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CELL INJURY AND CELLULAR ADAPTATIONS I.
(necrosis, atrophy, intracellular accumulations, pigments) (Encephalomalacia, haemorrhagic lung infarction, anemic kidney infarction,
focal necrosis– myocardial infarction, diffuse liver necrosis, muscular
atrophy, hydropic change kidney, vacuolar change, liver steatosis,
lipomatosis of pancreas, amyloidosis of kidney and tongue)
General medicine
MUDr. Zuzana Čierna
MUDr. Svetoslav Štvrtina
MUDr. Michal Palkovič, PhD. Lucia Donárová
Department of Pathology, Faculty of Medicine UK & UH
Branch : Staré mesto
Sasinkova 4, Bratislava
Prof. MUDr. Ľudovít Danihel, CSc.
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vital tissue
Pathological agent: (Hypoxia a ischaemia.
Physical agents.
Chemical agents and drugs.
Microbial agents.
Immunologic agents.
Nutritional derangements.
Ageing.
Psychogenic diseases.
Iatrogenic factors.
Idiopathic diseases.)
CELLULAR
ADAPTATIONS
(atrophy,
hypertrophy,
hyperplasia,
metaplasia,
dysplasia)
REVERSIBLE
CELL INJURY
(intracellular
accumulations)
IRREVERSIBLE
CELL INJURY
(cell death –
necrosis,
autolysis,
apoptosis)
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Necrosis • irreversible injury
• intravital cell death
• types:
- coagulative necrosis
- liquefaction (colliquative) necrosis
- caseous necrosis
- fat necrosis
- fibrinoid necrosis
• outcome of necrosis:
– resorption
– reparation
– pathologic calcification
– gangrene (large ischemic coagulative necrosis – extremities, appendix,...); wet gangrene = infected necrosis caused by anaerobic microorganism
• distinguish from apoptosis!!!
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Encephalomalacia (91)
• Liquefaction necrosis of the brain tissue
• With or without bleeding
• Etiology - focal necrosis of the brain tissue (thrombosis, embolia, atherosclerosis, hypotension...)
• Characteristic finding: debris-laden macrophages (eliminatory reaction)
• Result – postnecrotic (postmalatic) pseudocyst
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Oedematous brain tissue Debris-ladden macrophages
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Detail - Debris-ladden macrophages
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Hemorrhagic lung infarction (6)
• Coagulative necrosis of the lung tissue
• Cause – ischemia through lung embolism
(mostly deep vein thrombus)
• Develops only if there isn’t lung circulation
failure – patient survives
• At the same time there must be lung
hypertension and/or lung venostasis
• Triangular shape of lung infarction has its base
under the pleura, peak points towards lung hilus
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Hemorrhagic
lung
infarction
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Base is under the pleura
Peak points towards lung hilus
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Numerous erythrocytes in the alveoli, shadow of alveolar septa.
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Anemic kidney infarction (5)
• Coagulative necrosis of the kidney tissue
• Cause – local ischemia of the kidney tissue
• Demarcation edge is composed of leukocytes and
erythrocytes (hyperemia)
• Result - scar
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Anemic infarction Hyperemic edge
Scars after infarction
Kidney
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Infarction
Kidney
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Anemic kidney infarction
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Infarction - necrosis Demarcation reaction –
leukocytes, hyperemia
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Necrosis – tissue shadowing
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Scar after kidney infarction
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Focal necrosis – myocardial infarction (93)
• Local ischemia of the tissue – coagulative necrosis
• Causes - thrombosis, embolism, atherosclerosis or spasmus of
coronarny artery, change in the amount and composition of
blood, arteritis (syphilis, LCA – large cell arteritis), increased
energy output
• Located predominantly in the left ventricle of the heart
• Transmural (STEMI) / non-transmural (N-STEMI)
• Complications – arrhythmia, blood pressure and volume
changes, heart failure, wall aneurysm (thromboembolism),
myocard rupture (cardiac tamponade), pericarditis
• Result - myocardial scar or death
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Typical
appearance
of myocardial
infarction
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myocardial infarction
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myocardial infarction - detail
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Scar after myocardial infarction
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Diffuse liver necrosis (111)
• Etiology - toxic damage or inflammation
• Hepatocytes are preserved only in islands of
living tissue, perifocally with lymphocytic
inflammatory cells
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Cellular adaptations
• Physiologic adaptation – to the physiologic needs
• Pathologic adaptation – to non-lethal pathologic injury
• Adaptations:
• 1. atrophy – reduction of the number and size of cells
• 2. hypertrophy – increase in the size of cells
• 3. hyperplasia – increase in the number of cells
• 4. metaplasia – reversible change of one type of mature cells to another type of mature cells
• 5. dysplasia – disordered cellular development
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Atrophy (cellular adaptation)
• reduction of the number and size of cells
of normal developed organs / tissues
• Simple atrophy – shrinking of cells, tissues and
organs
• Numeric atrophy – reduction in the number of
cells
• Hypoplasia – developmentally small size
• Aplasia – failure of development
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Atrophy - numeric
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Physiologic – normal process of ageing
(lymphoid tissue in thymus, gonads after
menopause)
Pathologic: 1. Starvation atrophy
2. Ischemic atrophy
3. Atrophy of inactivity
4. Neuropathic atrophy
5. Endocrine atrophy
6. Pressure atrophy
7. Idiopathic atrophy
Atrophy (cellular adaptation)
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Muscular atrophy (302)
• Etiology – vascular, neurogenous,
metabolic, endocrine, functional
• Next image – striated muscle, left: partially
preserved hypertrophic muscle fibers,
right: atrophic muscle fibers.
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Intracellular accumulations
(„dystrophy“)
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Intracellular accumulations
(„dystrophy“) • Accumulation of constituents of normal cell
metabolism produced in excess (lipids,
proteins, carbohydrates, amyloid, urate)
• Accumulation of abnormal substances due to
lack of some enzymes (storage diseases,
inborn errors of metabolism)
• Accumulation of pigments; endogenous,
exogenous
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Morphology of reversible cell
injury
1. Hydropic change (cloudy swelling,
vacuolar degeneration)
- intracelul.accumulation of sodium →
flow of water into the cell → mitochondrial
swelling and cellular swelling
e.g. hydropic change kidney
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Hydropic change kidney (1)
(„parenchymatous dystrophy“)
• Toxic, ischemic, higher drainage
• Epithelial cells of proximal ducts are
enlarged with narrowing of the lumen,
nucleus is preserved, eosinophilic
granulated cytoplasm, electronogram
shows mitochondrial swelling
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Vacuolar change (201)
(„vacuolar dystrophy“) • Electrolyte balance disorder (infusion of
hyperosmotic glucose, saccharose, changes in excretion of aldosterone), toxic impact, lack of oxygen
• Kidney – proximal ducts, enlargement of ductal epithelial cells, clear cytoplasm, nucleus preserved
• Histochemically there is a need to distinguish between glycogen, fat, mucus
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Morphology of reversible cell
injury 2. Fatty change:
a) steatosis – intracellular accumulation of neutral
fat within parenchymal cells
- mostly in hepatocytes
b) lipomatosis – deposition of mature adipose cells
in the stromal connective tissue
Similar finding in storage disease
c) lipidosis (lysosomal, non- lysosomal)
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Steatosis of liver
• Intracelullar accumulation of fat substances
• Etiology:
1.Conditions with excess fat (obesity, DM, congenital
hyperlipidaemia)
2.Liver cell damage (alcohol, starvation, hypoxia, chronic
illnesses, hepatotoxins, drugs)
- Microvesicular
- Macrovesicular
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Lipomatosis of pancreas (78)
• Etiology – metabolic, functional
• Increase of fat cell number
• Replacement of the pancreatic cells for
preservation of size and shape
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Morphology of reversible cell
injury 3. Hyaline change:
-Intracellular hyaline (hyaline droplets, hyaline degeneration,
Mallory`s hyaline, hyaline inclusions, Russell`s bodies)
-Extracellular hyaline (hyaline arteriolosclerosis in ren. vessels
in hypertension, hyalinised glomeruli in chronic GN, corpora amylacea,
hyalinised scar of fibrocollagenous tissues)
4. Mucoid change:
-Epithelial mucin
-Connective tissue mucin
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Intracellular accumulations
(„dystrophy“) • Metabolic glycid (sacharide) disorders
– Diabetes mellitus
• Type 1. (old name - insulin dependent)
• Type 2. (old name - insulin non-dependent)
• Impaired glucose tolerance (Impaired Fasting Glucose)
• Gestational Diabetes mellitus
– Glycogenosis (I. – VIII. Type) storage diseases
• I. Gierke disease
• II. Pompe disease
• III. Forbes disease
• IV. Andersen disease
• V. McArdle-Schmidt-Pearson disease
• VI. Hers disease
• VII. Type of colagenosis
• VIII. Type of colagenosis
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Amyloidosis („amyloid dystrophy“)
• Pathologic, nondecomposable protein of a
β-structure with fibrillary aggregation
• fibril proteins (95%) and non-fibrillar
components (5%)
• Systemic (generalised) and Localised
• Primary and Secondary
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Amyloidosis of kidney (tongue) (2)
• Outcome of chronic process
(inflammation, tumors)
• Presence of homogenous eosinophilic
material (amyloid) in the wall of glomerular
capillaries
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Staining with - Congo Red
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Staining with Congo Red - Fluorescence
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Tongue – hematoxiline-eosine dye, amyloid
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Staining with - Congo Red - Fluorescence