Histopathology

Published in Histopathology
Monday, 04 September 2017 17:55
Histopathology (compound of three Greek words: ἱστός histos "tissue", πάθος pathos "suffering", and -λογία -logia"study of") refers to the microscopic examination of tissue in order to study the manifestations of disease. Specifically, in clinical medicine, histopathology refers to the examination of a biopsy or surgical specimen by a pathologist, after the specimen has been processed and histological sections have been placed onto glass slides. In contrast, cytopathology examines (1) free cells or (2) tissue micro-fragments (as "cell blocks").

RENAL BIOPSY: INDICATIONS, CONTRAINDICATIONS, COMPLICATIONS AND PROCEDURE

Published in Clinical Pathology
Wednesday, 23 August 2017 22:32
Renal biopsy refers to obtaining a small piece of kidney tissue for microscopic examination. Percutaneous renal biopsy was first performed by Alwall in 1944. In renal disease, renal biopsy is helpful to:
 
  • Establish the diagnosis
  • Assess severity and activity of disease
  • Assess prognosis by noting the amount of scarring
  • To plan treatment and monitor response to therapy
 
Renal biopsy is associated with the risk of procedure-related morbidity and rarely mortality. Therefore, before performing renal biopsy, risks of the procedure and benefits of histologic examination should be evaluated in each patient.
 
Indications for Renal Biopsy
 
  1. Nephrotic syndrome in adults (most common indication)
  2. Nephrotic syndrome not responding to corticosteroids in children.
  3. Acute nephritic syndrome for differential diagnosis
  4. Unexplained renal insufficiency with near-normal kidney dimensions on ultrasonography
  5. Asymptomatic hematuria, when other diagnostic tests fail to identify the source of bleeding
  6. Isolated non-nephrotic range proteinuria (1-3 gm/24 hours) with renal impairment
  7. Impaired function of renal graft
  8. Involvement of kidney in systemic disease like systemic lupus erythematosus or amyloidosis
 
Contraindications
 
  1. Uncontrolled severe hypertension
  2. Hemorrhagic diathesis
  3. Solitary kidney
  4. Renal neoplasm (to avoid spread of malignant cells along the needle track)
  5. Large and multiple renal cysts
  6. Small, shrunken kidneys
  7. Acute urinary tract infection like pyelonephritis
  8. Urinary tract obstruction
 
Complications
 
  1. Hemorrhage: As renal cortex is highly vascular, major risk is bleeding in the form of hematuria or perinephric hematoma. Severe bleeding may occasionally necessitate blood transfusion and rarely removal of kidney.
  2. Arteriovenous fistula
  3. Infection
  4. Accidental biopsy of another organ or perforation of viscus (liver, spleen, pancreas, adrenals, intestine, or gallbladder)
  5. Death (rare).
 
Procedure
 
  1. Patient’s informed consent is obtained.
  2. Ultrasound/CT scan is done to document the location and size of kidneys.
  3. Blood pressure should be less than 160/90 mm of Hg. Bleeding time, platelet count, prothrombin time, and activated partial thromboplastin time should be normal. Blood sample should be drawn for blood grouping and cross matching, as blood transfusion may be needed.
  4. Patient is sedated before the procedure.
  5. Patient lies in prone position and kidney is identified with ultrasound.
  6. The skin over the selected site is disinfected and a local anesthetic is infiltrated.
  7. A small skin incision is given with a scalpel (to insert the biopsy needle). Localization of kidney is done with a fine bore 21 G lumbar puncture needle. A local anesthetic is infiltrated down to the renal capsule.
  8. A tru-cut biopsy needle or spring loaded biopsy gun is inserted under ultrasound guidance and advanced down to the lower pole. Biopsy is usually obtained from lateral border of lower pole. Patient should hold his/her breath in full inspiration during biopsy. After obtaining the biopsy and removal of needle, patient is allowed to breath normally.
  9. The biopsy should be placed in a drop of saline and examined under a dissecting microscope for adequacy.
  10. Patient is turned to supine position. Vital signs and appearance of urine should be monitored at regular intervals. Patient is usually kept in the hospital for 24 hours.
 
Kidney biopsy can be divided into three parts for light microscopy, immunofluorescence, and electron microscopy. For light microscopy, renal biopsy is routinely fixed in neutral buffered formaldehyde. Sections are stained by:
 
  • Hematoxylin and eosin (for general architecture of kidney and cellularity)
  • Periodic acid Schiff: To highlight basement membrane and connective tissue matrix.
  • Congo red: For amyloid.
 
For electron microscopy, tissue is fixed in glutaraldeyde. In immunohistochemistry, tissue deposits of IgG, IgA, IgM, C3, fibrin, and κ and λ light chains can be detected by using appropriate antibodies. Many kidney diseases are immune-complex mediated.

Koss' Diagnostic Cytology And Its Histopathologic Bases, 5th Ed. 2005, (TEXTBOOK)

Published in Downloads
Monday, 02 May 2016 10:21
Description: The most influential and frequently cited pathology classic is now in its Fifth Edition, with thoroughly revised chapters and over 3,000 brand-new full-color illustrations. This two-volume work provides comprehensive, current information on the principles and techniques of cytopathology and the cytologic evaluation of benign and malignant disorders at every anatomic site.
This edition provides greatly expanded coverage of the interpretation of aspirated cell samples. Innovations in the practice of cytopathology and data on molecular biology and cytogenetics have been incorporated into the organ system chapters. This edition also has a greater focus on avoiding diagnostic errors. A bound-in image bank DVD is included in this edition.

Diagnostic Histopathology of Tumors by Fletcher, 4th Ed. 2013

Published in Downloads
Sunday, 01 May 2016 10:11
Description:  Diagnose tumors with confidence with Diagnostic Histopathology of Tumors, 4th Edition. Dr. Christopher Fletcher's renowned reference provides the advanced, expert guidance you need to evaluate and interpret even the most challenging histopathology specimens more quickly and accurately. Diagnose efficiently and effectively using diagnostic flow charts, correlations of gross appearances to microscopic findings, and differential diagnosis tables for better recognition and evaluation of similar-looking entities. Employ immunohistochemistry, molecular and genetic diagnostic tests, and other modern techniques as well as the best morphologic diagnostic methods to effectively identify each tumor or tumor-like entity. Utilize new, clinically important molecular genetic data and updated classification schemes to help guide treatment and targeted therapy. Apply the latest techniques and diagnostic criteria with completely rewritten chapters on Small and Large Intestines, Heart, Larynx and Trachea, Ear, and Peritoneum. Find critical information quickly thanks to more tables and bulleted lists throughout. Access the entire text and illustrations online, fully searchable, at www.expertconsult.com.

Robbins and Cotran's Pathologic Basis of Disease, 8th Edition. 2009

Published in Downloads
Monday, 25 April 2016 01:36
Description: One of the best-selling medical textbooks of all time, Robbins and Cotran Pathologic Basis of Disease is the one book that nearly all medical students purchase, and is also widely used by physicians worldwide. A "who's who" of pathology experts delivers the most dependable, current, and complete coverage of today's essential pathology knowledge. At the same time, masterful editing and a practical organization make mastering every concept remarkably easy. Online access via Student Consult includes self-assessment and review questions, interactive case studies, downloadable images, videos, and a virtual microscope that lets you view slides at different magnifications. The result remains the ideal source for an optimal understanding of pathology.
  • Offers the most authoritative and comprehensive, yet readable coverage available in any pathology textbook, making it ideal for USMLE or specialty board preparation as well as for course work.
  • Includes access to the complete contents online via Student Consult, along with self-assessment and review questions, over 100 interactive clinical case studies, downloadable images, videos, and a virtual microscope that lets users view slides at different magnifications.
  • Delivers a state-of-the-art understanding of the pathologic basis of disease through completely updated coverage, including the latest cellular and molecular biology.
  • Demonstrates every concept visually with over 1,600 full-color photomicrographs and conceptual diagrams - many revised for even better quality.
  • Facilitates learning with an outstanding full-color, highly user-friendly design.
 

Atlas and Synopsis of Lever's Histopathology of the Skin 2nd Edition - 2007

Published in Downloads
Sunday, 24 April 2016 05:34

Description: Based on Lever's Histopathology of the Skin, Second Edition, this full-color atlas presents an algorithmic pattern recognition approach to differential diagnosis of skin diseases. Whereas Lever's classifies diseases by pathogenesis, this atlas aids in differential diagnosis of unknown cases by classifying diseases morphologically, based on their location in the skin and the patterns and cell types seen through the microscope. Within each morphologic category, prototypic disorders are described and illustrated with full-color photomicrographs, and a list of differential diagnostic possibilities is presented. The atlas contains over 1,300 full-color illustrations.

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