Educational Case: Burn Injury-Pathophysiology, Classification, and Treatment

Abstract

The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see http://journals.sagepub.com/doi/10.1177/2374289517715040.¹.

Keywords: disease mechanism; environmental mechanisms; pathology competencies; physical injury; thermal injury.

Figure 1.

A 74-year-old man with severe burn injury. Note the skin sloughing on the abdomen and the necrotic eschar on the hand.

Figure 2.

Low magnification (×40) image immediately after a burn showing separation of the epidermis from the dermis consistent with blister formation (star) and hemorrhage (arrow) in the dermis. Hematoxylin and eosin stain. Scale bar = 250 micrometer.

Figure 3.

High-magnification image (×200) showing denudation and sloughing of the epidermis after burn injury (arrow). Inflammation in the dermis including neutrophils and lymphocytic infiltrate, heralding the attempts at repair, is also shown (black star). Neutrophils are seen near the sloughing epidermal surface, while the dermal infiltrate is lymphocyte-predominant. Note the underlying skeletal muscle below the dermis (red star) with minimal hypodermis, consistent with an area of the body with minimal subcutaneous adipose tissue. Hematoxylin and eosin stain. Scale bar = 100 micrometers.