해부병리학의 발전이 현대의학의 발전에 원동력이 되어온 것은 주지의 사실이다. 특히 해부병리학은 과거에 잘못된 인식 부족과 시설 미비로 임상에서의 활용도가 매우 낮은 편이였으나, 최근에는 과거와 달리 단순한 기술에 의한 형태학적인 관찰이 아닌 전자현미경을 이용한 초미세구조의 관찰이나 특수 조직화학적인 검사, 즉 면역 조직화학이나 효소조직화학적 검사, 그리고 분자병리학, 자가 방사법 등에 이르기까지 다양하고 심도 있는 질병진단의 수단으로 응용되고 있는 실정이다. 따라서 조직검사 업무에 종사하는 임상병리사들의 질적 향상 또한 매우 중요하다 하겠다.

그동안 조직검사학에 대한 이론과 실습에 관한 많은 책들이 출간되어 임상병리사 국가고시를 준비하는 수험생들에게 큰 도움을 준 것은 사실이지만 방대한 분량의 내용을 보다 효과적으로 정리하고, 최신시험 경향에 맞추어 국가고시에 대비하기란 쉬운 일이 아닌 것으로 생각되어, 임상병리사 국가고시를 준비하는 수험생들에게 보다 짧은 시간에 최대의 효과를 얻을 수 있도록 요약되고 정리된 개정판의 조직검사학 문제집을 발간하게 되었다. 본 문제집의 내용은 초판 때와는 달리 최근에 많이 출제되고 있는 K형의 문제를 첨가하여 기본문제와 연습문제로 구성하였으며 기본문제편에서는 조직검사에 따른 단위별 중요사항을 보다 자세한 설명으로 단원 전체 내용을 이해할 수 있도록 하여 조직검사학의 기초적개념을 충분히 이해하도록 하였으며, 연습문제편에서는 기초적 개념을 토대로 좀더 실무적이고 현실감 있는 문제를 접하도록 하여 앞으로 많은 변화가 예상되는 국시원의 정책에 부합할 수 있도록 하였다.



좋은 참고서가 되도록 노력은 하였으나, 아직 미흡한 점이 많을 것으로 생각된다. 앞으로 더욱 다듬어 수험생들에게 고충을 덜 수 있도록 하겠다. 끝으로 본 문제집 개정판을 발간하는데 많은 조언을 주신 조직, 세포분과 위원회 교수님들, 그리고 고려의학 최병진 사장님과 편집부 직원 여러분께 진심으로 감사를 드립니다.



2011년 10월

저 자

A. 기본문제


총론 ································································································································ 1


Ⅰ. 조직검사학의 개요 및 표본제작과정 ···································································· 1



각론 ································································································································ 4


Ⅰ. 고정(Fixation) ········································································································ 4


1. 일반 고정 ······················································································································· 4


2. 고정제 ··························································································································· 13


3. 고정액 ··························································································································· 18
1) Formalin 용액 ············································································································ 24
2) Zenker’s 용액 ············································································································ 29
3) Helly’s 용액 ·············································································································· 32
4) Bouin’s 용액 ·············································································································· 32
5) Carnoy’s 용액 ············································································································ 33
6) 탄수화물을 위한 고정액 ·························································································· 35
7) 미생물을 위한 고정액 ······························································································ 36
8) 효소 및 면역조직화학적 검색을 위한 고정액 ······················································· 36
9) 지방 검출을 위한 고정액 ························································································ 38
10) 박물용 표본을 위한 고정액(Kaisering 용액) ························································· 39



4. 고정색소 ······················································································································ 40

5. 고정에 영향을 미치는 요소 ······················································································· 42


Ⅱ. 수세(Washing) ····································································································· 45


Ⅲ. 뼈조직의 표본제작 및 탈회(Decalcification) ··················································· 46


1. 비탈회 뼈조직의 표본제작 ························································································· 47
2. 탈회 뼈조직의 표본제작 ···························································································· 49


Ⅳ. 탈수(Dehydration) ······························································································· 61


Ⅴ. 투명(Clearing) ···································································································· 67


Ⅵ. 침투(Impregnation, Infilteration) ····································································· 77


Ⅶ. 포매(Embedding) ······························································································· 87


Ⅷ. 박절(Section) ···································································································· 104


Ⅸ. 동결절편(Frozen Section) ·············································································· 124


Ⅹ. 염색(Stain) ········································································································ 132


1. 염색 이론(Theoretical stain) ················································································· 132

2. 일반염색(General stain) ························································································· 144

3. 특수염색(Special stain) ·························································································· 168
1) 조직학적인 특수염색(Histological special stain) ····················································· 168
2) 일반적인 조직화학적 특수염색(Histochemical special stain) ·································· 199
3) 특수 조직화학적 특수염색(Histochemical special stain) ······································· 239
4) 신경조직의 검출을 위한 염색법 ··········································································· 260
5) 조직에서 미생물 검출을 위한 염색법(Tissue microbiological special stain) ·········· 269
6) 기생충 검출을 위한 염색법 ·················································································· 281
7) 무기질 및 생체색소 검출을 위한 염색법 ····························································· 284
.. 봉입(Mountin) ···································································································· 294
.. 전자현미경학적 검사 및 분자병리학적 검사 ················································ 302
1. 전자현미경학적 검사 ································································································ 302
2. 분자병리학적 검사 ··································································································· 309
B. 연습문제
. 고정(Fixation) ··························································································································· 310

1. 일반 고정 ··················································································································· 310

2. 고정제 ························································································································ 313

3. 고정액 ························································································································ 315
1) Formalin 용액 ········································································································· 317
2) Bouin’s 고정액 ······································································································· 321
3) Carnoy’s 고정액 ······································································································ 324
4) Zenker’s 고정액 ······································································································ 325
5) Helly’s 고정액 ········································································································ 327
6) Orth’s 고정액 ·········································································································· 327
7) 친크롬성 고정액 ···································································································· 328
8) Absolute Ethanol과 Methanol 고정액 ······································································ 329
9) Acetone 고정액 ······································································································· 331
10) B-5 고정액 ············································································································ 332
11) 탄수화물을 위한 고정액 ······················································································ 332
12) 지방 검출을 위한 고정액 ···················································································· 332
13) 미생물을 위한 고정액 ·························································································· 333


4. 기타 ···························································································································· 334


Ⅱ. 탈회(Decalcification) ······················································································ 336


Ⅲ. 탈수(Dehydration) ··························································································· 339


Ⅳ. 투명(Clearing) ·································································································· 343


Ⅴ. 침투(Impregnation, Infilteration) ·································································· 346


Ⅵ. 포매 및 삭정(Embedding and trimming) ····················································· 351


Ⅶ. 박절(Section) ···································································································· 357


Ⅷ. 동결절편(Frozen Section) ·············································································· 373


Ⅸ-1. 염색(Stain) ···································································································· 379
1. 일반염색 ····················································································································· 379


Ⅸ-2. 염색(Stain) ····································································································· 398
1. 특수염색 ····················································································································· 398
1) 조직학적인 특수염색(Histological special stain) ····················································· 398
2) 일반적인 조직화학적 특수염색(Histochemical special stain) ·································· 416
3) 특수 조직화학적 특수염색(Histochemical special stain) ········································· 424
4) 신경조직의 검출을 위한 염색법 ··········································································· 440
5) 조직에서 미생물 및 Virus 검출을 위한 염색법 (Tissue microbiological and virus special stain) 448
6) 기생충 검출을 위한 염색법 ·················································································· 462
7) 무기질 및 생체색소 검출을 위한 염색법(Mineral special stain) ··························· 467
8) 특수염색에 관한 종합문제 ···················································································· 482


X. 봉입(Mountint) ···································································································· 499


XI 전자현미경(Electron microscope) ···································································· 501
1. 고정 ···························································································································· 501
2. 고정액 ························································································································ 502
3. 탈수, 투명, 침투, 포매 ··························································································· 505
4. 박절 ··························································································································· 507
5. 염색 ··························································································································· 509
6. 기타 ···························································································································· 510