Pathology Practical Book Questions
Define sanogenesis-
mechanisms of healing
Clinical case 4- 4. The autopsy of a patient with pernicious anemia shows dilatetd right heart chamber. The myocardium is loose and pale. As a result of the hypoxy subendocardial, mainly in the area of papillary muscles (fig. 10, 11), are the major changes. What changes do you expect to see ? Name it!
"Tiger heart"- cardiomyocytes along veins are with fat degeneration
Possible outcomes of disease are:-
(Getting well) Recovery Development of chronic state Death
Define clinical death-
Clinical death is a reversible state (within few minutes). There is a stop of breathing and cardiac function. With adequate resuscitation, basic vital functions can be restored
Definition of a pigment?
Coloured substance
Is it possible a thrombus formation out of the lumen of blood vessels?
No, thrombi form only in vessels
Clinical case 3- 3. Biopsy of a tissue with fatty change is fixed in formalin. What would be seen if the tissue is fresh frozen (fig. 5), stained with H-E ? Can it suggest a fatty degeneration ?
The cells are filled with empty vacuoles and their nuclei are displaced to cell periphery
The most important factor for a tissue to develop hypertrophy or hyperplasia is?
The cells must have the ability to proliferate
What organ diagnosis would you set if the autopsy of an old man shows: complicated atherosclerotic plaques of aorta and renal arteries with ulceration and thrombosis. (fig.63) Right kidney is small in size. In the middle part of kidney is found depressed area measuring 3 x 4 cm with pale color, firm by consistency and triangle shape (fig.64).
Anemic infarction of kidney, due to thrombosis of renal artery
In which cases inflammation is additionally injuring the tissues instead of protecting them? Give some examples.
Autoimmune disease
Describe the tests for proving: Thromboembolism-
Autopsy- cut pulmonary trunk & take out contents
In which cells is predominantly stored glycogen in patients with diabetes?
In hepatocytes- in nucleus and cytoplasm- of the liver. In epithelial cells of proximal convulated tubules of the kidney
Which are main histological signs of chronic inflammatory process?
Infiltration of ly, pl cells, macrophages, epitheloid cells, multinucleated giant cells, fibroblasts
What are Mallory bodies in liver cells. When are they seen?
Mallory bodies are found in hepatocytes when there is hyaline degeneration • cytoplasm shows eosinophilic globular deposits of cytokeratin • they are believed to represent degeneration of cytoskeleton of damaged hepatocytes in alcoholic hepatitis and viral hepatitis • outcome is poor - focal or total coagulative necrosis occur Intracellular accumulation of proteins/alcoholic hyaline in the hepatocytes around the nucleus in alcoholic hepatitis, T lymph consist of intermediate filaments of cylokeatin.
Define pathomorphosis-
Morphological changes during therapy changes of morphological pattern typical of a particular disease under influence of its treatment
Is dysplasia an adaptive process?
No, disorder in cell development, characterised by cellular proliferation and disorderly arrangement of cells from basal layer to the surface layer and cellular and nuclear plemorphism. Dysplasia is premalignant lesion (condition)
What is pathology?
Pathology is a scientific study of the structure and function of the body in disease. (Study of (logos) suffering (pathos))
Indicate 6 types of arterial hypertension depending on causes and mechanisms of origins:
Physiological Angioneurotic After ischaemia After compression Inflammatory Collateral
What is an intraoperative histological consultation (frozen section)?
Rapid histologic answer
From where most often pathologist take specimen for proving systemic amyloidosis?
Rectum, gingiva, abdominal fat
What are resemblances and differences between lipogranukoma and oleogranuloma?
Resemblances: granuloma type foreign body against lipids Differences: lipogranuloma- against endogenous lipids Oleogranuloma- against exogenous lipids
is if possible to prevent embolism? How?
Yes it is possible by early movement of bed ridden patients after operation and by medicines as acetisal/ and anticoagulants Pt should stand up early after surgery
Do Intracellular accumulations depend on the type and intensity of injurious stimuli? Explain why!
Yes they depend on Short duration of ischemia which causes reversible cell injury, while persistent ischemia causes cell death.
Is there anything in common between inflammatory and immune reaction or they are 2 completely independent reactions of organism against pathological agents?
Yes, Inflammation is a part of congenital (inborn) immunity
Can a person develop gout (podagra) even if he doesn't overfeed nor has any genetic error in the metabolism of Uric acid. Explain why!
Yes, Renal gout- decreased excretion of ucate salts from kidneys
Is if possible a thrombus formation in heart cavities?
Yes, when there is slow blood flow and turbulence of blood
Define different types of obesity: a) Android type b) gynoid type c) upper and lower type of obesity: - the expected prognosis?
a) Android type- upper type of obesity, normal for men b) gynoid type- lower type of obesity, normal to women c) upper and lower type of obesity: upper type- accumulation of fats in face, neck and shoulders. Lower type- in hips and foot - the expected prognosis?
Clinical case 21: The autopsy of a man died from acute rheumatism - a new attack the pericardial sac is found covered with grey velvet-like membrane.At some places, the membrane becomes fibrillary (fig. 66). a) set the diagnosis b) what other complication of this disease would you expect if the patient survived the present attack? c) how can you prove the composition of the membrane?
a) Fibrinous pericarditis b) heart vice- of mitral valve - stenosis is insufficient c) histochemical stain for fibrin
Indicate types of embolism dependent on: a) content of embolus- b) according to the way of blood flow- c) according to the character of obturated blood vessel-
a) air, gas, fat, bone marrow, amniotic fluid, atheromatous, elastic, dark red, unattached to the vessel wall, take the shape of vessels b) O Orthograde - following blood flow, venous or arterial, venous emboli start in big circle and go towards small circle in system of lung artery, long route. shorter route for arterial emboli O Retrograde - against the blood flow, occur in large blood vessels in cases of metastasis of prostate carcinoma O Paradoxical - venous emboli bypasses lungs by travelling through an incompletely closed foramen ovale and subsequently blocking flow in venous arteries c) venous, arterial, cardiac emboli
Clinical case 12- The external examination of 85- year old cachectic bed ridden due to brain infarction man showing smelling and black appearing edematous skin sores located at the sacro-lumbar region and the buttock. a) define skin lesions? b) explain the mechanism of its appearance? c) what are the complications of this condition?
a) decubitus- bed sores b) damages circulation because of compression c) infections
Clinical case 23- A month after an inguinal herniation operation a 35-year-old man felt a small nodule at the place of scarring (fig. 68). The nodule has been resected and inspected under the microscope to contain lymphocytes, macrophages, giant cell and collagen fibers (fig. 69). a) set the diagnosis? b) the microscopic finding lacks the most important one. What is it?
a) granuloma type foreign body b) surgical thread (suture)
Clinical case 13- At the autopsy of 53 years old male, who suffered from nephrolithiasis, are found the following changes in kidneys: enlarged kidneys with unevenl surface, on cut surface some parts of parenchyma are seen thin to 5-6 mm, pyelo-calyx system is dilatated. In right kidney's ureter is found calculus small, brown, with rough surface. a) Name the condition of dilatation of kidney's calyxes and pyelon. b) what is the adaptive process developed in kidneys parenchyma? c) put in order the described changes according to their morphogenesis?
a) hydronephrosis b) atrophy of pressure c)obstruction of the ureter caused by calculus leads to hydronephrosis
Clinical case 6- Body of a man with total cachexy (extreme weight loss) is sent for autopsy. The skin is dark bronze. The 2 suprarenal glans are entirely ruined by tuberculosis. a) which is the disease? b) why is the skin coloured so? c) what is the pigment in the skin?
a. Addison's disease, chronic adrenal insufficiency b. The decreased level of cortisol leads to increased secretion of ACTH c. structurally identical to MSH, melanin
Define pathogenesis
development of a disease "how"
Purpose of pathological autopsy? Conditions for autopsy to be done?
is done after 4th hour of death when we see biological signs- livors, rigor mortis, algor mortis and desiccation Purpose is to find the cause, study response to treatment, and educate others. physician must be present. Must include result of dissection and necropsy examination. According to law; body can be taken when there are no diagnostic problems except those of children, pregnant women or those given birth. All pts who died at hospitals in Bulgaria are subject to autopsy
Clinical case 10- Young hematologist does not comply with the recommendation of his boss and appoint loading dose of anticancer agents in a patient with malignant blood disease and 800,000 leukocytes / mm3 (Fig. 37). Their number decreased rapidly, but instead of improvement on 8-th day the patient died of renal failure. Why? (Fig. 38)?
Because rapidly decreased leukocytes leads to increased Uric acid in blood and accumulation of Uric salts in renal tubules, which causes their obstruction and renal failure.
Define biological death-
Biological death is an irreversible cessation of respiration, cardiac and brain activity and follows after the clinical death Signs of biological death are early and late
What is the difference between fibrinoid degeneration and fibrinoid necrosis?
FD- affects fibrillary components of intestitium; FN also affects cells
What is the connection between fat degeneration in liver and diabetes?
Fat degeneration is accumulation of lipids in parenchymal cells Lipomatosis is accumulation of lipids in the Mesenchymal cells of the organs, obesity is common increase of fat tissue in body.
Can thrombosis develop after death?
No, thrombosis are formed antemortem Or No, only before death, after post mortem blood clots
Define- Etiology
cause for the disease "why"
What are the early signs of death?
(Within first 2hrs of death, and are completely developed and visible up to the fourth hour after death. Provide diagnosis of death) Early signs include: livors, algor mortis, rigor mortis, dessicatio The early signs are of death are livores and rigor mortis Livores is the earliest sign and consists of dark purple marks on the skin which become pale by pressing. More intense in people who suffered from heart failure and less distinct in those with anaemia. Their formation is from accumulation of blood in the lowest parts of the body after cessation of blood circulation (post- mortem hypostasis). Post-mortem blood clots are formed in the veins and R heart. These have to be distinguished from thrombi formed while alive. Pathological features of the PM clots are: smooth, shiny surface, elastic consistency, not connected to vessel wall, gradually the plasma and destroyed erythrocytes imbibe tissues. In skin and and subcutaneous structures, this process leads to formation of late postmortem lividity which does not become pale by pressure. Rigor mortis Stiffness of muscles after death. Appears within first couple hrs and during the following hrs it involves subsequently all parts of the body- from the mandible, through the shoulders to the trunk. Algor mortis is cooling of the body Caused by cessation of metabolic activity accompanied by loss of heat from body Process continues until temperature equal to environmental one (and lower) The rate of process is l'C per hour Dessicatio is drying/decay of the body caused by loss of water into surrounding environment. Latest sign of death Caused by autolysis of the soft tissues It firstly appears in the glandular tissues due to abundance of hydrolytic enzymes Autolysis of the stomach and intestines is called postmortem gastromalacia Caused by the digestive enzymes and putrefactive bacteria in the gastrointestinal tract The tissues have a dark green colour and repulsive odour Decay is accelerated in cases of septic shock or warm temperature. Delayed when body is in cold environment
Which are causes for hypercalcaemia?
Hyperparathyroidism Bone destructive lesions as multiple myeloma Hypervitaminosis D, renal failure
Clinical case 17- Indicate character and name of pathological processes if at autopsy are established the following changes: 1. Enlarged heart with dilatated heart cavities, brown- gray 'loose' myocardium, artificial pace-maker implanted in the myocardium of right ventricle (fig. 53) 2. Lungs - dense with rusty brown color (fig. 54). 3. Liver - with translucent Glisson's capsule, unclear structure on cut surface showing depressed dark red areas with the size of a pin surrounded by yellow-brown area (fig. 55). 4. Kidneys are firm by consistency with dark violet color and sharp border between cortex and pyramids on cut surface(fig. 56). 5.Spleen is enlarged, dense with dark violet color (fig. 57), 6. peritoneal cavity is found 500 cm clear, yellow fluid (fig. 58). 1. 2 3. 4. 5. 6.
1. Total hypertrophy and dilation of heart 2 brown induration of lungs 3. Nutmeg liver- straight type 4. Chronic venous congestion of kidney 5. Chronic venous congestion of spleen 6. Ascites, caused by congestion
Classification and main representatives of the pigment?
1. endogenous pigments - normal constituents of cells 2. exogenous pigments - introduced into body from environment classification of endogenous pigments? 1. hemoglobinogenic pigments 2. proteinogenic 3. lipidogenic physiological pigments? They are ferritin, hemosiderin and bilirubin 1. Ferritin • ferroproteide • in liver, spleen, bone marrow and lymphatic nodes 2. Hemosiderin • iron-containing • formed by aggregation of ferritin • identified by light microscopy as golden-yellow to brown granular pigment • found in mononuclear phagocytes of bone marrow, spleen and liver • ferric iron seem by Prussian blue staining 3. Bilirubin • iron-free pathological pigments? 1. Hemotoidin • iron-free • orange-brown crystal pigment • formed extravascularly in center of hemorrhages or foci of necrosis in anaerobic conditions 2. Hematin • brown-black pigment • derived from hemoglobin • 2 types: a) chloric and b) hemomelanin chloric hematin - formed in gastric erosions and ulcers due to interaction between hemoglobin and gastric excretion (muriate acid) hemomelanin - brown pigment produced by malarial parasites from hemoglobin. taken up by monocytes in blood and deposited in liver and spleen 3. Porphyrin • precursor of heme • deposits in blood and urine • clinical symptoms are: photophobia, erythema, dermatitis • spleen, bones, teeth, urine become dark red • porphyria develops when metabolism of porphyrin is disturbed - congenital or acquired. • acquired observed intoxications, avitaminosis, pernicious anemia and liver diseases. exogenous pigments? 1. Inhaled pigments • most common are carbon or coal dust • others: silica, stone dust, iron, iron oxide, asbestos • Anthracosis (deposition of carbon particles) seen in almost every adult lung and generally provokes no reaction of tissue injury 2. Ingested pigments • chronic ingestion of certain metals = pigmentation • argyna is chronic ingestion of silver compounds • chronic lead poisoning = blue lines or teeth • carotenemia - yellowish-red colouring of skin due to excessive ingestion of carrots • tattooing - pigments like india ink, cinnabar and carbon introduced into dermis in tattooing where pigment taken up by macrophages and lies permanently in connective tissue
Jaundice - types and morphological changes
1. prehepatic/hemolytic jaundice 2. intrahepatic/hepatocellular jaundice 3. posthepatic/obstructive jaundice Hemolytic jaundice: • increased indirect bilirubin in serum, hypercholic stools & increased urobilinogen in urine • occurs due to an excessive breakdown of red blood cell membrane in a variety of conditions such as: 1. genetic membrane defect 2. immune reaction 3. circulation of intravascular toxic substances —> rbc destruction 4. familial jaundice in spherocytosis 5. sickle cell anemia 6. Rh incompatibility 7. infections (malaria, sepsis, clostridial infection) 8. leukemia • in these conditions, excessive amount of pigment has not passed through liver for conjugation and liver's capacity to conjugate is exceeded —> increased level of unconjugated bilirubin in plasma • it can crytallize in tissues and brain —> necrosis • injury of brain —> bilirubin encephalopathy (kernicterus) Hepatocellular jaundice: • increased direct and indirect bilirubin serum, normal stool colour & increased bilirubin & urobilinogen in urine • occurs from both failure of hepatocytes to conjugate bilirubin and of bilirubin to pass through liver into the intestine • liver is light yellow-green-ish colour of saffron ("saffron liver" failure of conjugation can result in: 1. hepatocellular jaundice e.g. viral hepatitis and hypoxic necrosis 2. drug-induced jaundice e.g. disturbance of glucuronide conjugation 3. intrahepatic cholestasis e.g. congenital intrahepatic occlusion, tumours, inflammations or cirrhosis 4. mushroom, arsenic, phosphorous poisoning Obstructive jaundice: • increased direct bilirubin in serum, acholic stools & increased bilirubin in urine • results from obstruction of passage of conjugated bilirubin from hepatocytes to intestine • conjugated bilirubin is water-soluble and excreted in urine • liver is dark green OJ can appear in these cases: 1. stenosis of extrahepatic bile ducts 2. gall stones 3. pancreatic tumour compression 4. fibrosis of small intrahepatic ducts (bile ducts become distended with conjugated bilirubin)
For which morphological state of atherosclerosis is typical the deposition of Ca in atherosclerotic plaques? What is the type of classification?
3rd complicated ather. Plaques Dystrophic calcification
Indicate differences between acute and chronic access?
Acute abscess- there is no own wall Chronic access- has own wall, called pyogenic membrane
Which are expectations from the typical cell content in the areas of acute and chronic inflammation?
Acute inflammation- Ly- infiltration in virus infections Chronic- neutrophil, leukocyte in chronic abscess
Name atleast 3 causes for development of granulation tissue?
After necrosis In chronic inflammation Healing of wounds
Describe the tests for proving: Air and gas embolism-
Air- autopsy: cut under water- RV if bubble appears Gas- presence of air bubble, so in blood
What is the definition of 'sago' spleen and 'lardaceous' spleen?
Amyloidosis of spleen Sago spleen • splenomegaly not marked • cut surface shows translucent pale and waxy nodules resembling sago grains • microscopically: deposits begin in walls of arterioles in connective tissue of white pulp and may replace the follicles Lardaceous spleen • moderate to severe splenomegaly (weight up to 1kg) • cut surface shows map-like areas of amyloid • microscopically: deposits in walls of splenic sinuses and small arteries in connective tissue of red pulp
Methods of taking biopsy-
Biopsy- live microscopic, investigation of surgically removed tissue Types- surgical, excision, incision, punch, shave, curettage, puncture Fine needle aspiration biopsy is a test of high importance which is used to diagnose lesions from breast, lymph, thyroid and salivary glands · Excision (entire removal or small lesions) • Incision - entire removal is impossible · Punch biopsy - seen in dermatology, uses a cylindrical knife • Shave biopsy - non-tumour skin lesions • Curettage - seen in cavities or when the sample is already detached from the surface · Puncture biopsy - with or without aspiration
Define- a) anemic infarction
Cessation of arterial blood flow in organs that leads to necrosis caused by arterial occlusion in solid organs • blood flows quickly into affected tissue bc limited flow of collaterals • blood lyses and in 24hr, area has image of coagulative necrosis • in small infarctions e.g. in renal cortex, anemic center is hidden —> pseudohemorrhagic infarction • pale infarcts occur in heart, spleen, kidneys • gangrene of limbs also anemic infarcts
What formalin is the most common fixative? Put down other fixatives!
Cheap/ effective
What are the pros and cons of cytology and biopsy?
Cytology- not invasive Biopsy- invasive Biopsy- live microscopic, investigation of surgically removed tissue Types- surgical, excision, incision, punch, shave, curettage, puncture Fine needle aspiration biopsy is a test of high importance which is used to diagnose lesions from breast, lymph, thyroid and salivary glands · Excision (entire removal or small lesions) • Incision - entire removal is impossible · Punch biopsy - seen in dermatology, uses a cylindrical knife • Shave biopsy - non-tumour skin lesions • Curettage - seen in cavities or when the sample is already detached from the surface · Puncture biopsy - with or without aspiration Cytology - screening tests for early diagnosis of inflammatory and tumours of different localizations. Slides prepared quickly, non-invasive, non-traumatic and painless E.g. PAP test, sputum smear, pleural puncture Answers verified by a histological examination
Define death-
Death is the end of life after cessation of respiratory, cardiac and brain function It can be of natural causes, disease or violence Natural causes death is rare as it is a result of physiological againing and wearing out of the tissues
What are the late signs of death?
Decay- hydrolytic enzymes cause breakdown of tissue. Usually glandular tissue breaks down first due to high abundance of hydrolytic enzymes. This is followed by intestinal tissue which has high amounts of bacteria and hydrolytic enzymes. In septic state and in warm conditions, decay occurs faster. Cool conditions can slow down decay.
Which are the signs of death?
Early and late
A resident in surgery is looking for a consultation with regard to a breast nodule in a young woman: can a morphological examination be done prior to surgery? How the specimen should be taken and in what fixative? Which are the other options for a routine examination? What additional morphological methods can be involved?What is your advice?
FNA- fine needle aspiration
What is the difference between fibrinoid necrosis and other types of necrosis?
Fibrinoid necrosis- affects fibrillary components of interstitium and also affects cells.
Define what is common and different in fibrosis, sclerosis and chirosis ?
Fibrosis- abnormal accumulation of collagen Sclerosis- end stage of fibrosis Chirosis- fibrosis which causes organ deformation
Where (in which cell) do we see lipid accumulation in 'tiger heart'?
In cardiomyocytes along veins
Gangrene of the appendix and gangrenous appendicitis- where is the difference?
In gangrene- first occurs thrombosis of app- act -> necrosis In gangrene appendicitis- first occurs in inflammation -> of thrombosis of app.act
Clinical case 8- 57 -year old diabetic patient died from sudden heart death. The autopsy reveals: bilateral pedunculated nodular lesions at the place of the ear-rings resembling 'cherries' (fig. 21). Left arm - starry scar after BCG-vaccination (fig. 22), on both arms and on thighs - callous lesions from burning (fig. 23, 24). Ileocaecal area - large The heart (480 g), milky like spot on epicardium of front wall of left ventricle (fig. 26), measuring 2,5 cm and firm greyish band (3,5 x 2 cm) in the septum and partly on the posterior wall (fig. 27). Lungs (520 and 580 g each): lung edema. In the apex - patchy consolidation (fig. 28). Left pleural adhesions (previously suffered pneumonia) (fig. 29). Kidneys (100 and 110 g each): small size, difficult decapsulation revealing finely granular pale cortex contrasting to the pink medulla (fig. 30). Spleen - firm covered with whitish glazed like capsule (fig. 31). Ovaries - decreased and firm with small greyish nodules (fig. 32). The femur bone is showing (said to be achieved after accident) a spindle shaped firm nodule (fig. 33). elevated scar from appendicites (fig. 25). Which organs show hyalinosis and and which fibrosis? Explain why?
Fibrosis- scars of back, scar after BC6- vaccination, in the pulmonary apex, pleural adhesions, in the myocardium, in the ........ Hyalinosis- on epicardium, in spleen capsule, in ovaries.
Define main branches of pathology( general, clinical, experimental)
General pathology- common damages in all tissues Clinical pathology- Pathologic changes in organs and systems due to various diseases Experimental pathology- studying partial changes in animals
What is common between 'glazed spleen' and 'corpus albicans ovarii?
Glazed spleen occurs after chronic inflammation Corpus albicans ovarie is physiological process
What are the main signs of granulomatous inflammation?
Granuloma is a circumscripted, tiny lesion, composed of proliferation and transformation of cells with phagocytic activity • inflammation characterised by formation of granulomas e.g. TB, leprosy, syphilis, actinomycosis, sarcoidosis etc. • distinctive pattern of chronic inflammatory reaction • it is a cluster of modified macrophages with epithelioid appearance in the area of inflammation that form due to infectious material or foreign objects • a 'granuloma' is a circumscribed, tiny lesion - 1mm in diameter, composed of epithelioid cells and rimmed at periphery by lymphoid cells • 'granule' like lesion • 'oma' here indicates inflammatory mass or collection of macrophages
What is the difference between health and disease?
Health - a sustainable dynamic equilibrium of the organism with environment through which the correlation between structure and function allows the body to realise its biological potential Disease- significant disturbances of the normal function of the body due to changes in the environment or weakness of the biology of the individual.
What is the clinical meaning of hyalinosis in heart arterioles and in pancreas?
Hyalinosis in heart causes ischemic heart disease Hyalinosis in pancreas is a physiological process
Clinical case 9- Patient with chronic pulmonary tuberculosis and bronchiectatic disease dies from ver and renal insufficiency. At autopsy, enlarged, firm and pale are both liver and kidneys. The pathologist proves the origin of organ changes at the time of autopsy (fig.45). Name the condition- What causes- Put in order the described changes according to their morphogenesis?
Hydromeplcosis Atrophy Pulmonary tuberculosis and bronchiectatic disease -> amyloidosis of liver and kidneys -> cause for death Liver and renal failure
Which is the main biologic characteristic of metaplasia? List the types of metaplasia.
Reversible change in which one cell type is replaced by another cell type. Epithelial and Mesenchymal type of metaplasia A. Epithelial metaplasia - common type, changes are patchy or diffuse, results in replacement by stronger but lesser specialized epithelium • common types: squamous & columnar 1. squamous metaplasia • bronchus in chronic smokers • uterine endocervix in prolapse of uterus/old age • gall bladder in chronic cholecystitis • prostate in chronic prostatitis • renal pelvis and UB in chronic infection and stones • vitamin A deficiency - in nose, bronchi, urinary tract, lacrimal and salivary glands 2. columnar metaplasia - transformation to columnar epithelium • intestinal metaplasia in healed chronic gastric ulcer • in chronic bronchitis and bronchiectasis B. Mesenchymal metaplasia - less commonly, transformation from one mature type of mesenchymal tissue to another • types: osseous & cartilaginous 1. osseous metaplasia • formation of bone in fibrous, cartilage, myxoid tissue • in arterial wall in old age • soft tissues in myositis ossificans • in cartilage or larynx and bronchi of elderly people • in chronic inflammation scar 2. cartilaginous metaplasia • healing of fractures • occurs in undue mobility
What microscopic characteristics describe organs
Size Shape Form weight Colour Consistency Elasticity Superficial/ cut surface
Define tanatogenesis-
Study of death clinical, morphological and biochemical changes that occur in the process of dying
Define- b) hemorrhagic infarction
The area of necrosis is infiltrated with blood occurs in lungs, liver, SI and in other organ with thrombosis of main veins Hemorrhagic (red) infarction encountered in combination of 1) venous occlusion, 2) loose tissues 3) tissues with double circulation and 4) previously congested tissues e.g. lungs, intestine
Clinical case 5- 5. 39 -year old male with pyrexia and enlarged lymph nodes is complaining from coughing and asthma. On X-ray large foci with central cavitations are found and the diagnosis of disseminated malignant melanoma is suspected. The biopsy from the lymph nodes shows brown-black pigment in cells which don't appear to be tumor-like (fig.12,13,14). Meanwhile, it is cleared that the patient is a venous drug abused. Decision of the case comes after the internal examinations which shows blood- borne pneumonia but doesn't explain the pigment in lymph nodes (fig.15). What has most probably led to the appearance of pigment in the lymph nodes? What is the difference between fat degeneration, lipomatosis and obesity?
The patient has a tattoo and by lymphatic vessels the tattoo pigment reacts with the regional lymph nodes
Is coagulation in normal hemostasis and thrombosis one and the same process?
They are common, but hemostasis is a physiological process and thrombus is decomposed by anti coagulation system. In thrombus this balance is impaired.
Which are organ exceptions from the ordinary gross characteristic of atrophic process? Why?
This process is called pseudohypotrophy: Emphysema Hydronephrosis
Describe gross and histological differences in thrombus and post Mortem 'blood clots'!
Thrombus is dry, fragile, greyish white, attached to blood vessel wall lines of zahn Post mortem- small, elastic, darkened, not attached to blood vessel wall, take the shape of vessel
What is Von Gierke' disease? Which are the target organs?
Von Gierke's diseases - autosomal recessive disorder which causes a deficiency of glucose-6-phosphatase, an accumulation of glycogen in the liver and hypoglycaemia due to reduced formation of free glucose from glycogen. Fat is metabolised instead causing hypolipoproteinaemia, ketosis and hyperuricemia. In infancy - stunted growth, hepatomegaly with intracytoplasmic and intranuclear glycogen. Enlarged kidneys with intracytoplasmic glycogen in tubular epithelial cells. Gout, skin xanthomas and haemorrhagic diasthesis due to platelet dysfunction is seen. Glycogen storage disease/ glycogenolysis; the target organs are liver and kidneys.
Clinical case 18- The autopsy of old man, who died suddenly, are found ulcerated atherosclerotic plaques in aorta and large arterial vessels. Heart shows big size and dilatated heart cavities. In the 'ear' in right auricle is found easy friable, brown-gray material with uneven surface,which is attached to the endocardium (fig. 59). The right ventricle is also enlarged with clearly visible bandles of the papillary muscle of tricuspid valve (fig. 60) Organs are with violet color and enlarged size. Main trunk and the two basic branches of a. pulmonalis are filled with gray-brown friable matter(fig. 61). a) Name the changes in heart ! b) what is the process in right heart ear and a.pulmonalis? c) additional information for the status of which organ is necessary to explain the changes in the heart and why? d) what autopsy technique is used when the above described findings in pulmonary artery are suspected?
a) hypertrophy and dilation of heart b) thromboembolism c) atherosclerotic plaques in aorta explain the changes in left heart ventricle. The condition of ,lungs as responsible for changes in right heart cavities. d) technique for proving of thromboembolism in pulmonary artery
Clinical case 24- Having in mind the biological cycle of hydatid cyst ( enchinococcus) answer the following questions: a) which organ will more probably 'host' the parasite? b) what vessel is transporting the oncospheres? c) what is the second most common location of echinococcus in human body. d) is the rupture of the parasite cyst a danerous comolication and why? e) a parasite in the spleen as shown in the thermacroscopic demonstration, how the parasite reaches the organ? f) is it important to search very carefully for the presence of 'daughter' cysts and why?
a) liver In man b) by portal vein c) lungs d) yes, because of the risk of anaphylactic shock as secondary echinoccosis e) from liver microcirculation to pulmonary microcirculation to spleen f) because of risk of secondary echinococcosis
Clinical case 14- Bronchoscopic biopsy of 68 years old male who is complaining of persistant, irritating, uninfluenced by the therapy cough: pale, elevated patch in one of the main bronchus is seen. On histology bronchial mucosa is seen overlaid by multilayer squamous epithelium. a) Name the process in the wall of the bronchus: b) clinical data doesn't mentioned the cause for this condition? Most probable the cause is: c) complications?
a) metaplasia b) chronic bronchitis c) pulmonary cancer
Clinical case 11- The autopsy of 62-year-old heavy smoking and obese patient admitted to the dermatological department for some skin rush reveals irregular 'clay-like' yellowish area measuring 3,5 cm, (Fig. 39) on the anterior wall of the left ventricle of the heart. The lesion affects part of the inter-ventricular septum and the myocardium in this area is structureless. Descendent branch of left coronary artery is atherosclerotic (Fig. 40). a) set the diagnosis- b) the patient could have been transported to cardiologic department- why?
a) myocardial infarction- coagulative necrosis b) for urgent special treatment of myocardial infarction
Clinical case 1- The autopsy of a 65-year old alcohol addict with diabetes, emphysema and pneumonia reveals major changes in liver - large and heavy (2100 g), with smooth surface, soft by consistency (fig. 1). The cutting surface is yellow-brown and the lobular structure is unclear. The pathologist suggests a degenerative process but hesitates about its nature - protein, fat or carbohydrate degeneration. Help him ! 1. How should the doctor proceed? a) number of specimens? b) size of specimen? c) fixatives? d) cutting? e) stains?
a) number of specimens- 3 b) size of specimen- 1x1x1 c) fixatives- d) cutting- on freezing microtome e) stains-proteins and carbs- PAS
Clinical case 16- At the autopsy of 65 years old woman is found : enlarged heart ( 550gr. ) with increased thickness of the myocardium measured under the cuspid valves 23 mm. Anterior infarction of myocardium is seen complicated with rupture of the wall and blood in the pericardial sac measuring about 250ml (fig. 52). a) cause of death is: b) the name of process is:
a) pressure over venous vessels of the heart b) haemopericardium
The autopsy of a 65-year old alcohol addict with diabetes, emphysema and pneumonia reveals major changes in liver - large and heavy (2100 g), with smooth surface, soft by consistency (fig. 1). The cutting surface is yellow-brown and the lobular structure is unclear. The pathologist suggests a degenerative process but hesitates about its nature - protein, fat or carbohydrate degeneration. Help him ! What do you expect to see in: a) protein degeneration- b) fat degeneration- c) carbohydrate degeneration-
a) protein degeneration- red coloured large granular casts in cytoplasm of cells b) fat degeneration- orange (red) stained vacuoles with different size in cytoplasm c) carbohydrate degeneration- red
Clinical case 20- the autopsy of a 32 -year old man shows abundant yellowish exudate covering the Targe hemispheres. The exudate 'enters' the adiacent sulci and the meninges are edematous and hyperemic. The brain tissue is also edematous, hyperemic and glistening (fig. 65). a) set the diagnosis? b) what is seen in memninges on microscopy? Point 2 diseases that can complicate with the picture described above:
a) purulent leptomeningitis b) purulent exudate c) purulent sinusitis, otitis, angina
Describe tests for proving of: a) massive thromboembolism in the trunk of a.pulmonalis b) air embolism c) how can we prove amniotic embolism? d) why gas embolism is often compared to opening of a bottle with carbonated drink?
a) y shaped incision of a. Pulmonalis b) incision under water in pericardial sac c) microscopic sections d) divers if they come up quickly = gas embolism N dissolved = bubbles in blood
Clinical case 22- The medical examination of a 29 -year old, febrile with heavy headache, accelerated heart beat and sore throat man the doctor finds purulent angina complicated with peritonsillar abscess. (fig 67). a) is it possible to have the same complication as described in case 20? Why? b) is it possible to have the same complication as described in case 21? Why? c) what therapy would you prescribe? O tonsillectomy O antibiotics O physical therapy O pain relief O immune stimulation
a) yes, in transported infection to the brain b) yes, if the Pathologic agent is beta- hemolytical streptococcus group c) antibiotics
Clinical case 7- A 52- year old often suffering from'angina' in the past developed heart valve defect (fig. 17). Recently complaing from coughing and asthma when in bed. The patient is reporting for rusty expectoration (fig.18, 19). At auscultation - small moist noises at both lung bases. a) what is the reason for this complication? b) what is the process in lungs? c) why are the expectorations rusty by colour? d) will the changes in lung be reserved to normal after mitral valve prothesis? Explain why?
a. Acquired heart vice of mitral valve in rheumatism b. Brown induration of lungs c. Siderophages, called also cells of heart d. No- because fibrosis is irreversible
Iron containing pigments - hemosiderin and hemochromatosis
pathology of hemosiderin's metabolism? Hemosiderosis occurs in 2 situations: a) local and b) systemic 1. local hemosiderosis • local breakdown of red cells in tissues e.g. internal hemorrhage • mechanism is extravascular hemolysis • occurs regularly around areas of bruising and hemorrhage • in each instance, pigment is localised inside the cells of reticuloendothelial system • in lungs - hemosidern-laden macrophages (siderophages) are referred to as 'heart failure cells' 2. systemic hemosiderosis (visceral siderosis) • mechanism is intravascular hemolysis • seen in liver, spleen and sometimes kidneys if hemolytic anemia & pts requiring blood transfusion • generalised form of this condition is secondary hemochromatosis • pigment leaves deep brown colour on tissues and organs when present in high concentrations • occurs in pts with chronic ineffective erythropoiesis (thalassemia major) • extreme alcohol ingestion —> hemosiderosis due to augmentation of iron uptake by alcohol microscopy of arteries: • thickened walls • sharply narrowed/obliterated lumen • hyaline accumulates in subendothelial areas of vascular wall —> destruction of elastic and middle membranes What changes are observed in long-standing hypertension or diabetes mellitus? • walls of arterioles (esp. of kidney) become hyalinized due to extravasated plasma protein and deposition of basement membrane material What is fibrous tissue formation? • new fibroblasts originate from fibrocytes and mitotic division of fibroblasts • some of these fibroblasts have morpho and functional features of smc (myofibroblasts) • collagen fibrils appear around day 6 • as maturation occurs - more collagen formed while number of active fibroblasts and new blood vessels decreases • resulting in formation of inactive looking scar known as cicatrisation
Define morphogenesis-
structural changes in disease
