HISTOPATH LEC - LESSON 3 (AUTOPSY) Flashcards by Shaila Silo

a surgical procedure to obtain tissue from a living organism for its microscopical examination, usually to perform a diagnosis.

Biopsy

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Indications of Biopsy

Inflammatory changes of unknown cause that persist for long periods
Lesion that interfere with local function
Bone lesions not specifically identified by clinical and radiographic findings
Any lesion that has the characteristics of malignancy

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lesion is totally red or has a speckled red appearance

Erythroplasia

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lesion is ulcerated or presents as an ulcer.

Ulceration

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lesion has persisted for more than two weeks.

Duration

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lesion exhibits rapid growth

Growth rate

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lesion bleeds on gentle manipulation

Bleeding

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lesion and surrounding tissue is firm to the touch

Induration

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lesion feels attached to adjacent structures

Fixation

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four major types of biopsy

cytology,
aspiration biopsy,
incisional biopsy,
and excisional biopsy

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typically used as an adjunct to, not a substitute for, incisional or excisional biopsy procedures

Oral Cytology

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allows examination of individual cells, but cannot provide the histologic features crucial for an accurate and definitive diagnosis.

Cytology

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Developed as a diagnostic screening procedure to monitor large tissue areas for dysplastic changes.

Oral Cytology

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Lesions that lend themselves to cytologic examination may include:

post-radiation changes, herpes, fungal infections, and pemphigus

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Advantages of Oral Cytology

 Cytology may be helpful when large areas of mucosal change are noted, or in areas with difficult surgical access.

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Disadvantages of Oral Cytology

Not very reliable with many false positives.

2. Expertise in oral cytology is not widely available

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the use of a needle and syringe to remove a sample of cells or contents of a lesion.

Aspiration Biopsy

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The inability to withdraw fluid or air indicates that the lesion is what

probably solid

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Indications of Aspiration Biopsy

To determine the presence of fluid within a lesion
To a certain the type of fluid within a lesion
When exploration of an intraosseous lesion is indicated

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A radiolucent lesion in the jaw that yields straw colored fluid on aspiration is most likely what

cystic lesion

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The aspiration of blood might indicate what

vascular malformation

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The intent of this type of biopsy is to sample only a representative portion of the lesion.

incisional biopsy

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well suited for diagnosis of oral manifestations of mucocutaneous and vesiculoulcerative diseases, such as lichen planus, pemphigus, etc.

Punch Biopsy

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This is done by applying Firm pressure with a circular brush is applied, rotated five to ten times, causing light abrasion.

Brush Biopsy

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Disadvantage of using punch biopsy

difficult to obtain adequate, representative tissue deeper than the superficial lamina propria .

Biopsy report includes

1. the name of the clinician, 2. date the specimen was obtained 3. pertinent characteristics of the specimen.

Indications of Incisional Biopsy

1. Whenever the lesion is difficult to excise because of its extensive size 2. In cases where appropriate excisional surgical management requires hospitalization or complicated wound management.

Indications of Excisional Biopsy

1. Should be employed with small lesions. Less than 1cm 2. The lesion on clinical exam appears benign. 3. When complete excision with a margin of normal tissue is possible without mutilation.

autopsy is also known as

post mortem examination, necropsy or obduction

a medical procedure that consists of a examination of a dead body to determine the cause & manner of death & to evaluate any disease

autopsy

autopsy is performed by a specialized doctor medical called

pathologist

it determines the cause, mode and manner of death or to evaluate any disease or injury that may be present for research or educational purposes

autopsy

"autopsy"

to see for oneself

"necropsy"

seeing a dead body

Purpose of Autopsy (7)

Autopsies are performed for either legal or medical purposes. Autopsies can be performed when any of the following information is desired: 1. Determine if death was natural or unnatural 2. Injury source and extent on the corpse 3. Manner of death must be determined 4. Time since death 5. Establish identity of deceased 6. Retain relevant organs 7. If infant, determine live birth and viability.

Autopsy is performed in certain cases such as (5)

1. Committed suicide 2. Unknown cause of death 3. Unknown dead bodies 4. Homicide (The killing of one human being by another) 5. The organs are tissues of the body are examined to established the exact cause of death , to learn more about a disease

External examination of dead body without incisions, fluids can be collected with the helpof needle.

Post mortem

Rules of Medico - Legal Autopsy (9)

1. Authorization. 2. Identification. 3. Visit of scene of crime. 4. History of the case. 5. Verification of the injuries noted by the police. 6. Examination. 7. Notes. 8. Preservation of viscera and other tissue. 9. List of artifacts.

Types of Autopsy (6)

1. Postmortem examination 2. Psychological autopsy 3. Medical /clinical/ pathological / hospital autopsy. 4. Virtual Autopsy 5. Anatomical autopsy 6. Medico legal autopsy

Carried on a patient who dies in a hospital

medical / academic autopsy

Objectives of Medical / Academic Autopsy

1. To determine the cause of death. 2. To confirm or establish the clinical diagnosis 3. To evaluate the effects of treatment given during life. 4. Performed by a pathologist' with consent of relatives.

performed to study normal structure of human body.

anatomical autopsy

Anatomist and medical students perform this.

anatomical autopsy

undertaken on alleged cases of suicide to know about the mental status of deceased at the time of death.

psychological autopsy

Psychological autopsy is performed to know about :

1. Background of person 2. His habits ,mental status, personality, character. 3. Relation to others

Examination of external surfaces of corpse by inspection incision without giving examination.

postmortem examination

Essential examination of dead body, to rule out or establish foul play in death.

medico - legal autopsy

It is performed in pursuance of law to establish the cause and manner of death and also to establish or rule out foul.

medico - legal autopsy

Three main types of medico - legal autopsy

1. Forensic 2. Clinical/Academic 3. Coroner’s

No family permission is required to complete this type of autopsy

forensic

carried out when the cause of death may be a criminal matter such as accident or burns.

forensic

usually performed in hospitals for research & study purposes

clinical / academic

To complete this type of autopsy, permission from the deceased’s legal next of kin is needed

clinical / academic

type of autopsy involves cases where no medical cause of death is readily available

coroner's

Long term storage of dead bodies temperature and purpose

- 20 C; for preservation

Short term storage of dead bodies temperature and purpose

+ 4 C; for autopsy purpose

This incision / approach approach is most often used in forensic autopsies so as to allow maximum exposure of neck structures for later detailed examination.

y - shaped incision

This incision made from the tips of both shoulder, in a horizontal line across the region of the collar bones to meet at sternum in the middle.

t shaped

a plastic or rubber brick placed under the back of the body, causing the arms & neck to fall backward while stretching & pushing the chest upward to make it easier to cut open

body block

Post mortem signs of death

pallor mortis, algor mortis, rigor mortis livor mortis

Post mortem signs of death occur in the first _________ after death.

24 to 48 hrs

the first sign of death

pallor mortis

post mortem sign of death. the heart stops beating, the circulation of blood throughout the body decreases

pallor mortis

second sign of death

algor mortis

post mortem sign of death. not an accurate way to back calculate the time of death

algor mortis

third sign of death

rigor mortis

means stiff death

rigor mortis

post mortem sign of death. contraction of the muscles in the body after death

rigor mortis

fourth sign of death

livor mortis

this color develops because of hemoglobin forms deoxyhemoglobin

purple

can be very useful for determining time of death

livor mortis

the process of breakdown of proteins and liquefaction of most organs

putrefaction

process by which organic substances are broken down into simpler forms of matter.

decomposition

process is completed when all soft tissues have been eliminated, leaving only disarticulated bones.

skeletonization

Characteristics of lesions that raise the suspicion of malignancy (7):

``` Erythroplasia Ulceration Duration Growth rate Bleeding Induration Fixation ```