Pathology: Cellular and Tissue Injury, Part 3

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Questions and Answers

In a patient with suspected gout, which of the following is a key characteristic of sodium urate deposition?

  • Deposition exclusively within cardiac muscle, causing restrictive cardiomyopathy.
  • Deposition in the skin, kidneys, and joints, particularly affecting the metatarsophalangeal joint of the big toe. (correct)
  • Deposition primarily in the brain tissue, leading to cognitive impairment.
  • Deposition within the lung parenchyma, leading to pulmonary fibrosis.

Which of the following is the primary reason for the development of light brown paranuclear pigments in cardiac cells in an 84-year-old male?

  • Deposition of lipochrome (lipofuscin) resulting from tissue breakdown. (correct)
  • Intracellular buildup of glycogen as a result of a storage disease.
  • The effect of metastatic calcification following hypercalcemia.
  • Accumulation of hemosiderin due to increased iron absorption.

What microscopic finding is characteristic of cells affected by glycogen storage diseases?

  • Cells displaying a 'signet-ring' morphology, indicating mucin accumulation.
  • Cells with needle-shaped crystal inclusions.
  • Extracellular amorphous deposits of amyloid.
  • Cells that appear swollen with clear cytoplasmic vacuoles and stain positive with PAS (correct)

Which of the following best describes the microscopic appearance of cells distended with mucin, characteristic of conditions such as catarrhal inflammation or mucoid carcinoma?

<p>Signet-ring cells with distended cytoplasm and potential rupture. (C)</p> Signup and view all the answers

Which of the following is a defining feature of hyalinosis?

<p>Presence of glassy, refractile, homogenous, structureless protein material that stains red with eosin. (C)</p> Signup and view all the answers

Systemic amyloidosis can be associated with which of the following conditions?

<p>Plasma cell tumors (multiple myeloma) and inflammatory conditions such as tuberculosis (TB). (C)</p> Signup and view all the answers

What microscopic characteristics confirm amyloid deposits in tissue samples?

<p>Eosinophilic staining with H&amp;E and orange-red appearance with Congo red stain, exhibiting apple-green birefringence under polarized light. (C)</p> Signup and view all the answers

What is dystrophic calcification characterized by?

<p>Abnormal deposition of calcium salts in nonviable tissue despite normal blood calcium levels. (A)</p> Signup and view all the answers

Which of the following conditions is an example of metastatic calcification?

<p>Calcium deposition in the kidney tubules due to hypervitaminosis D. (D)</p> Signup and view all the answers

What is the primary difference between dystrophic and metastatic calcification?

<p>Dystrophic calcification occurs in nonviable tissues with normal calcium levels, while metastatic calcification occurs in viable tissues with hypercalcemia. (C)</p> Signup and view all the answers

In cases of chronic lead poisoning (plumbism), what is the route of entry for the exogenous pigment leading to tissue accumulation?

<p>Ingestion of contaminated substances. (B)</p> Signup and view all the answers

What is the underlying mechanism by which lipofuscin accumulates within cells?

<p>Increased tissue breakdown leading to released phospholipids that are phagocytosed by cells. (C)</p> Signup and view all the answers

Patients requiring repeated blood transfusions are at risk for developing which type of tissue accumulation?

<p>Generalized hemosiderosis due to the iron content of blood. (D)</p> Signup and view all the answers

Which of the following statements correctly links a tissue accumulation with its associated condition?

<p>Gout is marked by the deposition of sodium urate in tissues, resulting from disturbed purine metabolism. (A)</p> Signup and view all the answers

Select the scenario that best describes the pathogenesis of metastatic calcification.

<p>A patient with hyperparathyroidism experiences calcium deposition in the gastric mucosa. (C)</p> Signup and view all the answers

A pathologist is examining a lung biopsy from a coal miner. Which type of pigment accumulation is most likely to be observed?

<p>Anthracosis from carbon particles. (A)</p> Signup and view all the answers

Which of the following is the most likely outcome of progressive amyloidosis?

<p>Progressive organ dysfunction due to vascular compression and pressure atrophy. (A)</p> Signup and view all the answers

How does the primary form of gout differ from the secondary form in terms of etiology?

<p>Primary gout is typically familial, resulting from increased purine breakdown or decreased clearance, while secondary gout is due to increased cellular destruction. (D)</p> Signup and view all the answers

In a patient with suspected amyloidosis, which of the following sequences accurately describes the diagnostic process involving tissue staining?

<p>H&amp;E stain showing eosinophilic deposits → Congo red stain showing orange-red deposits → Polarized light microscopy showing apple-green birefringence. (D)</p> Signup and view all the answers

A 22-year-old woman has congenital anemia that requires repeated blood transfusions for many years. What cellular change would likely be observed?

<p>Hemosiderin in hepatocytes (A)</p> Signup and view all the answers

Which of the following best explains the pathophysiology behind crystal-induced arthritis in gout?

<p>Deposition of monosodium urate crystals in joints and soft tissues, triggering an inflammatory response. (A)</p> Signup and view all the answers

Which of the following is the most likely sequence of events that leads to lipofuscin accumulation in cells?

<p>Increased cellular metabolism and oxidative stress results in increased lipid peroxidation, leading to the formation of lipofuscin from indigestible residues. (A)</p> Signup and view all the answers

A patient with a history of chronic alcoholism and cirrhosis is at risk for developing which type of tissue accumulation?

<p>Accumulation of hemosiderin in the liver as a result of abnormal iron metabolism. (B)</p> Signup and view all the answers

What is the underlying mechanism by which hypercalcemia leads to metastatic calcification?

<p>Increased serum calcium levels exceeds saturation point, causing calcium phosphate crystals to precipitate and deposit in tissues with a slightly alkaline microenvironment. (A)</p> Signup and view all the answers

A patient with a history of intravenous drug use presents with tattoos and local skin infections. Which type of pigment accumulation is likely present in the skin?

<p>Exogenous pigment from the tattoo ink as a result of inoculation. (D)</p> Signup and view all the answers

Which of the following descriptions best explains the effects of amyloid deposition on organ function?

<p>Progressive organ dysfunction due to vascular compression and pressure atrophy. (B)</p> Signup and view all the answers

Which of the following are familial or genetic mutations associated with primary gout?

<p>Enzymatic and transporter proteins. (B)</p> Signup and view all the answers

A pathologist is examining a renal biopsy from a patient with a history of multiple myeloma. What sequence of staining would they expect to see to confirm amyloid?

<p>Hematoxylin and eosin (H&amp;E) showing amorphous material, Congo red showing orange-red deposits, and polarized light microscopy validating apple-green birefringence. (B)</p> Signup and view all the answers

In a microscopic examination of an atheroma, which form of calcification is most likely to be observed?

<p>Dystrophic calcification. (B)</p> Signup and view all the answers

Which of the following conditions can cause hypercalcemia?

<p>Vitamin D intoxication. (D)</p> Signup and view all the answers

A pathologist examines tissue from a patient with suspected occupational lung disease. Which of the following patterns of pigment accumulation is most indicative of pneumoconiosis?

<p>Patchy deposition of exogenous pigments within alveolar macrophages. (D)</p> Signup and view all the answers

In a patient who has been diagnosed with cardiac amyloidosis, which outcome is the most likely development?

<p>Progressive decline in cardiac function, vascular resistance. (B)</p> Signup and view all the answers

A 55-year-old man with a history of alcoholism presents with swollen and painful joints, particularly in the metatarsophalangeal joint of the big toe. Uric acid crystal deposition results in which type of cell injury?

<p>Inflammation and damage in joints. (C)</p> Signup and view all the answers

When examining heart tissue from an elderly patient, the presence of lipofuscin pigment is noted. What reflects the significance of this finding?

<p>It indicates previous cellular damage or oxidative stress. (D)</p> Signup and view all the answers

A patient with a history of hepatitis C develops liver cirrhosis. Which accumulation may be observed in biopsy of the liver?

<p>Focal accumulation of hemosiderin due to blood products. (C)</p> Signup and view all the answers

What is the impact of calcification in atherosclerosis on blood vasculature?

<p>Vascular elasticity. (D)</p> Signup and view all the answers

During initial environmental exposure assessments, what is the pathogenesis of lung diseases caused by dust inhalation?

<p>The activation of alveolar macrophages. (D)</p> Signup and view all the answers

A pathologist examines a patient diagnosed with systemic amyloidosis. Which long-term effect on organ systems is more likely?

<p>Systemic infiltration. (C)</p> Signup and view all the answers

A patient with suspected gout exhibits elevated levels of uric acid. What is the most critical factor determining the formation of sodium urate crystals in the joint tissues?

<p>The absolute concentration of serum uric acid exceeding its solubility threshold. (B)</p> Signup and view all the answers

What is the underlying mechanism by which abnormal glycogen metabolism leads to cellular swelling and clear cytoplasmic vacuoles in glycogen storage diseases?

<p>Osmotic pressure changes due to glycogen accumulation. (D)</p> Signup and view all the answers

Hyalinosis is characterized by the accumulation of glassy, refractile, homogenous material. Which of the following cellular mechanisms contributes most significantly to this accumulation?

<p>Extracellular deposition of aggregated plasma proteins or basement membrane components. (C)</p> Signup and view all the answers

In systemic amyloidosis, which pathogenic mechanism most directly leads to organ dysfunction?

<p>Vascular compression and pressure atrophy due to amyloid deposits. (C)</p> Signup and view all the answers

What is the primary pathophysiological mechanism that differentiates metastatic calcification from dystrophic calcification?

<p>The systemic calcium and phosphate balance. (B)</p> Signup and view all the answers

Flashcards

Gout Definition

Disturbance in purine metabolism, leading to sodium urate deposition, elevating blood and urine levels.

Primary Gout Cause

Familial; males are more prone. Caused by increased purine breakdown or decreased clearance.

Secondary Gout Cause

Increased cellular destruction, such as in Polycythemia rubra vera.

Gout Deposition Sites

Skin, kidney, and joints, especially the metatarsophalangeal joint of the big toe.

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Carbohydrate/Glycoprotein Accumulation

Abnormal accumulation of carbohydrates or glycoproteins within cells or tissues.

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Glycogen Accumulation

Occurs in glycogen storage diseases due to abnormal glycogen metabolism.

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Microscopic Appearance of Glycogen Accumulation

Cells are swollen with clear cytoplasmic vacuoles; identified with PAS stain.

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Mucin Accumulation

Occurs in catarrhal inflammation and mucoid carcinoma.

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Microscopic Appearance of Mucin Accumulation

Cells distended with mucin (signet-ring cells) may rupture, releasing mucin.

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Hyalinosis Definition

Presence of glassy, refractile, homogenous, structureless protein material that stains red with eosin.

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Examples of Hyalinosis

Russell's bodies in Rhinoscleroma and Corpora amylacia in prostatic hyperplasia.

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Amyloidosis Definition

Extracellular deposition of abnormal fibrillary protein appearing as homogenous eosinophilic material.

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Localized Nodular deposits

Affects tongue, larynx, lung.

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Senile Amyloidosis

Cardiac or cerebral (Alzheimer disease)

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Endocrine Amyloidosis

Amyloidosis in endocrine tumors

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Primary Systemic Amyloidosis

Occurs in plasma cell tumor called multiple myeloma.

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Secondary Systemic Amyloidosis

(Also called reactive amyloidosis) occur in inflammatory diseases as TB.

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Amyloidosis Diagnosis

Diagnosis involves tissue biopsy, H&E staining, Congo red staining, and polarized light.

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Amyloidosis H&E Stain

Eosinophilic with H&E stain.

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Amyloidosis Congo Red Stain

Orange red with Congo red stain.

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Amyloidosis Polarized Light

Apple green under polarized light with Congo red stain

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Effects of Amyloidosis

Progressive organ dysfunction due to vascular compression and pressure atrophy.

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Pathological Calcification

Abnormal deposition of calcium salts in tissue other than bone and teeth.

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Appearance of Pathological Calcification

Appears as chalky white and hard to the naked eye, dark blue under a microscope.

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Dystrophic Calcification

Occurs in nonviable tissue with normal blood calcium levels.

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Examples of Dystrophic Calcification

Calcification in fat necrosis, walls of chronic abscesses, old scars, etc.

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Metastatic Calcification

Occurs in viable tissue with hypercalcemia.

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Causes of Metastatic Calcification

Excess absorption of calcium, excess mobilization of calcium from bone.

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Sites of Metastatic Calcification

Kidney (in tubules), walls of arteries, mucosa of the stomach, lung alveoli.

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Stone Formation

Precipitation of calcium salts in biliary, urinary, and salivary ducts.

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Pathological Pigments Definition

Colored substances that stain tissue, may be exogenous or endogenous.

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Exogenous Pigment Entry

Routes include inhalation, ingestion, and inoculation (tattooing).

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Endogenous Pigments

Melanin, lipochrome (lipofuscin), and hemosiderin.

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Melanin Pigment Variations

Involves hyperpigmentation (nevus, melanoma) and hypopigmentation (vitiligo, albinism).

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Lipochrome (Lipofuscin) Pigment

Yellowish-brown fat-soluble pigment normally in the heart, testis, etc.

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Increased Lipochrome

Increases due to tissue breakdown, seen in old age, wasting diseases, and cancer cachexia.

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Hemosiderosis Definition

Deposition of hemosiderin (iron-containing pigment).

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Localized Hemosiderosis

Due to localized hemorrhage.

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Generalized Hemosiderosis

Primary (inborn error) or secondary (transfusions, hemolytic anemias).

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Gout is disturbed metabolism of

Purine amino acids

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Repeated blood transfusions

Hemosiderin in hepatocytes

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Brown atrophy of heart is due to?

Lipochrome

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Study Notes

  • Study notes on pathology of cellular and tissue response to injury (part 3).

Gout

  • Gout is a disturbance in purine metabolism
  • It results in the deposition of sodium urate in tissues and increased levels in blood and urine.
  • Primary causes are familial with a higher occurrence in males; it is due to increased purine breakdown or decreased clearance.
  • Secondary causes include increased cellular destruction seen in Polycythaemia rubra vera.
  • Sodium urates are deposited in the skin, kidney, and joints, often affecting the metatarsophalangeal joint of the big toe.

Carbohydrates & Glycoproteins

  • Glycogen storage diseases result from abnormal glycogen metabolism.
  • Cells swell with clear cytoplasmic vacuoles; Periodic Acid Schiff (PAS) stain is used and will test positive.

Mucin

  • Examples, catarrhal inflammation and mucoid carcinoma.
  • Cells are distended with mucin (forming signet-ring cells)
  • The cells may ultimately rupture and release mucin (mucin lacks).

Hyalinosis (Hyaline Deposition)

  • Hyalinosis is identified by:
    • Glassy appearance
    • Refractile
    • Homogenous
    • Structureless protein material
    • Stains red with eosin.
  • Examples include Russell’s bodies in Rhinoscleroma and Corpora amylacia in prostatic hyperplasia.

Amyloidosis

  • Amyloidosis is the extracellular deposition of abnormal fibrillary protein
  • Has a homogenous eosinophilic appearance.

Types of Amyloidosis

  • Localized: -Nodular deposits affect tongue, larynx, and lung -Senile cases affect cardiac or cerebral functions such as Alzheimer's -Endocrine amyloidosis found in endocrine tumors
  • Systemic (Generalized): -1ry amyloidosis occurs in plasma cell tumors like multiple myeloma -2ry amyloidosis (reactive amyloidosis) occurs in inflammatory diseases like tuberculosis (TB) -Heredofamilial amyloidosis

Diagnosis of Amyloidosis

  • Requires tissue biopsy.
  • Hx & E stain shows esinophilic properties
  • Congo red stain shows orange red
  • Under polarized light with Congo red, it appears apple green.

Effects of Amyloidosis

  • Results in progressive organ dysfunction due to vascular compression and pressure atrophy.

Pathological Calcification

  • Pathological calcification involves abnormal deposition of calcium (Ca) salts in tissues outside of bone and teeth.
  • N/E chalky white and hard.
  • M/E appears dark blue.
  • Three types: -Dystrophic calcification occurs in nonviable tissue with normal blood calcium levels -Found in fat necrosis, walls of chronic abscesses, old scars, dead bilharzial ova, fibrosed valves, and atheroma of large vessels -Metastatic calcification occurs in viable tissue with hypercalcemia -Hypercalcemia is caused by excess absorption of calcium from the intestine (e.g., Hypervitaminosis D or Milk-alkali syndrome) or excess mobilization of calcium from bone (e.g., Endocrinal disorders, prolonged immobilization, or bone destruction by malignant tumors) -Common sites are the Kidney (in tubules) (Nephrocalinosis), the wall of arteries, the mucosa of the stomach and the lung alveoli -Stone formation is caused by precipitation of Ca salts in the ducts, biliary tract, urinary tract, and salivary gland.

Pathological Pigmentation

  • Colored substances stain tissue.
  • There are exogenous and endogenous types.
  • Exogenous sources enter the body through inhalation (anthracosis/carbon particles), ingestion (chronic lead poisoning/plumbism), or inoculation (tattooing).
  • Two types of Endogenous Pigments: -Melanin pigment -Lipochrome (lipofuscin) pigment -Hemosiderin pigment.

Melanin Pigment:

  • Hyperpigmentation is localized in Nevus and Melanoma, and generalized with prolonged exposure to sunlight.
  • Hypopigmentation is localized in Vetiligo and generalized in Albinism.

Lipochrome (lipofuscin) Pigment

  • It is a yellowish-brown, fat-soluble pigment.
  • Normally present in cells of the heart, testis, seminal vesicles, corpus luteum, and adrenal cortex.
  • Increases due to tissue breakdown, releasing phospholipids which are phagocytosed by neighboring cells, leading to intracellular accumulation.
  • Causes include old age (brown atrophy of heart), wasting diseases, and cancer cachexia.

Hemosiderin Pigment

  • Deposition of hemosiderin (iron-containing brown pigment); a special stain Prussian Blue is used
  • Two Types: -Localized hemosiderosis is due to localized hemorrhage -Generalized hemosiderosis includes primary (due to inborn error of metabolism) and secondary (repeated blood transfusions or hemolytic anemias) forms.

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