INHOUD
Hoofdstuk 1: inleiding ............................................................................................................................................. 3
Diagnose.............................................................................................................................................................. 3
Morfologisch onderzoek ................................................................................................................................. 3
Hoofdstuk 2: ontsteking .......................................................................................................................................... 5
Acute, exsudatieve ontsteking ............................................................................................................................ 5
Chronische, proliferatieve ontsteking ................................................................................................................. 6
Chronische granulomateuze ontsteking ......................................................................................................... 6
Para-inflammatie ................................................................................................................................................ 6
Heling en herstel ................................................................................................................................................. 6
Stoornissen in heling ....................................................................................................................................... 7
Hoofdstuk 3: celpathologie: cellulaire adaptatie als reactie op celschade ............................................................. 8
Reversibele beschadiging .................................................................................................................................... 8
Atrofie ............................................................................................................................................................. 8
Hypertrofie ...................................................................................................................................................... 8
Hyperplasie ..................................................................................................................................................... 8
Metaplasie....................................................................................................................................................... 8
Intracellulaire stapeling................................................................................................................................... 9
Heat shock respons ......................................................................................................................................... 9
Irreversibele beschadiging .................................................................................................................................. 9
Coagulatienecrose ........................................................................................................................................... 9
Liquefactie necrose ....................................................................................................................................... 10
Gangreen ....................................................................................................................................................... 10
Speciale vormen necrose .............................................................................................................................. 10
Apoptose/anoikis .......................................................................................................................................... 10
Hoofdstuk 4: extracellulaire pathologie ................................................................................................................ 11
Collageenziekten ............................................................................................................................................... 11
Elastine pathologie ............................................................................................................................................ 11
Proteoglycaan pathologie ................................................................................................................................. 11
Pathologie van lamina basalis ........................................................................................................................... 11
Amyloïdose........................................................................................................................................................ 11
Classificatie.................................................................................................................................................... 11
Amyloid depositie ......................................................................................................................................... 12
Hoofdstuk 5: tumoren ........................................................................................................................................... 13
Histologische diagnose van tumoren ................................................................................................................ 13
Type tumor: persoonlijkheid ......................................................................................................................... 13
1
, Agressiviteit tumor: prognose....................................................................................................................... 14
Gradering en stadiëring van tumoren ........................................................................................................... 15
Morfologische tumormerkers ........................................................................................................................... 15
Groei van kankers ............................................................................................................................................. 16
Initiatie en promotie ..................................................................................................................................... 16
Progressie en heterogeniteit ......................................................................................................................... 16
Verspreiding van kankers .................................................................................................................................. 17
Invasie: directe uitbreiding ........................................................................................................................... 17
Metastasering: uitbreiding op afstand .......................................................................................................... 17
Mechanismen van invasie en metastasen .................................................................................................... 18
Precancereuze letsels........................................................................................................................................ 18
Metaplasie..................................................................................................................................................... 18
Dysplasie ....................................................................................................................................................... 19
Goedaardige tumoren als premaligne letsels ............................................................................................... 19
Andere premaligne letsels ............................................................................................................................ 19
Effect van de tumor op de gastheer ................................................................................................................. 19
Lokale effecten .............................................................................................................................................. 19
Systemische effecten .................................................................................................................................... 19
Effect van de gastheer op de tumor ................................................................................................................. 20
Tumorsupressor genen ................................................................................................................................. 20
Immuunreacties ............................................................................................................................................ 20
Stomareactie ................................................................................................................................................. 21
Aanpak van kanker ............................................................................................................................................ 22
2
, ZIEKTEMECHANISMEN: ALGEMENE
PATHOLOGISCHE ONTLEEDKUNDE
HOOFDSTUK 1: INLEIDING
Pathologische ontleedkunde = bestuderen en diagnosticeren van ziekte obv morfologische/genetische
kenmerken
Algemene pathologische ontleedkunde = gemeenschappelijke basisprincipes van zieke weefsels. Verbinding
basiswetenschappen en klinische wetenschappen
DIAGNOSE
- Door morfologische (en genetische) afwijkingen in weefsels/cellen een ziekte definiëren
- De behandelende arts een kader geven om de correcte behandeling te starten
- Bestuderen van ziektemechanismen
MORFOLOGISCH ONDERZOEK
- Microscopisch onderzoek: weefsel → cel
- Ultrastructureel onderzoek, moleculaire technieken: cel → chromosomen en genen
- Autopie, macroscopisch onderzoek: lichaam → orgaan
Vanaf 1850 stijging in kwaliteit van geneeskunde en impact van pathologische anatomie op geneeskunde
- Religieuze beperkingen
- Technische beperkingen
- Beperkt inzicht in bouw en functie van normaal menselijk lichaam
- Geen inzicht in elementaire eenheid van geneeskunde
RUDOLPH VIRCHOW (1821-1902)
“disease cannot be understood unless it is realized that the ultimate abnormality must lie in the cell”
- Grondlegger pathologische anatomie
- Pionier van sociale geneeskunde
- Anti-Darwinist
- Niet overtuigd dat micro-organismen ziekten konden verwekken (bacteriën wel aanwezig in zieke
cellen, maar zijn niet de oorzaak)
- Leukemie, trombose, embolie, functio laesa
- Chromatine, agenese, parenchym, atrofie, hypertrofie, amyloïd, myeline, osteoid
DOEL
- Ontsteking – tumor – iets anders?
- Tumor: goedaardig – kwaadaardig
- Gradering, stadiëring, metastasen
- Ontsteking: oorzaak – infectie – activiteit
- Metabole aandoening
- Graad van beschadiging
3
Hoofdstuk 1: inleiding ............................................................................................................................................. 3
Diagnose.............................................................................................................................................................. 3
Morfologisch onderzoek ................................................................................................................................. 3
Hoofdstuk 2: ontsteking .......................................................................................................................................... 5
Acute, exsudatieve ontsteking ............................................................................................................................ 5
Chronische, proliferatieve ontsteking ................................................................................................................. 6
Chronische granulomateuze ontsteking ......................................................................................................... 6
Para-inflammatie ................................................................................................................................................ 6
Heling en herstel ................................................................................................................................................. 6
Stoornissen in heling ....................................................................................................................................... 7
Hoofdstuk 3: celpathologie: cellulaire adaptatie als reactie op celschade ............................................................. 8
Reversibele beschadiging .................................................................................................................................... 8
Atrofie ............................................................................................................................................................. 8
Hypertrofie ...................................................................................................................................................... 8
Hyperplasie ..................................................................................................................................................... 8
Metaplasie....................................................................................................................................................... 8
Intracellulaire stapeling................................................................................................................................... 9
Heat shock respons ......................................................................................................................................... 9
Irreversibele beschadiging .................................................................................................................................. 9
Coagulatienecrose ........................................................................................................................................... 9
Liquefactie necrose ....................................................................................................................................... 10
Gangreen ....................................................................................................................................................... 10
Speciale vormen necrose .............................................................................................................................. 10
Apoptose/anoikis .......................................................................................................................................... 10
Hoofdstuk 4: extracellulaire pathologie ................................................................................................................ 11
Collageenziekten ............................................................................................................................................... 11
Elastine pathologie ............................................................................................................................................ 11
Proteoglycaan pathologie ................................................................................................................................. 11
Pathologie van lamina basalis ........................................................................................................................... 11
Amyloïdose........................................................................................................................................................ 11
Classificatie.................................................................................................................................................... 11
Amyloid depositie ......................................................................................................................................... 12
Hoofdstuk 5: tumoren ........................................................................................................................................... 13
Histologische diagnose van tumoren ................................................................................................................ 13
Type tumor: persoonlijkheid ......................................................................................................................... 13
1
, Agressiviteit tumor: prognose....................................................................................................................... 14
Gradering en stadiëring van tumoren ........................................................................................................... 15
Morfologische tumormerkers ........................................................................................................................... 15
Groei van kankers ............................................................................................................................................. 16
Initiatie en promotie ..................................................................................................................................... 16
Progressie en heterogeniteit ......................................................................................................................... 16
Verspreiding van kankers .................................................................................................................................. 17
Invasie: directe uitbreiding ........................................................................................................................... 17
Metastasering: uitbreiding op afstand .......................................................................................................... 17
Mechanismen van invasie en metastasen .................................................................................................... 18
Precancereuze letsels........................................................................................................................................ 18
Metaplasie..................................................................................................................................................... 18
Dysplasie ....................................................................................................................................................... 19
Goedaardige tumoren als premaligne letsels ............................................................................................... 19
Andere premaligne letsels ............................................................................................................................ 19
Effect van de tumor op de gastheer ................................................................................................................. 19
Lokale effecten .............................................................................................................................................. 19
Systemische effecten .................................................................................................................................... 19
Effect van de gastheer op de tumor ................................................................................................................. 20
Tumorsupressor genen ................................................................................................................................. 20
Immuunreacties ............................................................................................................................................ 20
Stomareactie ................................................................................................................................................. 21
Aanpak van kanker ............................................................................................................................................ 22
2
, ZIEKTEMECHANISMEN: ALGEMENE
PATHOLOGISCHE ONTLEEDKUNDE
HOOFDSTUK 1: INLEIDING
Pathologische ontleedkunde = bestuderen en diagnosticeren van ziekte obv morfologische/genetische
kenmerken
Algemene pathologische ontleedkunde = gemeenschappelijke basisprincipes van zieke weefsels. Verbinding
basiswetenschappen en klinische wetenschappen
DIAGNOSE
- Door morfologische (en genetische) afwijkingen in weefsels/cellen een ziekte definiëren
- De behandelende arts een kader geven om de correcte behandeling te starten
- Bestuderen van ziektemechanismen
MORFOLOGISCH ONDERZOEK
- Microscopisch onderzoek: weefsel → cel
- Ultrastructureel onderzoek, moleculaire technieken: cel → chromosomen en genen
- Autopie, macroscopisch onderzoek: lichaam → orgaan
Vanaf 1850 stijging in kwaliteit van geneeskunde en impact van pathologische anatomie op geneeskunde
- Religieuze beperkingen
- Technische beperkingen
- Beperkt inzicht in bouw en functie van normaal menselijk lichaam
- Geen inzicht in elementaire eenheid van geneeskunde
RUDOLPH VIRCHOW (1821-1902)
“disease cannot be understood unless it is realized that the ultimate abnormality must lie in the cell”
- Grondlegger pathologische anatomie
- Pionier van sociale geneeskunde
- Anti-Darwinist
- Niet overtuigd dat micro-organismen ziekten konden verwekken (bacteriën wel aanwezig in zieke
cellen, maar zijn niet de oorzaak)
- Leukemie, trombose, embolie, functio laesa
- Chromatine, agenese, parenchym, atrofie, hypertrofie, amyloïd, myeline, osteoid
DOEL
- Ontsteking – tumor – iets anders?
- Tumor: goedaardig – kwaadaardig
- Gradering, stadiëring, metastasen
- Ontsteking: oorzaak – infectie – activiteit
- Metabole aandoening
- Graad van beschadiging
3
