TONEGAWA Susumu 1987 Nobel prize antibody diversity

1. BASEL old university TONEGAWA Susumu 1987 Nobel prize antibody diversity

2. FREIBURG TAWARA, Sunao 1906 cardiac conducting system

3. LEISSIGEN / Interlaken Switzerland

4. EIGER north face - „top of Europe“ IMAI Michiko et al. 23.7.1969 Japanese direttissima route

5. Teaching Modules in Pathology Education Prof. Dr. Urs-N. Riede, Department of Pathology, University of Freiburg

6. Textbook: Georg Thieme, Stuttgart – New York first edition 1986 second edition 1988

7. Textbook: Georg Thieme, Stuttgart – New York third edition 1992 forth edition 1998

8. Textbook: Georg Thieme, Stuttgart – New York fifth edition 2004 chinese editions 1998, 2004

9. Color atlas: Georg Thieme, Stuttgart – New York german edition 1998

10. Color atlas: Georg Thieme, Stuttgart – New York english edition 2008 greek edition 2009

11. teaching in pathology:aims • The pathologic diagnosis of a disease results from the superposition of formal reaction patterns. • The diagnosis of formal reaction patterns requires the analysis of a few structural and color changes. • The stepwise analysis of the formal reaction patterns elucidates the progress of a disease.

12. Textbook: Springer Heidelberg – New York – Tokyo 2009BASICS IN GENERAL AND SPECIAL PATHOLOGY • new: • learning modules • structural pattern • contour pattern • consistency pattern • color pattern …

13. teaching in pathology:modules • Substructuring of a lesion into formal reaction patterns • Pathobiologic explanation of the reaction patterns • Assembling of distinct reaction patterns to a diagnosis • Reconstruction of the pathogenetic sequence • Training by cases of a virtual autopsy

14. quick-fix diagnosis: facial skin lesions The patient suffered from lupus erythematodes But why did she die?

15. color red pattern - inflammation - bleeding disorder distribution multiple pattern - septic purpura diagnosis by pattern analysis formal macrofocal pattern - lupus erythema microfocal - purpura

16. microfocal lung cancer miliary TBC patterns of expansion macrofocal skin erythema

17. macrofocal secondary tumor patterns of distribution (uni-) macrofocal multifocal microfocal systemic generalised primary tumor inflammation bleeding disorder destruction

18. spreading patterns lymphatic haematogenous cavitary coagulopathy inflammation inflammation inflammation cancer cancer cancer cancer cancer cancer dis-/continuous inflammation cancer discontinuous cancer

19. abscess sharp contours lipoma cyst destruction: - ischemia > infarction - inflammation > abscess proliferation: > benignoma retention:> (pseudo) cyst contour patterns fuzzy contours skin erythema melanoma instillation / infiltration: - gaz > emphysema - water > edema - cells > inflammation > malignoma

20. netlike reticular striped whirled muscle lung lymphangiosis fat interposition fibroma structural patterns diffuse diffus skin erythema

21. pseudo-membrane ulcer erosion epidermis mucosa subcutis submucosa surface patterns polyp

22. sphere • large: nodular • small: granular hollow sphere diffuse cystic pseudocystic granular nodular diffuse steric patterns

23. firm-elastic liquid brittle fluid liquefaction proteolysis soft pulpy soft tissue proteolysis consistency patterns hard fibrosis very hard ossification

24. color patterns: e.g. liver normal (perfusion) - hemoglobin fatty degeneration icterus bilirubin normal + oxy- hemoglobin leucemia (CLL) cholestasis bile cell infiltration neutral fat cyanosis melanoma siderosis desoxy- hemoglobin melanin hemosiderin

25. color patterns: white Tyndall-effect because of - coagulation - increase of collagen coagulation myofibroma pleuritis - increase of keratin - increase of fibrin - increase of cells leukoplakia carcinoma

26. color patterns: red oxyhemoglobin red desoxyhemoglobin red solar erythema livores cyanosis tyrosinogenous yellow-red porphyria / urin tyrosinogenous yellow-red inflammation (chemosis) pheomelanin

27. - retention - dilatation - inflammation - hyperplasia pre- stenosis normal post- - dysfunction - atrophy patterns of hollow organspatterns of stenosis complications - thrombus/embolus - neoplastic tumor - inflammatory tumor - foreign body - ligatur / accretion direction of removal

28. case history • 48 year-old patient • cigarette smoker (27 pack years) • onset: flu-like symptoms (caugh, fatigue) • x-ray: suspicion of pneumonia > antibiotics • recurrent pericardial + pleural effusions • back pain • accelerating respiratory insufficiency • cachexia • exitus

29. - white > cell increase = tumor tumor cut face right lung color pattern of the lesion ? - white > collagen increase - white > fibrin increase - white > keratin increase

30. - fuzzy > infiltration fuzzy contour infiltration: - water - cells cut face right lung contour pattern of the lesion? - sharp > encapsulation - sharp > destruction - fuzzy > edema

31. pulmonary lesion color contour consistency surroundings false false false false white fuzzy hard infiltrating lung cancer

32. cut face left lung formal pattern of the lesion - unifocal pattern - cystic pattern - diffuse pattern - reticular pattern

33. tumor cut face left lung color pattern of the lesion ? - white > collagen increase - white > fibrin increase - white > necrotic coagulation - white > tumor

34. progress of the lung cancer form color distribution surroundings false false false false reticular white diffuse infiltrating intrapulmonary tumor spreading (lymphangiosis)

35. - multinodular pattern surface of the visceral pleura formal pattern of the lesion ? - cystic pattern - reticular pattern - diffuse pattern

36. tumor surface of the visceral pleura color pattern of the lesion - white > collagen increase - white > fibrin increase - white > necrotic coagulation - white > tumor

37. - cavitary metastasis surface of the visceral pleura spreading pattern of the lesion - lymphogenous metastasis - hematogenous metastasis - ductogenous metastasis

38. systemic complications of the lung cancer form color steric spreading false false false false reticular white multinodular cavitary cavitary metastasis

39. - dark-red > cyanosis cyanosis cut face right lung color pattern of the lesion - bright red > bleeding - wine red > porphyria - yellow red > pheomelanin

40. stenotic pattern complications of the lesion - poststenotic atrophy - poststenotic dysfunction - prestenotic hyperplasia post- stenotic stenosis prestenotic cut face right lung - prestenotic retention

41. local complications of the lung cancer color form consistency stenotic pattern false false false false cyanosis diffuse proteolysis prestenotic prestenotic retention pneumonia

42. pathogenetic sequence of the lesions 1 > 2 > 3 > 4 3 > 2 > 1 > 4 4 > 1 > 3 > 2 1 2 3 4

43. false evaluation of student back to theory pathogenetic sequence of the lesions 1 > 2 > 3 > 4 3 > 2 > 1 > 4 4 > 1 > 3 > 2 2 > 4 > 1 > 3 2 4 1 3

44. tissue lesion teacher: formalpathogenetic patterns false student: explorative partialdiagnoses pathologic fulldiagnosis student‘s evaluation number of „false“

45. primary lesion expansion: macrofocal > primary lesion color: white > tumor contour: fuzzy > malignoma stenosis:prestenotic > secondary lesion > mucus retention color: cyanosis > no oxygenation consistency: pulpy > inflammatory proteolysis secondary lesion