 > 1 > 3
11
22
33
44
back to theory evaluation of student false
student‘s evaluation number of „false“
false
pathologic fulldiagnosispathologic fulldiagnosis
student:student: explorative partialdiagnoses explorative partialdiagnoses
teacher:teacher: formalpathogenetic patterns formalpathogenetic patterns
tissue lesiontissue lesion
expansion:expansion: macrofocal macrofocal> primary lesion> primary lesion
color:color: white white > tumor> tumor
contourcontour: fuzzy : fuzzy > malignoma> malignoma
stenosis:stenosis: prestenoticprestenotic> secondary lesion> secondary lesion> mucus retention> mucus retention
color: color: cyanosiscyanosis > no oxygenation> no oxygenation
consistency: consistency: pulpypulpy> inflammatory proteolysis> inflammatory proteolysis
primaryprimarylesionlesion
secondarysecondarylesionlesion