Exogenous Pigments - Ústav Patologie 1.LFpau.lf1.cuni.cz/file/6450/9-pigm-exog.pdf · Exogenous Pigments. Exogenous pigments –table of contents definition portals of entry traumatic

Jaroslava Dušková

Inst. Pathol. ,1st Med. Faculty, Charles Univ. Prague

General Pathology

Basic Principles of Cellular and Organ

Pathology

Exogenous

Pigments

Exogenous pigments – table of contents

definition

portals of entry

traumatic lesions

gastrointestinal tract

respiratory tract - pneumoconioses

silicosis

asbestosis

miners´disease

diff. dg. to pneumoconioses

- coniotoxicoses

- conioallergoses

PigmentsDefinition:

colored substances

in the organism

or environment

Colors result from the reflection of a particular wavelength of light from an object.

PigmentsClassification:

endogenous

– hemoproteins

derived

– autogenous

exogenous

Exogenous Pigments

- colored substances

entering the organism via traumatic lesions

respiratory tract

Exogenous Pigmentation

traumatic origin – tatuatio traumatica, arteficialis

– intoxication Pb, Ag, Au, Fe (!), Hg, Pt……

traumatic origin – tatuatio traumatica, arteficialis

mechanic instilation of „inert“ dyes

(china ink)

into the deep dermis

Tattoo

From Polynesian tatau.

In Tahitian - tatu.

The Polynesian practice became popular among

European sailors, before spreading to Western

societies

Mummy of Amunet from Ancient Egypt

Pre-Christian Germanic, Celtic and other central

and northern European tribes were often heavily

tatooed

Auschwitz survivor

Sam Rosenzweig

displays his

identification tattoo.

The Art ??

Tattoo

Tatuatio arteficialis

protest? aesthetic social communication?

Prevalence

• Female gender

• White or Hispanic

• Age 24 to 39 years

• Self-described risk takers

• College educated

• Single

• In stable family

relationships

• Moderate to strong

religious beliefs

• Interest in dissociating

from the past

Among individuals seeking tattoo

removal, the following features were

more common:

Tattoo Removal: New

Laser Options

J. of Drugs in

Dermatology

April 2013 | Volume 12 |

Issue 4 | Feature | 492

Piercing

Medical Tattoos

to ensure instruments are properly located for repeated application of radiotherapy

for the areola in some forms of breast reconstruction.

Tattooing has also been used to convey medical information about the wearer (e.g. blood group).

Tattoos are used in skin tones to cover vitiligo, skin pigmentation disorder.

London

Tatuatio

experimentalis

Tatuatio

Tattoo

inert – persistent

macrophage degraded

macrophage transported

secondary lymph node pigmentation

Tattoo Removal - Think before you ink

Maybe your new boss frowns upon your tattoos

or your sweetheart can't stand the name of your former...

Laser treatment is now the standard method of removal

for unwanted tattoos.

Laser removal is low risk, non-invasive, and has a very

low incidence of scarring (about 5%).

Tatuatio arteficialis - therapy

LASER = Light Amplification by Stimulated

Emission of Radiation

– low performance laser – biostimulation

– high performance laser – destruction of

pigmentation shifts – postinflammatory,

melasma (chloasma), tattoo

SURGERY / CRYOSURGERY

COMBINATION

COVER UP

Tattoo Removal - Think before you ink IPL – Intense Pulsed Light Therapy does not involve lasers, but the two processes are

similar. Most tattoos can be removed with only 3-4 sessions. The drawback is the expense -IPL can cost $10 and more per pulse.

The Process starts with a consultation with a dermatologist. There are around 100 different tattoo inks in use today, and some can be removed more easily than others.

The Pain of the laser pulse is most often compared to the sensation of having hot grease spattered on the skin, hair removed by extraction or to being repeatedly snapped with a rubber band. Anti-inflammatory drugs like ibuprofen are not recommended, as they may result in bruising.

The Procedure usually lasts 15-30 minutes per session. It involves laser pulses passing through the epidermis of your skin and into the dermis, where the tattoo ink absorbs the light energy. Over the following three to six weeks, the skin naturally removes the ink, which has been fragmented by the laser energy. A low-grade inflammation may occur after each procedure; this has been compared to mild sunburn, and any discomfort usually passes within a few days. After the skin has rested and the immune system has done its job (usually after 4-8 weeks), the patient is ready for another visit to the dermatologist.

Black, blue and red inks are most responsive to lasers and easiest to remove. Tattoos with green and yellow inks are the most resistant. Old tattoos may be easier to remove than new ones, as the inks can fade over time.

Each laser removal session can cost from $200-$1500, depending upon your practitioner. Most insurance companies don’t cover tattoo removal, since it is considered a cosmetic procedure. Some tattoos can be removed in 6-8 sessions, while others may require 16-18 sessions spanning over two years or more.

Tattoo

Removal

Tattoo Removal - Think before you ink

Temporary tattoo – e.g. with Henna

The paste is applied

and left on the skin

for several hours to

stain. The stain will

gradually fade away

as the skin sheds.

Henna tattoos can

last days to over a

month depending on

application and

aftercare.

Think before you inkTemporary tattoo - autocollants de tatouage

Pb, Ag, Au, Fe (!),

Hg, Pt, Bi…..

intoxication

side effect in metals containing therapies

Bismuth staining of the

tongue

(gastric ulcer treatment)

Lead poisoning

through Airways

PNEUMOCONIOSES

conditions or diseases elicited with dust particles

inhalation (<5)

Pneumoconioses– coniosis simplex

(anthracosis, siderosis)

– coniofibrosis (silicosis, asbestosis,

coal workers disease, siderosis)

– coniotoxicosis conioalergosis(byssinosis, berylliosis)

organic dusts

Anthracosis

pneumoconiosis caused by inert coal-like dust

(without quartz admixture)

no symptoms = coniosis simplex

100% population prevalence

Anthracosis pleurae

Anthracosis pulmonum et lnn. peribronchialium.

Metastases carcinomatosae lnn. peribronchialium

Anthracosis pulmonum

Sputum - macrophages

Sputum - siderophages / coniophages

SilicosisDef.:

pneumoconiosis caused by quartz dust with pronounced fibrosis response

CONIOFIBROSIS

long lasting exposition (20–40 years)

progression even after exposure elimination

part of miners disease

affinity to other lung diseases (tbc)

Silicosis

Pathogenesis:

toxic activity of quartz dust to macrophages

production of PDGF1, IGF-1, fibronectin

chemotaxins, IL-8

enzyme activation,

lung injury, inflammation,

FIBROSIS

SilicosisStages:

– diffuse reticular fibrosis (often clinically silent)

– silicotic nodules (+ perifocal emphysema)

– massive fibrosis

Silicosis

Silicosis gr. II

Silicosis – silica crystals (polarised light)

Silicosis

Complications:

pulmonary fibrosis

pulmonary hypertension

cor pulmonale

Cause of death

cardiorespiratory insuffitiency

Hypertrophia

excentrica ventriculi

dx. cordis

Coal Workers

Pneumoconiosis - CWP -

miners´disease

Coal macules- dust laden macrophages

Coal nodules – mild collagen admixture

Advanced

Combined silicosis & anthracosis

complicated often with tbc

AsbestosisDef.:

pneumoconiosis caused by Asbestos fibrils with pronounced fibrotising response

CONIOFIBROSIS

Asbestosfibrillar mineral with various forms and

fibrogenic capacity chrysotile (90%), amosite, croccydolite

AsbestosisPathogenesis:

toxic influence due to fibrils size and

concentration

fibrosis with feruginous bodies

hyalin pleural plaques

risk of mesotelioma and lung carcinoma and GIT

malignancies (Carlos Bedrossian-Venice 2006)

pleural effusions („mesot. in situ“ – Bedrosjan 2004)

other neoplasias?

Fibrous pleural plaque – marker of possible asbestosis!

Hyalinosis pleurae

Asbestosis

Hyalinosis pleuraeMesothelioma

Mesothelioma

Ca bronchogenes

Hyalinosis et metastases

carcinomatosae pleurae

parietalis

Asbestos is banned in most Western countries but related malignancies are still of clinical concern because of their long latencies.

The retrospective assessment of exposure - questionnaires and collection of medical history.

Fibers and asbestos bodies are counted in lung tissue, broncho-alveolar lavage, and sputum.

The etiology of lung cancer is difficult to define in cases of low-level asbestos exposure and concurrent smoking habits.

MESOTHELIOMA: The diagnosis difficult, because of sampling, fixation, and processing, and uses of immunohistochemical probes.

Assessment of exposure is crucial

Given the premise that asbestosis is necessary to causally link lung cancer to asbestos, it follows that the assessment of both lung fibrosis and asbestos body burden is necessary.

Lotti M, Bergamo L, Murer B.

Occupational toxicology of asbestos-related malignancies.

Clin Toxicol (Phila). 2010 Jul;48(6):485-96.

Park EK, Takahashi K, Jiang Y, Movahed M, Kameda T.:

Elimination of asbestos use and asbestos-related

diseases: An unfinished story.Cancer Sci. 2012 Oct;103(10):1751-5.

Asbestos - a proven human carcinogen.

Asbestos-related diseases (ARDs):

– lung cancer,

– malignant mesothelioma,

– asbestosis,

– pleural plaques, thickening and effusion.

The WHO and the International Labour Organization have called on

countries to stop using asbestos.

ARDs are increasing and asbestos use is continuing in the world.

Industrializing countries are faced with a myriad of forces prompting

them to continue using asbestos.

Full-scale international cooperation will thus be needed to achieve the

goal of eliminating ARDs.

Ultrastruct Pathol. 2014 Sep 30:1-6. [Epub ahead of print]

Electron Microscopy Remains the Gold

Standard for the Diagnosis of Epithelial

Malignant Mesothelioma: A Case Study.Oczypok EA, Oury TD.

Department of Pathology, University of Pittsburgh School of Medicine , Pittsburgh, PA , USA.

carcinoma

Mesothelioma

Emri SA:

The Cappadocia mesothelioma epidemic: its

influence in Turkey and abroad Ann Transl Med. 2017 Jun;5(11):239.

In three Cappadocian villages, Karain, Tuzkoy and

"old" Sarihidir, about 50% of all deaths (including

neonatal deaths and traffic fatalities) have been

caused by mesothelioma.

the epidemic linked to erionite exposure

interaction between genetic predisposition and

environmental exposure

carriers of germline BAP1 mutations have a very high

risk of developing mesothelioma and other

malignancies.

According to the most recent World

Health Organization (WHO) estimates, more than 107 000

people die each year from asbestos-related lung cancer,

mesothelioma, and asbestosis resulting from exposure at

work (1). The asbestos epidemic is far from over.

http://www2.epa.gov/asbestos

Pneumoconioses– coniosis simplex

(anthracosis, mild siderosis)

– coniofibrosis (silicosis, asbestosis, coal workers

disease, severe siderosis)

---------------------– coniotoxicosis conioalergosis

(byssinosis, berylliosis,….)organic „dusts“

Coniotoxicosis Conioalergosis

- diff. dg. to Coniofibroses

Berylliosis

• acute - toxic pneumonitis

• chronic – non caseating granulomas

Byssinosis – cotton dust

Farmer´s lung – moldy hay, actinomycetes,

Bird fanciers disease - bird feather dust

(dif. dg. chlamydophilla psittaci inf.)

Fibrosis pulmonum intersticialis

Hypertrophia excentrica

ventriculi dx. cordis

COR PULMONALE

decompensatum

Sergio Pin˜a-Oviedo, Carlos Ortiz-Hidalgo, Alberto G. Ayala Houston, Texas:

Human Colors—The Rainbow Garden of PathologyWhat Gives Normal and Pathologic Tissues Their Color?

Colors are important to all biologic organisms (that is, microorganisms,

plants, and animals, because they are crucial for camouflage and

protection, metabolism, sexual behavior, and communication.

Coloration of organisms results from the production of molecules

derived from cyclic compounds.

Because cells are microscopic and colorless as single units, they result

in a given color only when they accumulate in millions.

Unhealthy and/or neoplastic tissues usually retain the color of the cells

from which they derive but may also exhibit completely different color

characteristics.

Arch Pathol Lab Med, 2017, 141, 445-462

Sergio Pin˜a-Oviedo, Carlos Ortiz-Hidalgo, Alberto G. Ayala:

Melanins derived from the

metabolism of tyrosine

converted to

dihydroxyphenylalanine

(DOPA) and

dopaquinone

3 forms:

neuromelanin (B),

eumelanin (both

brown-black) (C), and

pheomelanin (golden

yellow-red) .

Lipofuscin derived from the

oxidation of lipids

wear and tear pigment

accumulates with age

predominantly in the

heart, liver, retina, and

often undetectable

macroscopically

A. PAS+ in cardiomyocytes

B. Autofluorescence in a

neuron

C. & D. Melanosis coli in

excessive use of laxativesnormal

Breast RCC

Liposarcoma

Lipoma

Schwannoma

Adrenocortical

adenoma

Carotenes are unsaturated hydrocarbons

chemically derived from isopentenyl

pyrophosphate and terpenes

include carotenes, lycopenes, and

xanthines.

Carotenes are fatsoluble molecules that

can produce all the colors of the visible

spectrum (purple, blue, green, yellow,

orange, and red) and are synthesized only

by plants.

Animals are unable to produce carotenes

and can only obtain them from their diet.

Because carotenes are lipophilic, they

associate with lipid-rich tissues.

Carotenemia (or xanthoderma) and

lycopenemia occurs after excessive

consumption of carrots, tomatoes, or

Cytochromes, the

Heme Group, Iron,

and Bile PigmentsPyrroles are heterocyclic

aromatic molecules composed

of a ring of 4 carbon atoms

and one nitrogen atom

(C4H5N).

Assembly of 4 pyrrole rings

forms the tetrapyrrole ring

protoporphyrin, a precursor of

several organic molecules.

Cytochromes mainly in

mitochondria & SER – liver

and kidney

Hemoglobin (Hb) gives all organs a pink-red or dark-red hue, depending on the volume of circulating blood and oxygen

(O2) concentration.

Congested blood in a small bowel infarct (F), and in a liver cavernous hemangioma (G) gives these tissues dark purple

color (deoxygenated Hb). Myoglobin is a main component in skeletal (I) and cardiac muscle (J). The color of organs also

results from the combination of cytochromes and Hb (spleen) (K) or myoglobin (heart) (J).

Methemoglobin – Fe3 - brown

Formalin turns Hb into hematin – blue-brown-gray

Plasmodia metabolize Hb into hemozoin

Biliverdin & bilirubin – yellow, greenish after oxidation.

Molecules

related to heme

groups

lung small bowel

Like eggshells, mammalian bones

and enamel are white because they

are mostly composed of CaPO4 .

Soft tissues (collagen), epithelia,

myelin, platelets, and leukocytes

lack color because:

they can not absorb carotenes

do not have enough

cytochromes

possess high content of DNA

(intrinsically white) in cells with

high n/c ratio

they are avascular/ or

minimally supplied

do not possess melanin,

lipofuscin

Type I collagen is the most

abundant protein in animal soft

tissues and is composed of banded

fibers (tropocollagens) with a

transverse periodicity.

Bone, cartilage, tendons, fasciae,

aponeuroses, the eye sclerae, the

tunica albuginea, and corpus

albicans

Exogenous Pigments - Ústav Patologie 1.LFpau.lf1.cuni.cz/file/6450/9-pigm-exog.pdf · Exogenous Pigments. Exogenous pigments –table of contents definition portals of entry traumatic

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