Principle and Practice of Human Pathology

Syllabus

Course Meeting Times

Lectures: 2 sessions / week, 3 hours / session

Mission

An increasing number of students in health sciences, engineering, bioinformatics, and other biomedical initiatives at MIT require an introduction to human pathology and issues posed by novel medical and diagnostic technologies. Currently, the only available course in human pathology is HST.030/031, which is designed primarily for HST MD and MEMP students and is based at the Harvard Medical School campus. HST.035 was designed to provide an alternative option for MIT students and to make human pathology accessible to a broader audience at MIT. In addition, by taking advantage of new technologies in “virtual microscopy,” HST.035 introduces a new integrated approach to pathology laboratories that streamlines clinicopathological case-studies and enables access to these educational materials from anywhere on the MIT campus.

Overview

This subject provides a comprehensive overview of human pathology with emphasis on mechanisms of disease and modern diagnostic technologies. Topics include (1) General Mechanisms of Disease (Inflammation, Infection, Immune Injury, Host Response to Foreign Materials, Transplantation, Genetic Disorders and Neoplasia), (2) Pathology of Lipids, Enzymes and Molecular Transporters, (3) Pathology of Major Organ Systems, and (4) Review of Diagnostic Tools from Invasive Surgical Pathology to Non-invasive Techniques such as Optical Spectroscopy, Functional Imaging, and Molecular Markers of Disease. The objectives of this course are achieved by a set of integrated lectures and laboratories, as well as a student-driven term project leading to a formal presentation on a medical, socioeconomic, or technological issue in human pathology.

Prerequisites

A basic understanding of cellular biology is required to study cellular pathology and mechanisms of disease. Although the formal prerequisites for the course are 7.01: (Introduction to Biology) and 7.05: (General Biochemistry), this requirement can be met by other courses or forms of experience (permission of the course director is required).

Required Textbook

• Required reading for lectures related to cellular and organ system pathology are assigned from Cotran et al., Robbins Pathologic Basis of Disease, 6th edition. Philadelphia, PA: W. B. Saunders, 1999, ISBN: 9780721673356. Although not all sections and chapters of this book will be assigned for reading, students are highly encouraged to read this book cover-to-cover during the spring semester.

• Required reading for other lectures and topics will be in the form of lecture notes, review articles, or original articles. These will be handed out in class during the course.

Additional Basic References

• An Interactive Case Study Companion to Robbins Pathologic Basis of Disease is available online to registered HST students. This is a great resource for learning more and testing your knowledge about basic human pathology.

• Junqueira, L. C., and J. Carneiro. Basic Histology: Text and Atlas. 10th ed. New York, NY: McGraw-Hill Companies, 2002. ISBN: 9780071378291, is recommended for those interested in learning more about normal histology.

• Lodish H., et al. Molecular Cell Biology. 4th ed. New York, NY: McGraw-Hill, 1999. ISBN: 9780716731368, is recommended for those interested in learning more about cellular biology. A limited online version of this book is available through the National Library of Medicine.

•  For additional reading in immunology and immunopathology, you can review Abbas, A. K. et al. Cellular and Molecular Immunology. Philadelphia, PA: W. B. Saunders, 2000. ISBN: 9780721682334.

• If you need additional references or reading recommendations, please ask!

Laboratories

There will be 12 laboratory sessions in the course, each lasting approximately 2 hours. These include:

Lab 1. Cells and Tissues - Part I
Lab 2. Cells and Tissues - Part II
Lab 3. Infection and Immunity
Lab 4. Transplantation and Biomaterials
Lab 5. The Heart
Lab 6. Kidneys and Blood Vessels
Lab 7. Lungs and Liver
Lab 8. The Gastrointestinal Tract
Lab 9. Red and White Blood Cells
Lab 10. The Nervous System
Lab 11. The Clinical Laboratories (at Harvard Medical School)
Lab 12. Autopsy Conference (at Harvard Medical School)

The first two laboratories are designed to familiarize you with the common structures of cells and tissues, the subsequent eight laboratories are focused on specific organs and organ systems pathology, and the final two laboratories are designed to introduce you to two specialized and important areas of hospital pathology. The web-based materials for each lab will be posted just-in-time for the corresponding lab, but will remain available through the course website for the remainder of the course.

Although the web-based laboratories are largely “menu-driven,” you are expected to use the materials presented to you to formulate your own thoughts and to ask questions. It is extremely important that you actively interact with the faculty during the laboratories. The images, cases and other materials presented to you contain a wealth of information that will only be accessible to you if you wonder and ask questions!

Minicases

The minicases are small case-studies designed to help you integrate the materials covered in class and in your readings. You are expected to review the minicases ahead of time and to formulate your opinion about each case. Although you are not expected to hand-in your responses to questions posed in each minicase, you should have spent enough time on each case to be able to participate in class discussions about each case. The minicases will be distributed approximately 1 week before each scheduled session.

Grading

Your final grade in HST.035 will be determined based on the following criteria:

• Mid-term exam (20%): Twenty multiple-choice or short-answer questions (1 point per question). Questions will draw on the information presented in lectures, as well as the reading assignments. Up to 40% of the questions on the mid-term exam may be based on questions designed by class as part of a homework assignment (the actual number of student-designed questions on the mid-term exam depends on the quality of questions as determined by the course director).

• Final exam (30%): Thirty multiple-choice or short-answer questions (1 point per question). Questions will draw on the information presented in lectures, as well as the reading assignments. The final exam covers the material presented in the entire course. Up to 40% of the questions on the final exam may be based on questions designed by class as part of a homework assignment (the actual number of student-designed questions on the final exam depends on the quality of questions as determined by the course director).

• Homeworks (20%): Ten homeworks assignments (2 points per homework assignment). The homework assignments are an essential part of this course. Failure to hand in fewer than 8 of the 10 homeworks will result in a drop in your final letter grade.

   

• Active participation in case discussions and laboratories (5%). Ten of the 12 laboratory sessions in HST.035 are web-based. Failure to complete fewer than 8 of these 10 laboratories will result in a drop in your final letter grade.

• Term presentation (25%): Each student is required to conduct a literature-based study on a medical, socioeconomic, or technological issue related to pathology or diagnostic medicine. Each student will produce a brief written summary (maximum 3 pages) and present his or her findings in a 20-minute presentation before Session 24. Students are encouraged to test and challenge established dogmas or practices in all aspects of diagnostic medicine, and to try to provide new or alternative solutions. Topics will emphasize broad and multi-disciplinary issues such as (but not limited to):

  • Inter- and intra-observer variability: how certain are pathological diagnoses?
  • Real-time diagnostic techniques: can machines make clinically acceptable diagnostic decisions?
  • What is the optimal screening strategy for dysplasia in Barrett’s esophagus or ulcerative colitis?
  • “Roundness factor” and other non-intuitive morphological features: is there a role for machines and robotics in routine diagnostic pathology?
  • What is “normal?”
  • Cost-effectiveness in the laboratory: should we examine hernia sacs or calcified heart valves?
  • Pathologists in the media: how are pathologists portrayed in the public media? Has the media portrayal of the pathologists been detrimental or beneficial to the practice of pathology?
  • Marketing of novel diagnostic technologies: can novel diagnostic technologies use traditional pathology as the gold standard, but at the same time aspire to become the gold standard?
  • How are laboratory reference ranges established in adults? How would you establish reference ranges for common blood analytes in infants and toddlers? How would you establish reference ranges for uncommon analytes in infants and toddlers?