Sparsh Gupta cellular adaptation ,intracellular accumulation

Wilson's disease:

Copper is usually deposited in periportal hepatocytes in the form of reddish granules in cytoplasm or reddish cytoplasmic coloration stained by rubeanic acid or rhodamine stain for copper or orcein stain for copper associated protein. Copper also gets deposited in chronic obstructive cholestasis.

Mallory hyaline bodies are seen all except (a) Indian childhood cirrhosis (b) Wilson's disease (c) Alcoholic hepatitis (d) Crigler-Najjar syndrome

Crigler-Najjar syndrome

Malarial pigment

Liver colour varies from dark chocolate red to slate-grey even black depending upon the stage of congestion.

Psammoma bodies are typically associated with all of the following neoplasms except (a) Medulloblastoma (b) Meningioma (c) Papillary carcinoma of the thyroid (d) Papillary serous cystadenocarcinoma of the ovary

Medulloblastoma

Transformation of one epithelium to other epithelium is known as

Metaplasia

Oncocytes are modified form of which of the following:

Mitochondria Oncocytes are epithelial cells stuffed with mitochondria, which impart the granular appearance to the cytoplasm.

True about metastatic calcification is (a) Calcium level is normal (b) Occur in dead and dying tissue (c) Occur in damaged heart valve (d) Mitochondria involved earliest

Mitochondria involved earliest When the calcium deposition occurs locally in dying tissues despite normal serum levels of calcium, it is known as dystrophic calcification. It is seen in atherosclerosis, tuberculous lymph node and aging or damaged heart valves. • The deposition of calcium salts in otherwise normal tissues almost always results from hypercalcemia and is known as metastatic calcification.

Wear and tear pigment in the body refers to

lipochrome

The light brown perinuclear pigment seen on H & E staining of the cardiac muscle fibres in the grossly normal appearing heart of an 83 year old man at autopsy is due to deposition as:

lipochrome Hemosiderin: It is a pigment deposited in conditions of excess iron. • Anthracotic pigment: It is pigment seen in the lung of coal

brown atrophy is due to

lipofuscin

In biliary cirrhosis

liver is enlarged and greenish-yellow in colour due to cholestasis. So liver is pigmented due to bile.

Metastatic calcification is most often seen in:

lungs lung are the most frequent involved of all organs.'

example of hypertrophy is:

uterus during pregnancy

Heterotopic calcification occurs in:

(a) Ankylosing spondylitis; (c) Forrestier's disease Pathologic calcification (Heterotopic calcification) is the abnormal tissue deposition of calcium salts together with small amounts of iron, manganese and other mineral salts. It may be of two types: Dystrophic calcification or Metastatic calcification

Pseudomelanin

After death, a dark greenish or blackish discoloration of the surface of the abdominal viscera results from the action of sulfated hydrogen upon the iron of disintegrated hemoglobin. Liver is also pigmented.

Mallory hyaline is seen in:

Alcoholic liver disease; (b) Hepatocellular carcinoma; (c) Wilson's disease; (d) I.C.C. (Indian childhood cirrhosis); (e) biliary cirrhosis Mallory bodies: Scattered hepatocytes accumulate tangled skeins of cytokeratin intermediate filaments and other proteins, visible as eosinophilic cytoplasmic inclusions in degenerating hepatocytes.

Dystrophic calcification is seen in: (a) Atheroma (b) Paget's disease (c) Renal osteodystrophy (d) Milk-alkali syndrome

Atheroma

Metastatic calcification occurs in all except: (a) Kidney (b) Atheroma (c) Fundus of stomach (d) Pulmonary veins

Atheroma

Dystrophic calcification is seen in:

Atheromatous plaque Atheromatous plaque would have dead cells, so, there is presence of dystrophic calcification. • Mnemonic: D for Dead and D for Dystrophic.

Gamma Gandy bodies contain hemosiderin and:

Ca++ In chronic venous congestion of spleen, some of the hemorrhages overlying fibrous tissue get deposits of hemosiderin and calcium, these are called as Gamma Gandy bodies or siderofibrotic nodules.

Dystrophic calcification is:

Calcification in dead tissue

Psammoma bodies show which type of calcification:

Dystrophic On occasion single necrotic cells may constitute seed crystals that become encrusted by the mineral deposits. The progressive acquisition of outer layers may create lamellated configurations, called psammoma bodies."

Calcification of soft tissues without any disturbance of calcium metabolism is called

Dystrophic calcification

A 36-year-old woman, Geeta presents with intermittent pelvic pain. Physical examination reveals a 3-cm mass in the area of her right ovary. Histologic sections from this ovarian mass reveal a papillary tumor with multiple, scattered small, round, laminated calcifications. Which of the following is the basic defect producing these abnormal structures?

Dystrophic calcification Dystrophic calcification is characterized by calcification in abnormal (dystrophic) tissue, while metastatic calcification is characterized by calcification in normal tissue. • Examples of dystrophic calcification of damaged or abnormal heart valves, and calcification within tumors • Small (microscopic) laminated calcifications within tumors are called Psammoma bodies and are due to single- cell necrosis. Psammoma bodies are characteristically found in papillary tumors, such as papillary carcinomas of the thyroid and papillary tumors of the ovary (especially papillary serous cystadenocarcinoma), but they can also be found in meningiomas or mesotheliomas. • With dystrophic calcification the serum calcium levels are normal, while with metastatic calcification the serum calcium levels are elevated (hypercalcemia).

The Fenton reaction leads to free radical generation when

Ferrous ions are converted to ferric ions Free radicals are generated through Fenton's reaction which is (H 2 O 2 + Fe 2+ → Fe 3+ + OH + + OH - ) • In this reaction iron is converted from its ferrous to ferric form and a radical is generated. • The other options are also examples of free radical injury but the questions specifically about Fenton reaction. • The effects of these reactive species relevant to cell injury include: lipid peroxidation of membranes, oxidative modification of proteins and lesions in DNA.

Psammoma bodies are seen in all except: (a) Follicular carcinoma of thyroid (b) Papillary carcinoma of thyroid (c) Serous cystadenoma of ovary (d) Meningioma

Follicular carcinoma of Thyroid Tumors (MOST for PG) • M - Meningioma • O - Papillary carcinoma of Ovary (serous ovarian cystadenoma) • S - Papillary carcinoma of Salivary gland • T - Papillary carcinoma of Thyroid • Prolactinoma, Papillary type of renal cell carcinoma • Glucagonoma (Psammoma bodies are seen in papillary thyroid cancer and not follicular thyroid cancer)

Breast at Puberty

Hyperplasia

Uterus after resection

Hyperplasia

uterus during pregnancy

Hyperplasia + Hypertrophy

Breast during lactation

Hypertrophy

An old man Muthoot has difficulty in urination associated with increased urge and frequency. He has to get up several times in night to relieve himself. There is no history of any burning micturition and lower back pain. On rectal examination, he has enlarged prostate. Which of the following represents the most likely change in the bladder of this patient?

Hypertrophy The patient is most likely suffering from benign hyperplasia of the prostate. The question however asks about the change in bladder which would be hypertrophy. This is secondary to the obstruction in the urine outflow following the smooth muscle in the bladder undergoes hypertrophy. Benign prostatic hyperplasia is due to action of the hormone dihydrotestosterone and not testosterone.

Russell's body" are accumulations of:

Immunoglobulins

All are true about metaplasia except (a) Slow growth (b) Reverse back to normal with appropriate treatment (c) Irreversible (d) If persistent may induce cancer transformation

Irreversible

lipofuscin

It is an insoluble pigment known as lipochrome and 'wear and tear' pigment. It is seen in cells undergoing low, regressive changes and is particularly prominent in liver and heart of ageing patient or patients with severe malnutrition and cancer cachexia.

A 28-year-old male executive presents to the doctor with complaints of "heartburn" non responsive to usual medicines undergoes endoscopy with biopsy of the distal esophagus is taken. What type of mucosa is normal for the distal esophagus?

Non-keratinized, stratified, squamous epithelium The esophagus is covered by non-keratinized, stratified, squamous epithelium for its entire length. Heartburn is usually a sign of gastric regurgitation of the acidic contents in the lower esophagus (acid reflux disease).

Pigmentation in the liver is caused by all except: (a) Lipofuscin (b) Pseudomelanin (c) Wilson's disease (d) Malarial pigment (e) Bile pigment

None

Which of the following is not a common site for metastatic calcification? (a) Gastric mucosa (b) Kidney (c) Parathyroid (d) Lung

Parathyroid Metastatic calcification may occur widely throughout the body but principally affects: • Interstitial tissues of gastric mucosa • Kidneys Q • Lungs Q Q Pulmonary veins Q • Systemic arteries • The common feature of all these sites, which makes them prone to calcification is that can loose acid and therefore they have an internal alkaline component favorable for metastatic calcification.

Russell bodies are seen in:

Plasma cells Russell bodies are homogenous eosinophilic inclusions that result from hugely distended endoplasmic reticulum.

ankylosing spondylitis

There is calcification and ossification usually most prominent in anterior spinal ligament that gives "Flowing wax" appearance Q on the anterior bodies of vertebrae.

A patient Ramu Kaka presented with complaints of slow progressive breathlessness, redness in the eyes and skin lesions. His chest X ray had bilateral hilar lymphadenopathy. His serum ACe levels were elevated. On doing Kveim test, it came out to be positive. Final confirmation was done with a biopsy which demonstrated presence of non-caseous granuloma. A diagnosis of sarcoidosis was established. Which of the following statements regarding calcification and sarcoidosis is not true? (a) The calcification in sarcoidosis begins at a cellular level in mitochondria (b) There is presence of dystrophic calcification (c) The granulomatous lesions contain macrophages which cause activation of vitamin D precursors (d) None of the above

There is presence of dystrophic calcification In sarcoidosis, there is presence of metastatic calcification because of the presence of increased concentration of calcitriol (most active form of vitamin D). Both the patterns of calcification begin in mitochondria.

An increase in the size of a cell in response to stress is called as hypertrophy. Which of the following does not represent the example of smooth muscle hypertrophy as an adaptive response to the relevant situation?

Triceps in body builders The enlargement of the triceps is an example of skeletal muscle hypertrophy (not smooth muscle hypertrophy).

A 50-year-old male alcoholic, Rajesh presents with symptoms of liver disease and is found to have mildly elevated liver enzymes. A liver biopsy examined with a routine hematoxylin and eosin (H & e) stain reveals abnormal clear spaces in the cytoplasm of most of the hepatocytes. Which of the following materials is most likely forming cytoplasm spaces?

Triglyceride Substance that can form clear spaces in the cytoplasm of cells as seen with a routine H&E stain include glycogen, lipid, and water. In the liver, clear spaces within hepatocytes are most likely to be lipid, this change being called fatty change or steatosis. • Increased formation of triglycerides can result from alcohol use, as alcohol causes excess NADH formation (high NADH/NAD ratio), increases fatty acid synthesis, and decreases fatty acid oxidation. • In contrast to lipid, calcium appears as a dark blue-purple color with routine H&E stains, while hemosiderin, which is formed from the breakdown of ferritin, appears as yellow-brown granules. • lipofuscin also appears as fine, granular, golden -brown intracytoplasmic pigment. It is an insoluble "wear and tear" (ageing) pigment found in neurons, cardiac myocytes, or hepatocytes.

Diffuse idiopathic skeletal hyperostosis (Forrestier's disease Q , ankylosing hyperostosis)

affects spine and extra-spinal locations. It is an enthesopathy, causing bony overgrowths and ligamentous ossification and is characterized by flowing calcification over the anterolateral aspects of vertebrae.

True about psammoma bodies are all except: Seen in meningioma (b) Concentric whorled appearance Contains calcium deposits Seen in teratoma

seen in teratoma The progressive acquisition of outer layers may create lamellated configurations, called psammoma bodies because of their resemblance to grains of sand. Some common cancers associated with psammoma bodies are: • M - Meningioma, Mesothelioma • O - Papillary carcinoma of Ovary (serous ovarian cystadenoma) • S - Papillary carcinoma of Salivary gland • T - Papillary carcinoma of Thyroid • Prolactinoma • Glucagonoma

both hyperplasia and hypertrophy are seen in? (a) Breast enlargement during lactation (b) Uterus during pregnancy (AIIMS May 2009) (c) Skeletal muscle enlargement during exercise (d) Left ventricular hypertrophy during heart failure

uterus during pregnancy Hypertrophy refers to an increase in the size of cells, resulting in an increase in the size of the organ. The increased size of the cells is due the synthesis of more structural components. • The massive physiologic growth of the uterus during pregnancy is a good example of hormone-induced increase in the size of an organ that results from both hypertrophy and hyperplasia • Regarding the 'a' choice, Breast enlargement during lactation; it is written in Robbins that prolactin and estrogen cause hypertrophy of the breasts during lactation. Hormonal hyperplasia is best exemplified by the proliferation of the glandular epithelium of the female breast at puberty and during pregnancy.