Pathology Lec 4 PDF

Tissue Accumulations and Deposits Inside the cell Depositions outside the cell both Inside and outside the cell Deposited pigments Mucoid and myxomatous change Gout Pathological calcification Amyl...

Tissue Accumulations and Deposits Inside the cell Depositions outside the cell both Inside and outside the cell Deposited pigments Mucoid and myxomatous change Gout Pathological calcification Amyloidosis Anthracosis Hyalinosis Lead Exogenous Parasitic pigmentation tattooing Pigments Melanin lipofuscin Endogenous Haemoglobin derived Iron pigment Exogenous pigmentation : Inhalation of carbon as anthracosis (black lung) Inoculation as tattoing Ingestion as lead Parasitic pigmentation Increase in melanin pigment exposure to sun,chloasma,Naevi,melanoma and Addison disease Lipochrome (lipofuscin) pigment : This pigment increased with aging and in wear and tear chronic diseases, when deposited in heart muscle, it leads to brown atrophy of heart Haemoglobin derived pigments : Bilirubin Haemosidrin Hematin Haemosiderosis : Is a condition, in which haemosidrin is formed due to ruptured vessels with release of RBCs outside vessels Haemosiderosis may be localized or generalized Ruptured vein Causes of localized haemosiderosis : Haemorrhage Haematoma Varicose vein Infarction Congestion Generalized haemosiderosis : RBCs destruction as in hemolytic anaemias Repeated blood transfusion Haemochromatosis (Bronzed diabetes) : Inborn errors of iron metabolism Liver (cirrhosis) Pancreas (diabetes mellitus) Skin (dark skin) Heart (heart failure) Mucin 1-Mucoid change if deposited inside the cell (push nucleus to periphery lead to signet ring pattern ) as in catarrhal inflammation 2-Myxomomatous if mucin deposited outside the cells (connective tissue) as in umbilical cord and fibroid (benign smooth muscle tumor of uterus) Umbilical cord Leimyoma Gout : Disturbance in purine metabolism leading to sodium urate crystals deposition in tissue Causes of gout Primary or hereditary (disturbabce of purine metabolism) Secondary mostly due to leukaemia Deposition of sodium urate crystals due to increased uric acid level Sites of deposition Any joints can be involved mainly Metatarsophalyngeal joint of big toe Non articular cartilage as nose and ear Kidney leading to renal failure Pathological calcification : Pathological deposition of calcium salts in sites other than bone and teeth. Types: Dystrophic calcification due to degneration or death of tissue (necrosis) Metastatic calcification Stones (urinary bladder and gall bladder) Calcified bilharzia ova Dead fetus Why dead tissue is liable for calcification ? Because dead tissue is relatively alkaline Release of alkaline phosphatase Metastatic calcification Deposition of calcium salts in living tissue due to either increase in calcium absorption or mobilization hypervitaminosis D hyperparathyroidism metastatic bone lesions Is the extracellular deposition Amyloidosis : of abnormal protein Nature of amyloid material Fibril protein P component Amyloid light AL Amyloid associated protein AA Types of Amyloidosis Haemodialysis associated Localized Systemic (Beta 2 microglobulin) Primary Amyloid Secondary Amyloid light associated Hereditary (transthyretin) neuropathy Familial Mediterranean fever  (deposition in certain organ as in tongue, Localized amyloidosis intestine, skin, adrenal gland) Pathogenesis of systemic Amyloidosis : Primary secondary Multiple myeloma is a malignant tumor of bone. Cell of origin is plasma cells Secondary Amyloidosis : Rheumatoid arthritis Chronic suppurative conditions : -Empyema (suppuration in pleural cavity) -Lung abscess -bronchiectasis Infective granulomas : -tuberculosis Malignant tumors : -Hodgkin lymphoma -Gastric carcinoma -Renal cell carcinoma  Primary (idiopathic) amyloidosis Secondary amyloidosis Chronic inflammatory or malignant destructive disease Rheumatoid arthritis. Idiopathic Chronic suppurative conditions Causes and Multiple myeloma (malignant (bronchiectasis, empyema, lung predisposing tumor of plasma cells affecting abscess). factors bone marrow) Infective granulomas Monoclonal gammopathy (tuberculosis). Malignant tumors (Hodgkin lymphoma, gastric and renal cell carcinoma). Inflammatory conditions activate macrophages which secrete Malignant plasma cells secretes light inteleukins that stimulat liver to chain of immunoglobulin leading to Pathogenesis synthesize serum amyloid accumulation of amyloid light protein associated protein which then which is accumulated in tissues converted to amyloid associated protein Type of amyloid AL (amyloid light) AA (amyloid associated) protein Amyloid Stains Gross staining (brown patches against yellow background) 1.Lugol’s iodine stain 2.Iodine and sulphuric acid stain Microscopic staining 1. Haematoxylin and eosin stain (amyloid Amyloid stained by appears pink) Congo reappears green 2. Congo red stain (it is the most specific stain ) by polarized light microscope 3. Metachromatic stain  1. Enlarged Gross affection of any organ : 2. Firm 3. Rubbery Liver histology liver: Wall of sinusoid, central vein and portal structures Liver amyloidosis  Renal amyloidosis Glomeruli ---> proteinuria Collecting tubules ---> Diabetes insipidus Afferent arteriols ---> Arteriolosclerosis, ischemia, reduced kidney Spleen (histologically formed of red pulp and white pulp) Focal type (white pulp) Diffuse type (red pulp)  Heart ----> Heart failure Stenosis or regurge of valves arrythemia Suprarenal gland ----> Addison disease Intestinal obstruction ----> malabsorption Diagnosis of Amyloidosis Biopsy with Congo red staining 1. Complications 2. renal failure 3. Heart failure 4. Intestinal obstruction 5. Addison disease Hyalinosis : Microscopic change in tissue manifested by homogenous structrureless and pinkish coloration Types of Hyalinosis : Connective tissue hyalinosis Blood vessel diseases such as atherosclerosis, hypertension and thrombus keloid Cellular hyalinosis : Mallory body in alcoholic cirrhosis Russel bodies in inflammation rich in plasma cells (pink globules in plasma cells) Benign prostatic hyperplasia: the Zinker degeneration: lumen of hyperplastic acini hyalinization of skeletal muscle showed hyalinized pink secretion of anterior abdominal wall and called corpora amylacea diaphragm due to toxemia by diphtheria or pneumonia Amyloidosis Hyalinosis Gross and microscopic change Microscopic change only Extracellular deposition Cellular and Extracellular deposition Has definite biochemical structure It has no definite structure Has special stains No special stains