This medical specialty  analyzes  the morphology (or  structure) of organs, tissues, cells and body fluids  with the aim of diagnosing injuries , through  microscopic  and macroscopic observation.

When necessary, this study is complemented with auxiliary diagnostic techniques, namely Histochemistry, Immunohistochemistry and Molecular Biology techniques, in order to produce a correct and complete diagnosis.

In order for a correct and sustained anatomopathological diagnosis to be made, it is essential to correlate it with clinical information, laboratory data and imaging exams of the patient.

What can be analyzed in Pathological Anatomy? 

In this specialty it is possible to analyze:

• Whole organs  or parts of organs (for example, the liver or part of it);

• Incisional or excisional biopsies, that is,  small fragments of tissue from an organ  collected by surgical, endoscopic or needle means, with or without imaging support;

• Body fluids  and secretions;

• Cells  from a lesion obtained by fine needle aspiration cytology or by scraping the lesion;

• Human body in its entirety, in the case of autopsy.

4 types of exams that include Pathological Anatomy

Examinations carried out in the pathological anatomy, which include, for example, biopsies, scrapings, aspirations and analyzes of fluids and secretions. Get to know each of the exams that are part of this medical specialty and that can be prescribed by the doctor according to different diagnostic needs.

1. Histopathology (biopsies, surgical specimens and perioperative exams)

Histopathology is the anatomopathological study of  morphological changes in the tissues  of surgical specimens (for example, an organ) or biopsies. The main objective of this exam is the  diagnosis of tissue lesions  to guide the treatment and prognosis of the patient.

Per-operative exams (extemporaneous exams) are  exams performed during the surgical act  and aim to guide the surgical team regarding the subsequent procedure of the intervention.

These exams are requested when there are  doubts  about the nature  of a particular lesion  ( whether benign or malignant ) or to assess the surgical margins of the lesion (ie, to ensure that the lesion has been completely removed).

2. Cytopathology and Molecular Biology

Through cytopathological analysis it is possible to study changes in isolated cells and/or in small groups. Biological samples can be obtained by scraping, natural desquamation or aspiration. Cytopathological exams performed in Pathological Anatomy are:

Cervico-Vaginal Cytology

Commonly known as the Papanicolaou test, Cervico-Vaginal Cytology is the oldest screening test for cervical cancer. It is the oldest screening test in the history of medicine and is still used today in its original format – conventional cytology.

This exam consists of obtaining cells from the cervix (exo and endocervix) for laboratory analysis. Since 2000, liquid cytology has been introduced, which significantly improves the quality of the sample to be observed and allows the use, from the same sample, of different Molecular Biology techniques.

Depending on the technique used, Cervico-Vaginal Cytology can be:

• Conventional:  the cells are collected with a brush and a smear is made on a glass slide, fixed with a suitable spray.

• Liquid medium (Thinprep®):  the collection is carried out in the same way, however, a cell suspension is created from the sample obtained, which is subsequently processed in the laboratory using specific equipment. This method allows obtaining a sample under ideal conditions, and avoids many of the drawbacks of conventional cytology.

• HPV test:  it is a Molecular Biology test also with the purpose of screening for cervical cancer. The HPV test used for screening researches 14 types of HPV and performs a partial genotyping, separating HPV 16 and 18, and the remaining 12 high-risk types. It can be used as a first-line test, simultaneously with cytology (co-test), or as a reflex test.

• Genotyping test:  this Molecular Biology test detects 28 types of high (19 types) and low risk (9 types) of HPV.

• Hypermethylation test:  persistent HPV infection accumulates epigenetic changes over time that will be responsible for the silencing of specific genes, the consequence of which will be cell dysregulation and the consequent evolution to cancer. However, and as this phenomenon is relatively rare, within the framework of a very common infection, it is necessary to distinguish, among the infections, which ones are in fact evolving into cancer. Thus, this test simultaneously studies 6 genes whose methylation status has been associated with cervical cancer.

• Panel of microorganisms:  using the same ThinPrep® sample, it is possible to identify some microorganisms, including: Chlamydia trachomatis; Mycoplasma genitalium; Mycoplasma hominis; Neisseria gonorrhoeae; Trichomonas vaginalis; Ureaplasma parvum and Ureaplasma urealyticum.

Cervico-Vaginal Cytology does not require any specific preparation. However, some care must be taken before its realization:

• When scheduling your appointment,  you must do it outside the menstrual period ;

• Two days before the exam, you should not have sexual intercourse  (the presence of these cells makes it difficult to prepare and read the cytology);

• Two days before, you should not use foams, creams, spermicides or any medication for vaginal application .

When a swelling is detected, by palpation or ultrasound, in superficial or deep organs, the doctor needs to know the nature of the lesion in order to make the appropriate decisions.

Aspiration biopsy  is a simple procedure,  performed using a fine needle with or without aspiration, which allows obtaining some cells to be analyzed under a microscope and to characterize the lesion. It is a minimally invasive technique, with around 95% accuracy , depending on the quality of the sample obtained.

This exam only takes  a few minutes  and, depending on the characteristics and location of the lesion to be studied, it can be guided by palpation,  ultrasound ,  CT scan  or even be associated with endoscopy techniques.

Then, the material is sent to the Pathological Anatomy laboratory to be analyzed and evaluated. The results of this exam must always be included in the clinical evaluation and interpreted together with the results of other complementary exams.

Because it is a simple exam, in which the patient only feels a slight discomfort similar to that of an injection, no preparation is necessary. It is only recommended that the patient  is not  fasting .

3. Body fluids and secretions

Cytopathological examination of body fluids and secretions has the main objective of  identifying infectious, inflammatory, hemorrhagic and neoplastic processes. 

In the  cytology of respiratory secretions,  the secretions range from the analysis of sputum, to the material collected from the bronchi during a bronchoscopy. The main objective is always the identification of neoplastic lesions.

In the case of  cytology of body fluids,  other body fluids can be analyzed, namely:  urine  (either from urination or from bladder washing),  ascitic fluid  (to clarify the cause of accumulation of this fluid in the abdominal cavity),  pleural fluid  (abnormal accumulation of fluid in the thin membrane surrounding the lung) and  joint fluid .

4. Necropsy (autopsy)

Necropsy (necros= death + scopion= observe), or simply autopsy, is a medical procedure whose objective is to  analyze the alterations of the organism after death .

Autopsies can be forensic doctors (performed in Forensic Medicine Centers) or clinics. Pathological Anatomy  only performs clinical autopsies,  which aim to clarify the cause of death in patients whose clinical status did not predict this outcome.

What is the role of Pathological Anatomy in Oncology?

When you are in the presence of an oncological disease, Pathological Anatomy is essential since it is  the anatomopathological diagnosis  that  will allow the appropriate and specific choice of treatment .

This medical specialty is also crucial in patient follow-up, therapeutic guidance and monitoring the response to treatments performed.

After the collection of biological material, laboratory processing and microscopic observation by the anatomopathologist, the diagnosis of the benign or malignant lesion is made.

If it is a malignant lesion , Pathological Anatomy can  stage the disease and predict how aggressive it is  and what kind of response it will have to treatments.

Currently, it is possible through Molecular Biology and Genetics techniques to study the genetic code of malignant tumors. It thus becomes possible to identify specific genetic mutations or alterations that enhance tumor growth or condition its response to treatments.

Pathological Anatomy at Unilabs

Pathological Anatomy is a fundamental specialty that cuts across all medicine. Through knowledge of human morphology, it is possible to identify lesions, what their degree is, and thus obtain an accurate diagnosis in conjunction with other complementary exams.

In oncology, this specialty is extremely important, as it allows predicting the therapeutic response that each patient will have. Thus, it is possible to customize cancer treatment so that it is more beneficial, effective and at lower costs.

At Unilabs we are at the forefront of Pathological Anatomy and Molecular Biology, following the technological and scientific advances to perform the most demanding exams and analyses.